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Pauline Cafferkey case shows we still know little of Ebola's long-term effects Pauline Cafferkey case shows we still know little of Ebola's long-term effects
(about 1 hour later)
Last week the Scottish nurse Pauline Cafferkey was in celebratory mood as she met the prime minister’s wife, Samantha Cameron. She flew down to London after being selected for a Pride of Britain award by the Daily Mirror and joined other winners and families for a reception at No 10 Downing Street.Last week the Scottish nurse Pauline Cafferkey was in celebratory mood as she met the prime minister’s wife, Samantha Cameron. She flew down to London after being selected for a Pride of Britain award by the Daily Mirror and joined other winners and families for a reception at No 10 Downing Street.
Cafferkey had contracted Ebola when volunteering for Save the Children’s KerryTown hospital outside Freetown in Sierra Leone last December. After successful treatment at the high-level isolation unit at the Royal Free hospital in London, she was discharged three weeks later. Cafferkey had contracted Ebola when volunteering for Save the Children’s Kerry Town hospital outside Freetown in Sierra Leone last December. After successful treatment at the high-level isolation unit at the Royal Free hospital in London, she was discharged three weeks later.
But like many Ebola survivors, it now transpires that Cafferkey, 39, has suffered longer-term side-effects. “To start with I had thyroid problems and then my hair fell out,” she told the BBC in an interview prior to the awards. “It’s taken me a good few months to recover from it, that’s the thing you don’t know long-term wise either, hopefully this is the end of it, you just don’t know.” But like many Ebola survivors, it now transpires that Cafferkey, 39, has suffered longer-term side-effects. “To start with I had thyroid problems and then my hair fell out,” she told the BBC in an interview prior to the awards. “It’s taken me a good few months to recover from it, that’s the thing you don’t know long-term-wise either, hopefully this is the end of it, you just don’t know.”
Related: Scottish Ebola nurse readmitted to hospital in 'serious condition'Related: Scottish Ebola nurse readmitted to hospital in 'serious condition'
More than a year after the epidemic, doctors are still learning about the long-term effects of Ebola. Before the latest outbreak, which has killed tens of thousands in west Africa, it was known the virus remained in semen and vaginal fluid and survivors were advised to abstain from sex for three months after recovery. More than a year after the epidemic, doctors are still learning about the long-term effects of Ebola. Before the latest outbreak, which has killed 11,300 people in west Africa, it was known that the virus remained in semen and vaginal fluid, and survivors were advised to abstain from sex for three months after recovery.
Since early 2015, US researchers and medics have discovered that the virus also continues to be present in ocular fluid in the eye and in spinal fluid. This year US researchers and medics have discovered that the virus also continues to be present in ocular fluid in the eye and in spinal fluid.
Further studies by Emory University suggest the virus could also remain in other sites such as the central nervous system, which could possibly affect the functioning of the brain, and in testicles and cartilage. Further studies by Emory University suggest the virus could remain in other sites such as the central nervous system, which could possibly affect the functioning of the brain, and in testicles and cartilage. They are all parts of the body which have “immune privilege”, an evolutionary adaptation that protects vital structures from the potentially damaging effects of foreign bodies.
They are all parts of the body which have “immune privilege”, an evolutionary adaptation that protects vital structures from the potentially damaging effects of foreign bodies.
Julian Hiscox, chair in infection and global health at the University of Liverpool, and Miles Carroll, the deputy director of Public Health England, are about to launch the biggest ever survivor study of Ebola. They will assess 120 Ebola survivors in Guinea, funded by the US Food and Drug Administration.Julian Hiscox, chair in infection and global health at the University of Liverpool, and Miles Carroll, the deputy director of Public Health England, are about to launch the biggest ever survivor study of Ebola. They will assess 120 Ebola survivors in Guinea, funded by the US Food and Drug Administration.
“I don’t think very much is known at all because the number of Ebola cases in previous outbreaks has been so small. We are now seeing properties of Ebola that tell us things that were previously unknown,” said Hiscox.“I don’t think very much is known at all because the number of Ebola cases in previous outbreaks has been so small. We are now seeing properties of Ebola that tell us things that were previously unknown,” said Hiscox.
Ian Crozier, an American doctor who contracted the virus in Sierra Leone last September, developed the most severe side-effects. He reported a burning sensation in his eyes and worsening blurred vision two months after his recovery.Ian Crozier, an American doctor who contracted the virus in Sierra Leone last September, developed the most severe side-effects. He reported a burning sensation in his eyes and worsening blurred vision two months after his recovery.
