Ebola Survivors Questions and Answers

The 2014 Ebola outbreak in West Africa has resulted in more Ebola survivors than ever before. Many of these survivors suffer from persistent medical conditions after recovery from Ebola, including joint pain, eye problems, headaches, and other chronic health issues. In addition to these complications, scientists know that Ebola virus can stay in certain body fluids even after recovery, including semen, ocular fluid in the eye, breast milk, and spinal column fluid.

The large number of Ebola survivors gives us the chance to better understand how Ebola affects people who have recovered, and to advise survivors on how to take care of themselves and their communities. CDC is working with partners to set up survivor support activities in West Africa to reduce the risk of Ebola reintroduction, help with survivors’ unique medical and psychological needs, and strengthen health systems. As CDC learns more, we will continue to update our guidance.

Do Ebola survivors have antibodies to the virus?

Recovery from Ebola depends on good supportive care and the patient’s immune response. Evidence from previous Ebola outbreaks shows that people who survived the disease had antibodies to the virus that could still be detected 10 years after recovery. We don’t know if people who recover are immune for life or if they can become infected with a different species of Ebola.

Some viruses, including Ebola, can linger for some time after recovery in parts of the body (for example, testes, eyes, spinal column fluid) not easily reached by the immune system. CDC and other researchers continue to study this issue and will share information as it becomes available.

Can Ebola virus stay in body fluids even after someone recovers?

Scientists know that Ebola virus can stay in some body fluids even after recovery. Ebola has been found in the semen of some men who have recovered from Ebola, and Ebola virus can stay in breast milk for some time after recovery. Ebola virus has also been isolated from the ocular fluid of a recovered Ebola patient.

It is not known how long the virus might be found in these fluids, but CDC and partners are working together to study how long the virus persists in various body fluids among Ebola survivors. They are also conducting viability testing to determine if the disease can be transmitted through these fluids.

The number of survivors from this Ebola outbreak is greater than previous outbreaks. This gives us the chance to understand how the disease affects people who have recovered, and how to advise survivors on ways to protect themselves and their communities. As CDC learns more about Ebola, we will continue to update our guidance.

What is an “immunologically privileged” site in the body?

There is evidence that certain parts of the body are “immunologically privileged,” which means that there are areas where Ebola virus, and other viruses and pathogens as well, can stay even after being cleared elsewhere in the body by the body’s immune response. Examples of immunologically privileged parts of the body include the testes, eyes, and spinal column.

Why does Ebola virus persist in semen for so long?

Evidence shows that the testes, where semen is made, do not have the same level of immune system defenses as other parts of the body, so it takes a longer time for virus to be removed by the immune system. The presence of infectious virus in an Ebola survivor’s testes does not seem to pose a risk of that survivor becoming infected again with Ebola. However, it is possible that Ebola could be spread through sex or other contact with semen. At this time, it is not known how long viable, intact virus can persist in the testes, but CDC and other researchers continue to study this issue and will share information as it becomes available.

Did CDC know that Ebola virus could reappear in survivors?

Many viruses have long-term effects; some are similar and some differ from the original disease. A large body of research exists for many viruses and other pathogens that cause illness, but not Ebola. Because there are now many more Ebola survivors than ever before, we can learn more about the longer term effects of Ebola. We are aware of the possible risk of continued presence of Ebola virus in body fluids after recovery, which we are thoroughly investigating. Ebola virus has been found in the semen of some men who have recovered from Ebola, and scientists know the Ebola virus can be found in breast milk even after recovery. Ebola virus also has been isolated from the ocular (eye) fluid of a recovered Ebola patient, and it is possible that the virus can linger in the spinal fluid.

Can Ebola survivors still spread the virus?

Some viruses, including Ebola, can linger for some time after recovery in parts of the body (for example, testes, eyes, spinal column fluid) not easily reached by the immune system. It is possible that Ebola could be spread through sex or other contact with semen. Because it is not known how long Ebola might be found in the semen of male survivors, they should abstain or use a condom for all sexual activity.

There is no known risk of getting Ebola through casual contact with an Ebola survivor. We do not yet know if those who have the virus in certain parts of the body (such as the eyes or spinal column) pose any risk of spreading the virus to others through invasive procedures, including healthcare providers, through invasive surgical procedures. CDC and other researchers continue to study this issue and will share information as it becomes available.

Is it safe for Ebola virus disease survivors to breastfeed?

Scientists know the Ebola virus can stay in breast milk even after a woman recovers from Ebola virus disease (EVD). We don’t know whether and for how long Ebola virus can be spread through breastfeeding and are studying this.

Breastfeeding while sick with Ebola virus disease: In several cases, Ebola virus genetic material has been found in breastmilk of lactating women while they were sick with EVD and for several days after they recovered. Babies who were breastfed by the acutely sick mothers have also become infected. Lactating women who are sick with EVD should be isolated, and safe alternative feeding if available should be given to baby. Donor breast milk or Ready to Use Infant Formula (RUIF), if available, may be an acceptable substitute.

Breastfeeding shortly after recovery from Ebola virus disease: Until we know more, a lactating mother who has survived EVD (while lactating) should not breastfeed her baby if she can give her baby a safer substitute. However, she can breastfeed if her breast milk can be shown to have no Ebola virus in it by laboratory testing or if there is no other way to feed her baby. Where available, testing of breastmilk for Ebola virus can help to guide decisions about when breastfeeding can be safely resumed.

Breastfeeding babies who were born after mother’s recovery from Ebola virus disease: We do not know of any babies becoming infected with Ebola virus from breastfeeding or close contact with a mother who is a recovered EVD survivor and had become pregnant after her recovery. A mother who survived EVD and became pregnant after recovery should breastfeed her child as there are many positive benefits of breast milk. Breastfeeding is safe and should be recommended for women who become pregnant and give birth after recovering from EVD.

Are scientists studying Ebola survivors?

The Sierra Leone Ministry of Health, CDC, and the World Health Organization are working together to determine how long Ebola virus persists or stays in various body fluids of Ebola survivors. We are conducting a “Virus Persistence Study,” which includes testing of body fluids in male and female Ebola survivors to determine how long the virus stays in specific fluids after recovery. The study is also conducting viability testing to determine if the disease can be transmitted through specific body fluids.

The pilot phase of this study is testing the persistence of Ebola virus in the semen of 100 male Ebola survivors in Freetown, Sierra Leone. So far, the study found that Ebola can remain in the semen for up to at least 9 months. Previous studies had detected Ebola virus in semen for up to 6 months. CDC is conducting further tests to determine if the virus is live and potentially infectious this long after recovery. The study also shows that the virus in semen reduces over time.

Because of the possible risk of sexual transmission, CDC advises male Ebola survivors to abstain or use condoms unless they know their semen is negative for Ebola.

Is there a surveillance system for Ebola survivors in the United States?

There is no formal surveillance system for Ebola survivors. Because there is evidence that male Ebola survivors can have infectious virus present in their semen, CDC advises that people avoid contact with semen from male survivors or use condoms for any type of sexual activity.

We are continuing to investigate the possible risk of the continued presence of Ebola virus in body fluids after recovery, and will update guidance for survivors, healthcare workers, and the public as we learn more.

What guidance is CDC offering Ebola survivors?

CDC updates guidance all the time as the science shows us new information about Ebola. Because Ebola virus has been found in the semen of some male Ebola survivors, CDC advises male survivors to practice safe sex. Male survivors should use condoms for all sexual activity and everyone should avoid contact with the semen of male Ebola survivors until more information is known. CDC and partners are educating survivors about the importance of safe sex and have provided access to free condoms and semen testing.