Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report

Emily Kainne Dokubo, Annika Wendland, Suzanne E. Mate, Jason T. Ladner, Esther L. Hamblion, Philomena Raftery, David J. Blackley, A. Scott Laney, Nuha Mahmoud, Gloria Wayne-Davies, Lisa Hensley, Eric Stavale, Lawrence Fakoli, Christopher Gregory, Tai Ho Chen, Augustine Koryon, Denise Roth Allen, Jennifer Mann, Andrew Hickey, John SaindonMehboob Badini, April Baller, Peter Clement, Fatorma Bolay, Yatta Wapoe, Michael R. Wiley, James Logue, Bonnie Dighero-Kemp, Elizabeth Higgs, Alex Gasasira, Desmond E. Williams, Bernice Dahn, Francis Kateh, Tolbert Nyenswah, Gustavo Palacios, Mosoka P. Fallah

Research output: Contribution to journalArticle

Abstract

Background: Outbreak response efforts for the 2014–15 Ebola virus disease epidemic in west Africa brought widespread transmission to an end. However, subsequent clusters of infection have occurred in the region. An Ebola virus disease cluster in Liberia in November, 2015, that was identified after a 15-year-old boy tested positive for Ebola virus infection in Monrovia, raised the possibility of transmission from a persistently infected individual. Methods: Case investigations were done to ascertain previous contact with cases of Ebola virus disease or infection with Ebola virus. Molecular investigations on blood samples explored a potential linkage between Ebola virus isolated from cases in this November, 2015, cluster and epidemiologically linked cases from the 2014–15 west African outbreak, according to the national case database. Findings: The cluster investigated was the family of the index case (mother, father, three siblings). Ebola virus genomes assembled from two cases in the November, 2015, cluster, and an epidemiologically linked Ebola virus disease case in July, 2014, were phylogenetically related within the LB5 sublineage that circulated in Liberia starting around August, 2014. Partial genomes from two additional individuals, one from each cluster, were also consistent with placement in the LB5 sublineage. Sequencing data indicate infection with a lineage of the virus from a former transmission chain in the country. Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later. Interpretation: Investigation of the source of infection for the November, 2015, cluster provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak. Funding: US Centers for Disease Control and Prevention, Defense Threat Reduction Agency, and WHO.

Original languageEnglish (US)
Pages (from-to)1015-1024
Number of pages10
JournalThe Lancet Infectious Diseases
Volume18
Issue number9
DOIs
StatePublished - Sep 2018
Externally publishedYes

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Ebola Hemorrhagic Fever
Liberia
Ebolavirus
Disease Outbreaks
Infection
Genome
Western Africa
Virus Diseases
Serology
Centers for Disease Control and Prevention (U.S.)
Fathers
Survivors
Siblings
Mothers
Databases
Viruses

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Dokubo, E. K., Wendland, A., Mate, S. E., Ladner, J. T., Hamblion, E. L., Raftery, P., ... Fallah, M. P. (2018). Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report. The Lancet Infectious Diseases, 18(9), 1015-1024. https://doi.org/10.1016/S1473-3099(18)30417-1

Persistence of Ebola virus after the end of widespread transmission in Liberia : an outbreak report. / Dokubo, Emily Kainne; Wendland, Annika; Mate, Suzanne E.; Ladner, Jason T.; Hamblion, Esther L.; Raftery, Philomena; Blackley, David J.; Laney, A. Scott; Mahmoud, Nuha; Wayne-Davies, Gloria; Hensley, Lisa; Stavale, Eric; Fakoli, Lawrence; Gregory, Christopher; Chen, Tai Ho; Koryon, Augustine; Roth Allen, Denise; Mann, Jennifer; Hickey, Andrew; Saindon, John; Badini, Mehboob; Baller, April; Clement, Peter; Bolay, Fatorma; Wapoe, Yatta; Wiley, Michael R.; Logue, James; Dighero-Kemp, Bonnie; Higgs, Elizabeth; Gasasira, Alex; Williams, Desmond E.; Dahn, Bernice; Kateh, Francis; Nyenswah, Tolbert; Palacios, Gustavo; Fallah, Mosoka P.

In: The Lancet Infectious Diseases, Vol. 18, No. 9, 09.2018, p. 1015-1024.

Research output: Contribution to journalArticle

Dokubo, EK, Wendland, A, Mate, SE, Ladner, JT, Hamblion, EL, Raftery, P, Blackley, DJ, Laney, AS, Mahmoud, N, Wayne-Davies, G, Hensley, L, Stavale, E, Fakoli, L, Gregory, C, Chen, TH, Koryon, A, Roth Allen, D, Mann, J, Hickey, A, Saindon, J, Badini, M, Baller, A, Clement, P, Bolay, F, Wapoe, Y, Wiley, MR, Logue, J, Dighero-Kemp, B, Higgs, E, Gasasira, A, Williams, DE, Dahn, B, Kateh, F, Nyenswah, T, Palacios, G & Fallah, MP 2018, 'Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report', The Lancet Infectious Diseases, vol. 18, no. 9, pp. 1015-1024. https://doi.org/10.1016/S1473-3099(18)30417-1
Dokubo, Emily Kainne ; Wendland, Annika ; Mate, Suzanne E. ; Ladner, Jason T. ; Hamblion, Esther L. ; Raftery, Philomena ; Blackley, David J. ; Laney, A. Scott ; Mahmoud, Nuha ; Wayne-Davies, Gloria ; Hensley, Lisa ; Stavale, Eric ; Fakoli, Lawrence ; Gregory, Christopher ; Chen, Tai Ho ; Koryon, Augustine ; Roth Allen, Denise ; Mann, Jennifer ; Hickey, Andrew ; Saindon, John ; Badini, Mehboob ; Baller, April ; Clement, Peter ; Bolay, Fatorma ; Wapoe, Yatta ; Wiley, Michael R. ; Logue, James ; Dighero-Kemp, Bonnie ; Higgs, Elizabeth ; Gasasira, Alex ; Williams, Desmond E. ; Dahn, Bernice ; Kateh, Francis ; Nyenswah, Tolbert ; Palacios, Gustavo ; Fallah, Mosoka P. / Persistence of Ebola virus after the end of widespread transmission in Liberia : an outbreak report. In: The Lancet Infectious Diseases. 2018 ; Vol. 18, No. 9. pp. 1015-1024.
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T1 - Persistence of Ebola virus after the end of widespread transmission in Liberia

T2 - an outbreak report

AU - Dokubo, Emily Kainne

AU - Wendland, Annika

AU - Mate, Suzanne E.

AU - Ladner, Jason T.

AU - Hamblion, Esther L.

AU - Raftery, Philomena

AU - Blackley, David J.

AU - Laney, A. Scott

AU - Mahmoud, Nuha

AU - Wayne-Davies, Gloria

AU - Hensley, Lisa

AU - Stavale, Eric

AU - Fakoli, Lawrence

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AU - Roth Allen, Denise

AU - Mann, Jennifer

AU - Hickey, Andrew

AU - Saindon, John

AU - Badini, Mehboob

AU - Baller, April

AU - Clement, Peter

AU - Bolay, Fatorma

AU - Wapoe, Yatta

AU - Wiley, Michael R.

AU - Logue, James

AU - Dighero-Kemp, Bonnie

AU - Higgs, Elizabeth

AU - Gasasira, Alex

AU - Williams, Desmond E.

AU - Dahn, Bernice

AU - Kateh, Francis

AU - Nyenswah, Tolbert

AU - Palacios, Gustavo

AU - Fallah, Mosoka P.

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