Guinea reports two more Ebola cases; review sheds light on CNS complications

Two more Ebola infections have been confirmed in Guinea, ending a 2-week period when the outbreak region reported zero cases, according to media reports citing World Health Organization (WHO) sources.

In other developments, European health officials today weighed in on what's known about the neurologic impacts of Ebola in light of a Scottish nurse's hospitalization for late complications that surfaced more than 8 months after her initial discharge.

Guinea's total grows by two

Earlier this week in its regular epidemiological report, the WHO warned that more Ebola infections were likely to be detected, given the number of contacts, many of them high-risk ones, still under monitoring, most of them in Guinea.

One of the country's new cases is from a known transmission chain in Forecariah district, where some of Guinea's most recent cases were detected, and the other is from Conakry, Reuters reported today.

Authorities aren't sure how the patient from Conakry, a 21-year-old man, was exposed to the virus. Fode Tass Sylla, spokesman for Guinea's Ebola task force, told Reuters that sexual transmission is one of the possibilities investigators are considering.

ECDC assessment covers Ebola neuro impacts

The European Centre for Disease Prevention (ECDC) in an updated risk assessment today addressed the recent hospitalization of a Scottish nurse who survived Ebola earlier this year after working in Africa. The report is ECDC's 13th since the outbreak emerged in West Africa in early 2014.

The agency noted that the European Commission requested an updated assessment on the latest developments on Oct 9, which was when nurse Pauline Cafferkey was transferred to Royal Free London's high-containment unit, where she is in critical condition.

The ECDC said more investigation is needed to fully understand the impact of the reappearance of viral RNA in the woman 8 months after her recovery. Officials have said Cafferkey has an unusual late complication of Ebola involving a severe central nervous system (CNS) disorder.

She received convalescent plasma during her Ebola hospitalization in January, and it's unclear whether that treatment may have influenced her immune response and ability to clear the virus, the group said.

In a literature review on related survivor issues, the ECDC said neurologic symptoms, including meningitis, encephalopathy, and seizures, have been reported in acute Ebola infections. Also, it highlighted a case report showing the virus can cross the blood-brain barrier and lead to encephalitis. The agency noted that the authors of the case report concluded that Ebola treatments should target the CNS. However, the ECDC said so far there's no evidence that Ebola virus in cerebrospinal fluid during the acute illness stage has any link to a relapse of CNS symptoms.

The risk of transmission to UK healthcare workers is very low, with those at most risk being individuals who cared for the patient before protective measures were adopted and those who were possibly exposed to her body fluids.

See also:

Oct 16 Reuters story

Oct 16 ECDC Ebola risk assessment

Oct 15 CIDRAP News story "Neuro complications cited in UK nurse's Ebola case"

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