BackgroundSurvivors of the 2014–2016 West Africa Ebola epidemic have been reported to suffer high levels of stigmatization after return to their communities. We sought to characterize the stigma encountered by a cohort of Ebola survivors in Liberia over time.MethodsEbola-related stigma was assessed from June 2015 to August 2017 in 299 adolescent and adult Liberian Ebola Survivor Cohort participants at three month intervals using adapted HIV stigma scales scored from 0 to 10 according to the proportion of answers indicating stigmatization.FindingsThe median time from Ebola Virus Disease (EVD) to study entry was 393 days (IQR 336–492). Participants (43% female) had a median age of 31 (IQR 25–40) years. Mean self-reported stigma levels were greater at baseline (6.28 ± 0.15 [IQR: 4.38–8.75]) compared to the first post-baseline visit (0.60 ± 0.10 [IQR: 0–0]; p<0.0001). During follow-up, stigma levels were stable. Baseline stigma significantly increased during enrollment and following clusters of Ebola re-emergence in Liberia. Survivors encountered primarily enacted and perceived external stigma rather than internalized stigma.ConclusionsEbola-related stigma was prevalent among Liberian survivors more than a year after EVD recovery. Self-reported stigma was greater in the period before cohort enrollment; however, some degree of stigmatization persisted years after EVD. Transient rises in stigma were observed following episodic Ebola re-emergence of EVD in Liberia. During future EVD outbreaks, enhanced public health interventions designed to prevent and mitigate Ebola-related stigma that is enacted and external should be implemented to support survivor recovery and community re-integration.

Among 149 men who survived Ebola virus disease (EVD) and donated semen 260–1016 days after EVD onset, Ebola virus (EBOV) ribonucleic acid (RNA) was detected in 13 (9%). Of 137 men who donated semen 2 years after EVD onset, 11 (8%) had an EBOV RNA-positive specimen. The mechanism underlying the persistence of EBOV RNA in semen is unclear, and it is unclear whether the detection of viral RNA represents the presence of infectious virus.

1. The concentration of protein in the serum and plasma of normal dogs is given. Analyses of serum from 38 animals yielded the following averages and standard deviations, (a) for albumin: 3.26 ± 0.48 gm. per cent, (b) for globulin: 2.72 ± 0.76 gm. per cent, and (c) for total protein: 5.98 ± 0.67 gm. per cent. Analyses of plasma from 19 animals showed, (a) for albumin: 3.38 ± 0.38 gm. per cent, (b) for globulin: 2.98 ± 0.55 gm. per cent, and (c) for total protein: 6.36 ± 0.71 gm. per cent. 2. A diet for dogs is described, the feeding of which results in a progressive decline in the concentration of protein in the serum. A composite curve constructed from the findings with 21 animals discloses a rapid initial fall and a slower subsequent decrease in albumin and total protein and an approximately constant level for globulin. The course of the globulin curve was subject to wide variation in separate experiments, both increases and decreases being recorded. 3. With five dogs the nitrogen balance was followed through a total of 42 metabolism periods of approximately 7 days each. The average daily loss of nitrogen was 1.15 gm. Approximate calculations disclose that only 3 or 4 per cent of the nitrogen eliminated is accounted for by the decline in circulating protein, the remainder being represented by loss from the tissues. 4. An episode is described with one dog when, during a period of self-imposed fasting, the serum albumin regenerated to a normal level, apparently at the expense of catabolized tissue protein. 5. The course of serum proteins is described during the recovery which follows interruption of the low protein diet and return to a regime of adequate feeding. 6. A discussion is given of the relationship between tissue proteins and plasma proteins. The data permit one to entertain the hope that a way will be found for stimulating an internal readjustment to provide temporary relief from hypoproteinemia, a way which will depend upon the potential ability of the tissues to provide sufficient protein for the needs of the plasma.

In the course of experiments undertaken to discover the effect of the flow and the composition of lymph on the formation of edema an opportunity has been afforded for comparing the albumin and globulin concentrations of blood serum with those of lymph serum obtained from lymphatics of the extremities of dogs. The comparison forms the basis of this communication. METHODSThe dogs used were of mongrel breeds and varied in weight from 15 to 26 kilograms. Lymph was obtained through cannulas inserted into one of the lymphatic trunks just above the ankle of either a front or a hind leg. Cannulization was performed sometimes under ether anesthesia, sometimes under nembutal anesthesia and sometimes with the aid of a local anesthetic (novocaine) only. With animals under general anesthesia the flow of lymph was promoted by gentle massage of the foot and ankle and passive motion of the extremity. The non-anesthetized dogs were prepared by the method described by White, Field and Drinker (1) and allowed to walk about the corridors, the normal motion of the extremity furnishing the stimulus for lymph flow. A fine fibrin clot which formed in the lymph on standing was removed before analysis. Blood was obtained by puncture of the femoral artery usually at the end of the period of lymph collection and the serum separated as soon as possible. In several instances blood serum obtained both before and after the collection of lymph failed to indicate any change in composition during the experiment.Methods of chemical analysis have been described in a previous paper (2). In some instances, because the quantities of lymph were limited, nonprotein nitrogen was determined on the serum only and the value so obtained used in calculating the lymph proteins. The error involved in such an assumption is small. In nine instances in which parallel determinations were made of lymph and serum nonprotein nitrogen, the average value for lymph was 24.5 mgm. per 100 cc. and for serum 22.7 mgm. per 100 cc.

Background Cohort studies have reported a high prevalence of musculoskeletal, neurologic, auditory, and visual complications among Ebola Virus Disease (EVD) survivors; however, little is known about the host- and disease-related predictors of these symptoms and their etiological mechanisms. Methods The presence and patterns of eight cardinal symptoms that are most commonly reported following EVD survival were assessed in the 326 EVD survivors participating in the ongoing longitudinal Liberian EVD Survivor Study. At quarterly study visits, symptoms that developed since acute EVD were recorded and blood was collected for biomarkers of inflammation and immune activation. Results At baseline (mean 408 days from acute EVD), 75.5% of survivors reported at least one new cardinal symptom since surviving EVD, which in 85.8% was rated as highly interfering with life. Two or more incident symptoms were reported by 61.0% of survivors with pairings of joint pain, headache, or fatigue the most frequent. Women were significantly more likely than men to report headache while older age was significantly associated with musculoskeletal and visual symptoms. In analyses adjusted for multiple comparisons, no statistically significant association was found between any symptom and 26 markers of inflammation and immune activation. Symptom frequency remained largely unchanged during study follow-up. Conclusions Post-EVD complications occur in a majority of survivors and remain present more than 4 years after acute infection. An association between markers of inflammation and immune activation and individual symptoms was not found, suggesting an alternative etiology for persistent post-EVD symptomatology.