Survivors of viral haemorrhagic fever: long-term effects and follow-up care
Long-term consequences after recovery were one of the six themes of the 2016 Berlin workshop. The West African epidemic left thousands of Ebola survivors, and follow-up showed that recovery from a VHF does not always mean the end of health problems – or, in rare cases, of infectiousness.
Common after-effects
Reported problems after Ebola virus disease include joint and muscle pain, fatigue, eye problems such as inflammation of the uvea, hearing problems and psychological distress. After Lassa fever, extreme fatigue, malaise and dizziness can last several weeks, and hearing loss is a recognised complication. Marburg survivors have experienced prolonged convalescence and multiple sequelae.
A nationwide retrospective cohort study in Guinea, published in The Lancet Infectious Diseases in 2019, examined subsequent mortality among Ebola survivors – underlining that survivors need structured medical follow-up.
Viral persistence
Ebola and Marburg viruses can persist in immune-privileged sites such as semen, the eye and the central nervous system in some survivors after the virus has cleared from the blood. Transmission caused by persistently infected survivors of the 2014–2016 outbreak was documented in the Journal of Infectious Diseases in 2018.
| Disease | Advice for male survivors |
|---|---|
| Ebola virus disease | Semen testing; safer sex and hygiene for 12 months from symptom onset or until semen tests negative twice |
| Marburg virus disease | Safer sex and hygiene for 12 months from symptom onset or until semen tests negative twice |
What good survivor care includes
- Regular clinical follow-up, including eye and hearing examinations
- Semen testing programmes and counselling for male survivors
- Mental health and psychosocial support
- Measures against stigma, so survivors can return to work and community life
- Involvement of survivor associations in outbreak response and community communication
Survivors' organisations, for example in Sierra Leone, have themselves run capacity-building workshops on identifying survivors and reducing stigma. Communication with communities is covered on the page infection prevention and community engagement.
Medical note: this page summarises public-health sources for general information. It is not medical advice. If you develop fever after travel to an affected area or after contact with a patient or with animal blood or ticks, contact a doctor or your local health authority by phone before attending in person, and mention the exposure.
Frequently asked questions
Can Ebola survivors still transmit the virus?
Rarely, yes. The virus can persist in semen and other immune-privileged sites, and transmission from persistently infected survivors has been documented. Semen testing and safer sex reduce this risk.
What long-term problems do Ebola survivors have?
Commonly reported problems include joint and muscle pain, fatigue, eye inflammation, hearing problems and psychological distress.
How long should male Ebola survivors practise safer sex?
WHO advises safer sex and hygiene for 12 months from symptom onset or until semen tests negative for Ebola virus twice.
Do Lassa fever survivors have lasting effects?
Fatigue, malaise and dizziness can continue for weeks, and hearing loss is a recognised complication.
Sources
- Institut Pasteur: Lassa fever – disease fact sheet
- ECDC: Factsheet for health professionals about Marburg virus disease
- WHO / Medbox: Ebola virus disease fact sheet (archived)
- WHO / Medbox: Marburg virus disease fact sheet (archived)
- German Federal Ministry of Health (BMG): Internationaler Expertenworkshop zu hämorrhagischen Fiebererkrankungen, 4 April 2016