CDC Ebola guidance reflects concern over spread via sex

Heightened concerns about possible the risk of Ebola transmission from the semen of male survivors prompted the US Centers for Disease Control and Prevention (CDC) to revise its advice about the disease yesterday, while World Health Organization (WHO) today said early tests have found no infectious disease link to a mysterious illness cluster in the country's Ondo state.

In the outbreak region, a few more Ebola infections and deaths have been reported, lifting the overall total to 25,863 infections, 10,715 of them fatal, the WHO said today. The numbers reflect 8 more illnesses and 13 deaths than the WHO's previous update on Apr 17.

CDC tweaks sexual activity guidance

For past Ebola outbreaks, some medical literature reports documented traces of the Ebola virus in the semen of male survivors, even after the virus has cleared from the bloodstream, which led to recommendations that survivors should abstain or take precautions in the 3 months after recovery. However, sexual transmission was strongly suspected as the source of exposure in Liberia's most recent case-patient, a 44-year-old Monrovia woman who died from her infection in late March.

That event, and a report last week of evidence of Ebola virus in the semen of a Liberian man 6 months after recovery, have renewed concerns about the sexual transmission route and has health groups modifying their advice for survivors until more information is known.

The WHO is urging survivors to take extra precautions until more research questions can be answered, such as whether the Liberian man's findings were an anomaly or if seminal fluid can be infectious for longer periods. It said that, as an extra precaution, survivors should consider proper use of condoms for all sexual acts beyond the 3-month period until more is known.

Yesterday's updated guidance from the CDC says scientists know that Ebola can stay in semen even after recovery and are doing studies to see if Ebola can be spread through sex. It said that, for now, sexual transmission can't be ruled out, and that survivors should not have sex (oral, vaginal, or anal) until more information is known. "Those who do have sex should use a condom correctly and consistently every time they have sex," the CDC said.

Infectious disease ruled out in Nigeria

In other developments, rumors have been swirling for the past week about a possible Ebola or other infectious disease link to a spate of illnesses and deaths in southwestern Nigeria's Ondo state, according to infectious disease news message boards and blogs that have been monitoring media reports and other outlets.

The WHO's regional office for Africa said today in a statement, citing Nigeria's health ministry, that rumors are false that an unidentified disease outbreak is behind 24 illnesses, 15 of them fatal, since Apr 15 in two Ondo state communities.

At a press briefing today in Abuja, health minister Fidelis Nwankwo said Nigerian health officials and their partners from the WHO were deployed to the Ondo city of Irele on Apr 15 to investigate rumors about an unidentified disease outbreak.

He said preliminary epidemiologic and laboratory investigations found no infectious disease link, but findings so far reveal a strong link to drinking gin that has been contaminated with methanol. Nwankwo said further lab studies are under way.

The illnesses affected men ages 20 to 75 years old, and 71% of them had a history of consuming locally made gin and were farmers, according to the WHO statement. Symptoms included sudden blurred vision, headache, and loss of consciousness, followed by death, within 24 hours of getting sick.

A Nigerian media story picked up by ProMED Mail on Apr 19 reported that Ebola Alert, a group of health professional volunteers who assisted with the Ebola outbreak, said tests on samples from victims were sent to a lab in Lagos, where they tested negative for Ebola and five other diseases: yellow fever, Lassa fever, Rift Valley fever, dengue, and West Nile disease. ProMED Mail is the online reporting system of the International Society for Infectious Diseases.

See also:                                                               

Apr 20 WHO Ebola update

Apr 19 updated CDC background on Ebola transmission

Apr 15 CIDRAP News story "Challenges in Guinea spur increase in Ebola cases"

Apr 20 WHO Africa regional office statement

Apr 16 FluTrackers thread on Nigeria illnesses and deaths

Apr 19 ProMED Mail post

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