Related: Sierra Leone: ‘Friends died from the virus they fought against’ | Isaac BayohRelated: Sierra Leone: ‘Friends died from the virus they fought against’ | Isaac Bayoh
In an interview in the New York Times he revealed that months after his apparent recovery, the pressure inside his eye, which had been dangerously elevated, began to drop and he felt his eye was turning to mush. “The eye felt dead to me,” Crozier said. In an interview with the New York Times he revealed that months after his apparent recovery the pressure inside his eye, which had been dangerously elevated, began to drop and he felt his eye was turning to mush. “The eye felt dead to me,” Crozier said.
The biggest shock came one morning about 10 days after his ocular symptoms started, when he saw that one eye, normally blue, had turned green. It transpired that the inside of his left eye was teeming with live, replicating virus.The biggest shock came one morning about 10 days after his ocular symptoms started, when he saw that one eye, normally blue, had turned green. It transpired that the inside of his left eye was teeming with live, replicating virus.
It is a reminder of how devastating the Ebola virus can be even to survivors. Hiscox said: “They have survived it because at some point they have mounted a massive immune response. But this causes inflammatory responses in the tissue which can be very serious. We’ve seen a number of people post-Ebola who have something that is very similar to chronic fatigue syndrome.”It is a reminder of how devastating the Ebola virus can be even to survivors. Hiscox said: “They have survived it because at some point they have mounted a massive immune response. But this causes inflammatory responses in the tissue which can be very serious. We’ve seen a number of people post-Ebola who have something that is very similar to chronic fatigue syndrome.”
Dr John S Schieffelin, a physician from Tulane University School of Medicine in Louisiana, who studied survivors in Kenema in Sierra Leone where both Crozier and the British nurse Will Pooley contracted the virus, has said the main problems seemed to be joint pains, chronic headaches and an interruption of periods in women. John Schieffelin, a physician from Tulane University’s school of medicine in Louisiana, who studied survivors in Kenema in Sierra Leone where both Crozier and the British nurse Will Pooley contracted the virus, has said the main problems seem to be joint pains, chronic headaches and an interruption of periods in women.
“I have met one former patient who appears to be deaf,” he told the New York Times. The hearing loss could result from brain inflammation or very low blood pressure for an extended period, both caused by Ebola, Schieffelin said.“I have met one former patient who appears to be deaf,” he told the New York Times. The hearing loss could result from brain inflammation or very low blood pressure for an extended period, both caused by Ebola, Schieffelin said.
Oliver Johnson, a British doctor who worked at the Connaught Hospital in Freetown, told the Guardian about one child survivor in his care in Sierra Leone who became blind and deaf. He told the Guardian on Friday: “Our understanding of Ebola is primitive”. He said the virus has been known to continue to exist in the eyes, ovaries, testicles and spinal cord post-recovery.
“If you were to take 100 Ebola survivors, we have no way of knowing what percentage of them have the virus hiding in these sites. That’s a very very big unknown. They are also tricky places to study. It is not easy to explore them, for obvious reasons.”
Schieffelin, who also studies lassa fever, says survivors of Ebola are similar to those of other major diseases. The trauma to the system is so severe that the complications can trigger ongoing health problems. One complication could be an autoimmune disorder where the immune system attacks the body’s own tissues.
He said he could not comment on Cafferkey’s case but would hesitate to draw any conclusion from the fact she is back at the Royal Free hospital, as physicians prefer to err on the side of caution. “The people that cared for her when she got Ebola are the people that know her best and they happen to be in that unit.”
Oliver Johnson, a British doctor who worked at the Connaught hospital in Freetown, told the Guardian about one child survivor in his care in Sierra Leone who became blind and deaf.
Survivors in west Africa do not get the same medical attention as survivors in the US and Europe, but it is because of people like Crozier, a patient and a member of his own medical team, that so much more is now known about the impact of Ebola.Survivors in west Africa do not get the same medical attention as survivors in the US and Europe, but it is because of people like Crozier, a patient and a member of his own medical team, that so much more is now known about the impact of Ebola.
The readmission of Cafferkey is a concern to her family and friends and of interest to the entire scientific community because so little is known about the long-term effects.The readmission of Cafferkey is a concern to her family and friends and of interest to the entire scientific community because so little is known about the long-term effects.
Peter Willis, the weekday editor of the Daily Mirror, who met her at the Pride of Britain awards, said: “She was fine last week. She was in good health and excited to be here. Our thoughts are with her family and was wish her a speedy recovery.”Peter Willis, the weekday editor of the Daily Mirror, who met her at the Pride of Britain awards, said: “She was fine last week. She was in good health and excited to be here. Our thoughts are with her family and was wish her a speedy recovery.”
Comedian Lenny Henry, who presented Cafferkey with her award last week, said: “It was a real pleasure to meet Pauline at the Pride of Britain Awards. I’m very sorry to hear she has been taken into hospital. I send my very best wishes to her for a speedy recovery.”