Despite Challenges, Liberia's Semen Screening Program for Ebola Successful

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Liberia’s Men’s Health Screening Program for Ebola survivors successful in spite of complex challenges.
Liberia’s Men’s Health Screening Program for Ebola survivors successful in spite of complex challenges.

The Men's Health Screening Program (MHSP), the first established nationwide in Liberia in 2015 to screen and counsel Ebola survivors, is showing success despite the challenges it is facing, according to the Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR).1

Lawrence J. Purpura, MD, of the Division of High Consequence Pathogens and Pathology at the National Center for Emerging and Zoonotic Infectious Diseases and the Epidemic Intelligence Service at CDC and colleagues examined the Liberian program, which faced several challenges. According to the report, these include obtaining resources, running semen testing programs while research is still being conducted, finding enough trained personnel and effectively communicating health messages, locating male Ebola survivors, helping to overcome the stigma of the disease, and dispatching local operations teams.

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Despite these challenges, “Approximately 80% of enrollees have graduated from the program,” the researchers wrote. They noted that “Engagement with the survivor community, communication, and flexibility were important to the success of the program.”

Enrollees have their semen screened for evidence of the virus, and are counseled on how to protect their intimate partners, since Ebola can be sexually transmitted months after infection.

In an interview with Infectious Disease Advisor, Barbara Knust, DVM, MPH, of the Division of High Consequence Pathogens and Pathology at the National Center for Emerging and Zoonotic Infectious Diseases at CDC said additional data that has emerged about the program includes, “a companion paper that was published in the Lancet Global Health in the end of August,” that reported “test results from the MHSP participants. We found persistence of Ebola virus RNA in semen 565 days from Ebola treatment unit discharge, far exceeding previous reports.”2

“Around the same time,” Dr Knust continued, “there was also a report of a Guinean survivor where semen tested at 531 days post-onset had detectable RNA published in Clinical Infectious Diseases, with evidence in that case of sexual transmission.”3 During the interview she said, “Several studies and semen testing programs are continuing to follow-up Ebola survivors and so there is likely more information to become available in the next months.”

Dr Knust added during the interview, “We have also identified individual differences in the length of time that traces of Ebola can remain in survivors' semen.” Older men seem to carry the virus for longer periods than younger men, but the reason why is unknown. It is not yet known what the risks are for viral persistence, or the effects on semen quality or fertility. “There is a great deal yet to be learned,” Dr Knust said.

When asked about the implications of the program, Dr Knust  “emphasized the importance of counseling and education about safe sex practices in addition to semen testing as a way to prevent reintroduction of Ebola virus from survivors who may still have traces of the virus in their semen.” The program shows how essential it is to offer lab testing and behavioral counseling so Ebola survivors can protect their partners. Dr Knust concluded the interview by saying that the MMWR report highlights the “number of innovations and lessons learned as a result of developing this program under an accelerated timeframe.”

Researchers stressed in the report that “lessons learned during the establishment of the MHSP in Liberia might inform the planning and implementation of future semen testing programs for other sexually transmissible diseases.”

References

  1. Purpura LJ, Soka M, Baller A, et al. Implementation of a national semen testing and counseling program for male Ebola survivors - Liberia, 2015–2016MMWR Morb Mortal Wkly Rep. 2016;65(36):963-966. doi: 10.15585/mmwr.mm6536a5.
  2. Soka MJ, Choi MJ, Baller A, et al. Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data.Lancet Glob Health. 2016;4(10):e736-743. doi: 10.1016/S2214-109X(16)30175-9.
  3. Diallo B, Sissoko D, Loman NJ, et al. Resurgence of Ebola virus disease in Guinea linked to a survivor with virus persistence in seminal fluid for more than 500 daysClin Infect Dis. 2016. pii: ciw601. doi: 10.1093/cid/ciw601.
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