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Resurgence of Ebola in Liberia

New cases of Ebola appeared in Liberia : what do we think about this resurgence of the disease ?

On the 23th of November, 2015, WHO reported a new outbreak of Ebola. THe 3 confirmed cases are being treated in Monrovia and the 150 contacts are medically being followed.

Facts
While WHO announced 2 consecutives times the end of the transmission of the disease in Liberia (no case reported since 42 days, 2 times of the incubation time) a new case just appeared in Monrovia. A young 15 year old boy has died. He was never in contact with a sick people and he never made any travel. His father and his brother are also infected. He was probably contaminated by a cured patient in which the virus persisted for several months. This phenomenon is called resurgence

Virus persistence

Numerous clinical data show that patients cured of the acute phase of the disease may keep the virus for months, is in the eye (25% of survivors complain of vision problems), amniotic fluid, placenta , breast milk, central nervous system and especially in the semen. Detected by RT-PCR, some patients excrete the virus in their semen for 9 months and over (at least 1/4 of men).

Nevertheless, although the transmission of virus from a cured patient to a healthy person is possible, especially during sexual intercourse, it is extremely rare; only 6 cases were reported. Two cases have been reported in Guinea and Sierra Leone,one in recent weeks.

The reaction
Obviously, the response must be very fast to avoid the establishment of a new transmission chain. Moreover, in the case of Liberia, these are in addition to the 3 patients, more than 150 contacts who are medically followed.

Vaccination trials are being conducted in Sierra Leone and Guinea. Contacts and contacts of contacts are vaccinated with the experimental vaccine rVSV-EBOV for which the Lancet published the first results: it showed 100% efficacy on 4123 people.

Bibliography
Ebola: 3 new confirmed cases, vaccination campaign. Medscape September 9, 2015
3 cases of Ebola in Liberia: the return? Medscape November 27, 2015
Persistence of the Ebola virus after the acute phase of the disease in survivors
Resurgence of Ebola in Liberia
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21-24
Nov. 2017
Paris-Nord Villepinte
France

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