Messages for the Care of Survivors of Ebola

Main Messages

• Survivors of Ebola virus disease (EVD) have been safely cared for in the United States.
• Survivors of EVD can be safely cared for when Standard Precautions† and the CDC guidance for caring for EVD survivors are followed.
• CDC has developed guidance for clinicians in U.S. healthcare settings for the safe management and care of survivors of EVD.
• CDC guidance for the management of survivors of EVD in U.S. healthcare settings can be found here.

Survivor Health Problems

• Many survivors of EVD have health problems after they recover from Ebola. Unfortunately, information is limited about these health problems and how long they last.
• The onset, severity, and how long these health problems last varies by survivor.
  • Commonly reported health problems include tiredness, headaches, muscle and joint pain, eye and vision problems (blurry vision, pain, redness, and light sensitivity), weight gain, and stomach pain or loss of appetite.
  • Other health problems can include memory loss, neck swelling, dry mouth, tightness of the chest, hair loss, hearing problems (ringing in the ears and hearing loss), pain or tingling in the hands and feet, inflammation of the pericardium (tissue around the heart), inflammation of one or both testicles, changes in menstruation, impotence, decreased or lost interest in sex, difficulty falling or remaining asleep, depression, anxiety, and post-traumatic stress disorder.
• In rare cases, survivors of EVD might develop new neurologic complications, which could include confusion, seizures, meningitis-like signs and symptoms, or loss of consciousness.

Patient Care for Survivors of EVD: Standard Precautions

• Healthcare personnel should not withhold any care from Ebola survivors.
• All patient care should be done using Standard Precautions^†
• There is no evidence that the care of Ebola survivors involving normal patient contact (e.g., with intact skin, sweat, tears, conjunctivae, saliva, earwax) poses any special risk of Ebola virus transmission to healthcare personnel as long as Standard Precautions^† are used.
• There is no evidence that women who become pregnant after they have recovered from Ebola pose special risk to health care providers.
• Women who become pregnant after they have recovered from Ebola should receive routine prenatal care. Standard Precautions† and correct waste management should be used during labor and delivery with attention paid to splash prevention.
• In the absence of neurologic symptoms, regional anesthesia should not pose a risk to hospital staff. (For those pregnant survivors with neurologic symptoms who require spinal anesthesia during delivery, see Patient Care for Survivors of EVD: When Extra Precautions are Recommended).
• Available evidence indicates that Ebola survivors who are asymptomatic (i.e., do not have a fever) do not pose a risk of transmitting the Ebola virus through blood draws.  

Patient Care for Survivors of EVD: When Extra Precautions are Recommended

• Healthcare personnel should not withhold any care from Ebola survivors. 
• For some survivors of EVD, it is possible that Ebola virus may stay in certain parts of the body, even after recovery from the disease and after the virus has disappeared from blood.
  • These parts of the body are considered “immunologically privileged” (protected) sites. 
  • These parts of the body include the testes, interior of the eyes, central nervous system (e.g., cerebrospinal fluid).
  • Whether the virus is present in these body parts and for how long varies by survivor. 
• When providing care to survivors of EVD, take extra precautions when performing any procedures involving contact with body fluids from immunologically protected sites.  Such procedures include obtaining and handling cerebrospinal fluid from an Ebola survivor with neurologic symptoms; performing an invasive ophthalmologic procedure on an eye in a patient with ocular disease such as uveitis or cataract; and procedures involving exposure to semen, such as infertility evaluations, or performing invasive procedures on the testes, prostate gland, or seminal vesicles. 
• For these and any other care activities that might involve contact with these body fluids, healthcare facilities and clinicians should:
  • Arrange expert consultation in advance or on an urgent basis as needed with the state health department and/or CDC. 
  • Assess capabilities of the facility, including the ability to correctly implement and maintain infection control, including contact precautions, environmental hygiene, and infectious waste management as needed (including in consultation with CDC in advance or on an urgent basis)
  • Assess the readiness, training, and competence of all staff potentially involved in care and their willingness to remain part of the care team knowing the possible risk of Ebola virus persistence. This should include any diagnostic laboratory and imaging personnel, environmental services staff, as well as direct care providers.
  • Determine appropriate personal protective equipment required based on a risk assessment of potential exposure during the procedure(s) and related care and ensure training on its use.  
• Ebola survivors who have any new or recurrent symptoms with or without fever should seek care and be assessed for both common community-acquired infections (e.g., malaria, influenza, common cold, typhoid fever, or gastroenteritis) as well as possible complications related to Ebola and Ebola virus persistence.  
• Healthcare workers should always follow Standard Precautions^†.
• Scientists continue to study the long-term effects of Ebola virus infection, including viral persistence, to better understand how to provide treatment and care to Ebola survivors.

†Standard Precautions include the minimum practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These practices are designed to both protect HCP and prevent HCP from spreading infections among patients. Standard Precautions include: 1) hand hygiene, 2) use of personal protective equipment (e.g., gloves, gowns, masks) when there is any potential for contact with blood, body fluids or broken skin*, 3) safe injection practices, 4) safe handling of potentially contaminated equipment or surfaces in the patient environment, and 5) respiratory hygiene/cough etiquette. 

*Healthcare personnel should use precautions when there is potential contact with blood, body fluids or broken skin, and any potential for splashing or exposure to a soiled surface during care, for which non-sterile gloves, disposable gowns, and face protection to prevent mucosal exposure should be used based on the expected risk.