British nurse Pauline Cafferkey back in hospital with Ebola complications

Sierra Leone Telegraph: 23 February 2016

 

British nurse Pauline Cafferkey who contracted the Ebola virus in December 2014, whilst working in Sierra Leone, but treated and declared Ebola free in London, has once again been flown back from her home in Scotland to an isolation unit at the Royal Free Hospital in London.

Doctor say that her condition is not thought to be life threatening, but this is the third time since contracting the virus in Sierra Leone in 2014 that she has been taken to hospital.

In October last year, Pauline Cafferkey was fighting for her life in intensive care at the Royal Free Hospital in London, where she was found to be carrying the Ebola virus, despite being declared Ebola free nine months previously.

Today’s breaking news will continue to have serious implications for the tens of thousands of people in Sierra Leone that have been treated and declared free of the virus. Their conditions are thought to be complex and multiple, with many suffering heart, liver and other vital organ failures.

Pauline Cafferkey’s latest episode is likely to confirm once again that the Ebola virus will linger in the body for a very long time, raising questions once again as to whether the thousands of patients declared Ebola free in Sierra Leone are still carrying the virus in a mutated and less virulent form; and if so, what risk does this pose for communities.

Back in October 2014, Pauline was treated with an experimental antiviral drug called GS5734,  developed by U.S. drug manufacturer –  Gilead Sciences, and was discharged from the Royal Free Hospital in London four weeks after.

The World Health Organization says in rare instances, Ebola can persist in parts of the body not covered by the immune system, including inside the eye, the brain, the spinal cord or in semen, though not much is known about the long-term implications.

More than 11,000 people in West Africa died during the recent outbreak in Sierra Leone, Liberia and Guinea.

Doctors and health officials in Sierra Leone told Reuters four months ago, that a handful of mystery deaths among discharged patients may be related to Ebola relapses.

But diagnosis they said was proving difficult because of a lack of expertise and appropriate  equipment required for detecting the presence of the virus in some of the most inaccessible parts of the body – such as the spinal fluid or eyeball.

Dan Kelly, founder of non-profit organisation ‘Wellbody Alliance’ who has worked on Ebola in Sierra Leone, also told Reuters that relapsing Ebola might affect 10 percent of all recovered patients.

He said this was based on two cases, including Cafferkey’s, where the live virus was detected among the roughly 20 survivors treated in Europe and the United States. Other experts have declined to give an estimate, saying it is too early to tell.

“One case reminds me of Pauline, but we were unable to find a laboratory willing to test the patient before the patient died,” he said. “In West Africa it (relapsing Ebola) is mostly undiagnosed, hardly treated and people are certainly dying of it.”

In Sierra Leone, there have been no reports of any new cases of Ebola, following the death of two people five weeks ago in the northern districts of Kambia and Tonkolili, although tens of thousands of people continue to suffer multiple morbidities, after recovering from the virus.

The number of people declared dead from the virus since the country was declared Ebola free on the 7^th November 2015 stands at two.

But there is continuous risk of another outbreak in Sierra Leone. Health authorities need to continue to rigorously monitor communities that are at risk.

Total dead in the last 273 days in Sierra Leone is 52, whilst total dead in the last 383 days stands at 708. Total cumulative deaths since May 2014 – when official counting began is 3,591; and the total cumulative cases since May 2014 is 8,706.

All 104 cases recorded in Sierra Leone since the 19th May 2015, were found along the Freetown – Northern Ebola axis of Freetown, Kambia, Port Loko, Bombali, and Tonkolili.