The World Health Organization and Congolese authorities are proposing changes to how some Ebola patients are cared for, new guidelines show, after a patient’s death challenged the accepted medical theory that survivors are immune to reinfection.
There are many unanswered questions surrounding the circumstances of the woman’s death in Democratic Republic of Congo, which has not previously been reported.
But it has raised concerns because the woman, whose name has not been released for confidentiality reasons, was thought to have had immunity after surviving infection, but fell ill again with Ebola and died.
“That was a big red flag event for all of us,” said Janet Diaz, who leads the World Health Organization’s clinical management team for the epidemic in Congo.
Congo’s Ebola outbreak has infected over 3,000 people and killed more than 2,000 since August last year. It is the second-worst outbreak after one in West Africa between 2013 and 2016 that killed more than 11,000 people.
The woman was working as a caregiver in the high-risk “red zone” of a treatment centre in Beni, eastern Congo, according to health officials familiar with her case.
She was one of dozens of people assigned to care for Ebola patients because it was assumed they would not get sick as Ebola survivors, although some researchers have considered reinfection to be at least a theoretical possibility.
Their presumed immunity allowed for closer contact with sufferers, many of them children.
Alima, the medical charity that co-ran the Beni centre where she worked, said she tested positive for Ebola and died in July before she could be readmitted for treatment.
But it is not yet known whether the woman received a false positive result the first time she was tested, experienced a relapse or was reinfected, health officials say.
Medical experts say it could be years before Ebola survivors’ immunity is fully understood. Yet the recent case is sufficiently worrying for health authorities to rethink how care should be provided to Ebola patients across eastern Congo.
The WHO and Congolese officials have drafted new guidelines, seen by Reuters, that warn that some Ebola survivors may have “incomplete immunity” and advise that additional measures should be taken to protect them from possible reinfection.
The new protocols would set limits on which Ebola survivors can work in treatment centres and standardise precautions that must be taken.
Survivors who had mild cases of Ebola and those who were found to have low viral loads – or lower levels of the virus circulating in their blood – while infected “need to be carefully assessed, as they may be at risk for having incomplete immunity after infection,” the draft says.
Diaz said the protocols were still being discussed with health organisations and could change in the drafting process.