BRAZZAVILLE, CONGO — People who survive Ebola can pass the virus on through sex if it persists in semen after recovery, but are not expected to spread it through sweat or saliva once discharged, the World Health Organization (WHO) has said, as it issued guidance on the sexual transmission of Ebola during the current outbreak.
Patrick Otim, programme area manager for emergency response at WHO’s Regional Office for Africa, said in a video that the virus “can be transmitted through sexual intercourse” when it persists in semen, a phenomenon known as viral persistence, Premium Times reported on 28 October.
Reducing the risk of sexual transmission of Ebola
Patients must have two negative blood tests before discharge, WHO said, so survivors who meet discharge criteria are not expected to transmit the virus through sweat or saliva because it will have been cleared from their blood. People who are actively ill, by contrast, can transmit Ebola through sweat and other body fluids.
To reduce the risk of sexual transmission of Ebola, WHO recommends that male survivors receive counselling on safer sex and access to condoms after discharge, and have regular semen testing until they record two consecutive negative results. Where a semen-testing programme is not available, WHO recommends safer sex for 12 months.
Viral persistence was documented during earlier Ebola outbreaks, when the virus was found in the semen of some male survivors months after recovery and rare cases of sexual transmission were linked to survivors. That experience shaped WHO’s current recommendations on the sexual transmission of Ebola.
Such transmission is considered rare, but because it can restart chains of infection after an outbreak appears to be over, health authorities treat it as an important part of ending outbreaks for good.
The guidance matters for countries managing survivors and contacts. Kenya has seven surviving confirmed patients among its nine cases, and the Democratic Republic of the Congo (DRC) reports more than 2,600 recoveries.
Kenya’s first patient, a Kenyan man who had worked in the DRC, flew home via Uganda on 3 October and died in a Nairobi hospital two days later, UN News reported. All contacts in Kenya and abroad had been traced and quarantined by 22 October, and the first 20 were released on 26 October after 21 days without symptoms.
The guidance would normally form part of discharge counselling for surviving patients in Kenya and the DRC, and for Nigeria’s patient, who is being treated in Geneva.
Outbreak passes 10,000 cases in DRC
The DRC’s Ministry of Public Health reported 10,060 confirmed cases and 4,887 deaths on Tuesday, Premium Times reported, citing Al Jazeera. The outbreak, declared on 15 May, is the largest and deadliest Ebola epidemic in the DRC’s history and the second largest globally after the 2014 to 2016 West African epidemic, which caused about 28,600 cases and more than 11,000 deaths.
About 80 per cent of new cases in the DRC fall outside known transmission chains, according to Al Jazeera, while Africa CDC says at least 95 per cent of cases must be linked to known contacts for an outbreak to be considered under control. WHO Regional Director for Africa Mohamed Janabi said progress in recovery, research and response offered reasons for hope. “Our teams are on the ground, working side by side with the government and partners to stop transmission and save lives,” he said.
The Tumaini vaccine trial began in Bunia, eastern DRC, on 23 October. WHO’s Dr Meg Doherty told UN News that results were expected to take “several months”.
WHO technical advisory groups evaluated two Bundibugyo-specific vaccine candidates last week, ChAdOx1 from the University of Oxford and the Serum Institute of India, and mRNA-1469 from Moderna, with recommendations due this week, UN News reported. Four people were vaccinated at the trial launch, and two vaccination rings are in place, with more being prepared. “Tumaini actually means ‘hope’ in Swahili, and is giving us some hope,” Doherty said.
Survivors often face stigma when they return home, and clear guidance helps families and communities understand that survivors who have been discharged are not a risk through ordinary contact. Counselling on the sexual transmission of Ebola can be offered alongside psychological support, since many survivors also cope with grief, fatigue and anxiety.
Survivor programmes typically offer follow-up clinics for joint pain, eye problems, fatigue and other after-effects that some survivors experience, as well as semen testing for men. Good survivor care also builds community trust, which encourages people with symptoms to seek treatment early rather than hiding illness.
Nigeria had no remaining confirmed case after its patient’s evacuation to Switzerland, though contacts remain under monitoring.
Why it matters: Clear survivor guidance limits hidden transmission and fights stigma, both vital as Ebola cases pass 10,000 across the region.
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