31 - Post-ebola Syndrome Presents with Multiple Overlapping Symptom Clusters: Evidence from an Ongoing Cohort Study in Eastern Sierra Leone

Background: Since the outbreak of Ebola Virus Disease (EVD) in West Africa from 2013-2016, a large cohort of survivors with persistent health complaints has emerged. This constellation of issues is termed post-Ebola syndrome. Here we characterize the symptoms and physical exam findings of this syndrome in a cohort of survivors from Sierra Leone 2.6 years after resolution of disease.Ebola survivors present with clusters of symptoms that represent sub phenotypes of post-Ebola syndrome


Methods: Potential survivor participants in Eastern Sierra Leone were identified and recruited through the Sierra Leone Association of Ebola Survivors. Household contacts of survivors were identified by enrolled survivors. Both groups were administered a questionnaire assessing self-reported symptoms. A physical exam was performed by a limited number of trained providers. Symptoms were then compared using hierarchical clustering. Statistical analysis of the correlations between clusters was conducted using conditional logistic regression. Both SPICE and principal component (PCA) analyses were performed to explore the relationships between symptom clusters.

Results: Between March 2016 and January 2019, 375 Ebola survivors and 1040 contacts were enrolled. At enrollment, Ebola survivors of all age groups reported significantly more symptoms than their contacts in all categories. Six symptom clusters were identified representing distinct organ systems. SPICE revealed 2 general phenotypes: with or without rheumatologic symptoms. Clusters including rheumatologic symptoms were correlated with one another (r = 0.63) but not with other clusters (r < 0.35). Ophthalmologic/auditory symptoms were moderately correlated with the non-rheumatologic clusters (r > 0.5). Interestingly, psychologic/neurologic, cardiac/GI and constitutional clusters correlated with one another (r > 0.6) p < 0.0001 in all cases. The symptom clusters were then mapped onto a PCA. Each symptom cluster separated from the remainder along PC1, particularly the phenotypes with rheumatologic symptoms.

Conclusion: This study presents an in-depth characterization of post-Ebola syndrome in Sierra Leonean survivors. The interrelationship between symptom clusters indicates that post-Ebola syndrome is a heterogeneous disease. The phenotypes identified may have unique mechanisms of pathogenesis, and require distinct therapies.

Presenting Author(s)

• 

  Sarah Talia Himmelfarb, MD

  Resident in Internal Medicine and Pediatrics
  Tulane University
  New Orleans, LA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• NB

  Nell Bond, PhD

  Post Doctoral Research Fellow
  Tulane University School of Medicine
  New Orleans, Louisiana

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AO

  Adaora Okoli, MD, MPH

  Internal medicine resident physician
  Tulane University school of medicine
  New Orleans, Louisiana

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JS

  John Schieffelin, MD, MSPH

  Associate Professor of Pediatrics
  Tulane University
  New Orleans, Louisiana

  Disclosure: Wolters-Kluwer (Independent Contractor)
• JS

  Jeffrey Shaffer, PhD

  Assistant Professor
  Tulane University
  New Orleans, Louisiana

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RS

  Robert J. Samuels, M.B.Ch.B

  Dr
  Vanderbilt School of Medicine, Visiting Scholar
  Nashville, Tennessee

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EE

  Emily J. Engel, MPH&TM

  Tulane VHFC Program Manager
  Tulane University
  New Orleans, Louisiana

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.