A man in India has been quarantined after his semen sample tested positive for Ebola. This man had been in Liberia, was infected with Ebola, got horribly sick and survived. He had the same Ebola-free documentation that all survivors get on release from the hospital, which indicates their blood no longer harbours the virus. Unfortunately for him this wasn’t enough to get him through airport security in New Delhi.
According to reports, this recovered Ebola patient tested negative before flying into New Delhi airport on November 10 where he was immediately quarantined – despite the paperwork and previous negative tests. It was only later, after he’d been held that they tested his semen and found evidence of the virus. And because they found “traces of the virus” he will be held under quarantine until his semen tests negative.
Ebola and semen
It is well known and has been shown in a number of studies that semen and breast milk can contain ebolavirus after it has been cleared from the rest of the bodily fluids; up to 90 days in semen.
This is not surprising as these are immune privileged sites in which immune responses are suppressed. In addition, antibodies in blood don’t make it to the testes.
Ebola is not the only hemorrhagic fever virus for which this is the case. Lassa virus can be detected in semen after the patient recovers and there is also considerable anecdotal clinical evidence that Junin virus, the agent that causes Argentine Hemorrhagic Fever, remains in semen after recovery.
However, finding “traces of virus” is not the same as finding infectious virus particles and at this point we don’t know what tests were used or what was found. And while the risk of sexual transmission is there – something I wrote about in a recent blog – it is extremely low. In fact only one study has found indirect evidence that one woman may have contracted Ebola from sex, but the researchers could not confirm that she actually had Ebola, or that she got it from sex.
However, because there is a risk, the US Centers for Disease Control recommends that male survivors of Ebola are specifically counselled on the risks of transmission through sexual activity at the time of discharge, and are warned to either abstain or use condoms for three months to protect their partners.
In addition, those who lived through the horror of a Liberian Ebola treatment centre are unlikely to be cavalier regarding its spread. The death and suffering they will have already seen must certainly take a toll. Quarantine is probably unnecessary. But “probably” clearly isn’t good enough for the Indian ministry of health, which has decided that the best way to handle this is to remove all chance for sexual transmission of Ebola via this survivor.
Taking no chances
If Ebola made its way into India it would be devastating, especially since many areas in India have the same kind of inadequate health care infrastructures and poor hygiene standards that led to the spiralling epidemic in West Africa.
Countries facing these types of situations have much more to worry about – and, although I may not think quarantine is necessary or even the right thing to do in this situation, I recognise that a health ministry with more than a billion lives at stake might be willing to take stronger measures to prevent the spread of a disease that is decimating parts of West Africa.
But we must keep this in perspective; it does not mean that we need to start quarantining survivors in developed countries. Countries with significant resources, high sanitation standards and good access to information about the virus should continue to keep Ebola at bay without adding to survivors’ burdens with unnecessary quarantines.
We’ve already seen what fear as a driving force has done in the US, where nurse Kaci Hickox was forced to publicly defy an order from state authorities to remain isolated for 21 days after returning virus-free from helping in Sierra Leone. I really hope we don’t lose sight of this as we continue to deal with Ebola.