Background With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illustrated by recent epidemics, good knowledge on extent of viral persistance or RNA detection in body fluids from survivors is urgently needed. Methods Ebola viral RNA shedding was studied with molecular assays in semen (n=1,368), urine (n=1,875), cervico-vaginal fluid (n=549), saliva (n=900), breast milk (n=168) and feces (n=558) from EVD survivors in Guinea (POSTEBOGUI cohort, n=802) at a regular base until 40 months after inclusion. Results 27/277 (9.8%) male survivors tested positive for Ebola RNA in at least one semen sample. The probability of remaining positive for Ebola RNA in semen was estimated at 93.02% and 60.12% after three and six months. Viral RNA in semen was more frequent in patients with eye pain (p=0.036), joint pain (p=0.047), and higher antibody levels to Ebola virus antigens (NP (p=0.001), GP (p=0.05) and VP40 (p=0.05)). Ebola RNA was only rarely detected in other body fluids from EVD survivors : saliva (1/454) urine (2/593), breast milk (2/168), cervico-vaginal secretions (0/273), feces (0/330). RNA was detected in breast milk one month after delivery but 500 days after discharge of Ebola treatment unit (ETU) in a women who became pregnant seven months after discharge from the ETU. Conclusions The frequency and potential long term presence of viral RNA in semen confirm that systematic prevention measures in male survivors are required. Our observation in breast milk suggest that our knowledge on viral reservoir in immune priveledged sites and its impact are still incomplete.

We conducted three successive seroprevalence surveys, three months apart, using a multistage cluster sampling to measure the extent and dynamics of the SARS-CoV-2 epidemic in Conakry, the capital city of Guinea. Seroprevalence increased from 17.3% (95% CI: 12.4-23.8) in December 2020 during the first survey (S1) to 28.9% (95% CI: 25.6-32.4%) in March/April 2021 (S2) then to 42.4% (95% CI: 39.5-45.3%) in June 2021 (S3). This significant overall trend of increasing seroprevalence (p <0.0001) was also significant in every age class, illustrating a sustained transmission within the whole community. These data may contribute to defining cost-effective response strategies.

Background Longitudinal analyses are needed to better understand long-term Ebola virus disease (EVD) sequelae. We aimed to estimate the prevalence, incidence and duration of sequelae and identify risk factors associated with symptom occurrence among EVD survivors in Guinea. Methods We followed 802 EVD survivors over 48 months and recorded clinical symptoms with their start/end dates. Prevalence, incidence and duration of sequelae were calculated. Risk factors associated with symptom occurrence were assessed using an extended Cox model for recurrent events. Results Overall, the prevalence and incidence of all symptoms decreased significantly over time, but sequelae remained present 48 months after Ebola treatment center discharge with a prevalence of 30.68% (95% confidence interval [CI] 21.40-39.96) for abdominal, 30.55% (95% CI 20.68-40.41) for neurologic, 5.80% (95% CI 1.96-9.65) for musculoskeletal and 4.24% (95% CI 2.26-6.23) for ocular sequelae. Half of all patients (50.70%; 95% CI 47.26-54.14) complained of general symptoms 2 years’ post-discharge and 25.35% (95% CI 23.63-27.07) 4 years’ post-discharge. Hemorrhage (hazard ratio [HR], 2.70; P = .007), neurologic (HR 2.63; P = .021) and general symptoms (HR 0.34; P = .003) in the EVD acute phase were significantly associated with the further occurrence of ocular sequelae, whereas hemorrhage (HR 1.91; P =.046) and abdominal (HR 2.21; P = .033) symptoms were significantly associated with musculoskeletal sequelae. Conclusion Our findings provide new insight into the long-term clinical complications of EVD and their significant association with symptoms in the acute phase, thus reinforcing the importance of regular, long-term follow-up for EVD survivors.

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