You’ve probably seen recent reports about a Glaswegian nurse,
Pauline Cafferkey, diagnosed with Ebola Virus Disease (EVD), who beat the
illness months ago, is back in intensive care due to complications from EVD
(1). A similar situation occurred when a US Physician, Ian Crozier, months
after being cleared of EVD began to lose vision in his left eye (2).
So what gives? How did Ebola reemerge in both these people’s
lives? The answer is kind of simple. EVD was never truly “cleared” from either
Cafferkey or Crozier’s body. So who’s to blame? Turns out, no one is to blame
but their own bodies.
For a bit of background, there are a few areas in our bodies
that are considered to be immune privileged: our eyes, male testes, and the brain.
This means these areas lack a close relationship with our immune system and
thus have low immune response times. Of particular interest, regarding EVD, are
the eyes and male testes. Human eyes lack extensive vascularization and are
relatively separated from the rest of our immune system making a robust immune
response difficult to mount. Likewise, a barrier of cells, similar to that in
the blood brain barrier, separates male testicles from our immune system in order
to protect developing sperm (3). What this all means is that when EVD invades a
body and takes up residence in a patient’s eye or in male testes, our immune
system has a very difficult time detecting and defeating the lingering virus in
a timely fashion.
Health professionals recommend male patients refrain from
sex for at least 3 months after EVD is not detected in their blood so that at
least takes care of EVD in the testes. What about EVD in the eyes though? In
Crozier’s case, it took weeks of intense treatment to finally restore vision to
his eye (2). How can countries such as those afflicted with pandemic levels of
EVD cope with the lingering effects of the disease? Unfortunately, many of the
affected countries had an already limited health capacity before Ebola and most
certainly have a diminished system now. It is a new challenge that health
professionals must face and solve soon or else thousands of people who beat
Ebola will have a new fight.
TL;DR: Ebola hangs around eyes and testicles (if you got’em)
even after you’re clear of the virus.
1. Hume, Tim. “UK’s first Ebola patient back in hospital in
serious condition after complication.” CNN Europe. 9 October, 2015. Web link: http://www.cnn.com/2015/10/09/europe/uk-ebola-nurse/
2. Varkey et al. “Persistence of Ebola Virus in Ocular Fluid
during Convalescence.” The New England Journal of Medicine 372;25 18 June,
2015. Web Link: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1500306
3. Fecht, Sarah. “Why testicles are the perfect hiding spot
for Ebola.” Popular Science: Health. 5 May, 2015. Web Link: http://www.popsci.com/why-ebola-lives-so-long-survivors-testicles
John, I think you bring up a good point at the end. This reoccurrence is an issue for individuals who were able to receive what may possibly be the best care for someone who has contracted the virus. Yet, Dr. Crozier and Pauline are still struggling with the repercussions of the disease. An article on ForeignPolicy.com advocates for some serious analysis of our global health system and reflections on what was done versus what could have been done. Today's technology provides the world with constant communication. Had some actions been taken sooner or a financially more robust response been carried out, different outcomes may have resulted. However, we will never know that. What can be done though is a reflection by the World Health Organization, as well as ourselves, in prioritizing global health measures. As some of us look to work with patients in the future, we should consider global health to be as much of a facet of impacting each of our patients' health as their own daily routine.
ReplyDeletehttp://foreignpolicy.com/2015/10/08/global-public-health-system-learn-from-ebola-mistakes-who/
I completely agree. It's noteworthy you pulled this info from Foreign Policy because this is a foreign policy matter. Not to be too cynical about it, but recall the reaction in the United States and most of the Western world. It was a resounding silence. Yes we sent millions of dollars in aid and even a large contingent of troops, but the overwhelming majority of Americans wanted nothing to do with Ebola. Moreover, many politicians, some even running for president right now** cough cough... Ted Cruz** wanted to close our borders completely. The world, and particularly the citizens of developed countries, must realize that threats such as those posed by Ebola are a global concern and must be treated as a human crisis more than a regional one.
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