Uncovering More Questions: Salome Karwah and the Lingering Impact of Ebola Virus Disease on the Reproductive Health of Survivors
- 322 Downloads
A relative dearth of research exists regarding the unique physical and social impact of Ebola on its female survivors. This fact is exemplified by the case of Salome Karwah who, in 2014, contracted Ebola virus disease (EVD), recovered, and then returned to the Ebola Treatment Unit (ETU) to care for other victims of the disease. For her heroism, Salome was recognized on the cover of Time Magazine as a Person of the Year for her work in combating the Ebola epidemic. Following the Ebola outbreak, Salome returned to care for Ebola patients together with her husband. In February 2017, and following complications of hypertensive disease of pregnancy, a healthy baby boy was delivered. Tragically, Salome died 4 days later of pregnancy complications, likely a result of eclampsia. Liberia has remained one of the most dangerous countries to be pregnant, both before, during, and after the Ebola epidemic. This chapter discusses the heroism of Salome, the potential implications of Ebola survivorship on the reproductive health of men and women, and the long-term persistence of Ebola virus in the genital tract of male and female survivors of the disease.
KeywordsEbola virus disease Ebola survivor Stigma Immune privilege Post-Ebola syndrome Pregnancy Miscarriage Stillbirth Menstruation Viral persistence Salome Karwah Médecins Sans Frontières Doctors Without Borders Semen
- Akwei, L. (2016). For the fourth time, Liberia declared Ebola-free as surveillance continues. Africa News. Retrieved November 7, 2017, from http://www.africanews.com/2016/06/09/for-the-fourth-time-liberia-declared-ebola-free-as-surveillance-continues//.
- All Africa. (2017). Liberia: MOH to establish Salome Karwah’s Foundation. All Africa. Retrieved February 24, 2018, from http://allafrica.com/stories/201710030765.html.
- Baker, A. (2017). Liberian Ebola fighter, a TIME person of the year, dies in childbirth. Time Magazine. Retrieved January 19, 2018, from http://time.com/4683873/ebola-fighter-time-person-of-the-year-salome-karwah/.
- Bart, S. M., Cohen, C., Dye, J. M., Shorter, J., & Bates, P. (2018). Enhancement of Ebola virus infection by seminal amyloid fibrils. Proceedings of the National Academy of Sciences, 115(28), 7410–7415. Retrieved September 22, 2018, from http://www.pnas.org/content/early/2018/06/20/1721646115CrossRefGoogle Scholar
- Christie, A., Davies-Wayne, G. J., Cordier-Lassalle, T., Blackley, D. J., Scott Laney, A., Williams, D. E., et al. (2015). Possible sexual transmission of Ebola virus-Liberia, 2015. MMWR Morbidity and Mortality Weekly Report, 64, 479–481. Retrieved January 19, 2018, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6417a6.htm.PubMedPubMedCentralGoogle Scholar
- Deen, G. F., Broutet, N., Xu, W., Knust, B., Sesay, F. R., McDonald, S. L. R., et al. (2017). Ebola RNA persistence in semen of Ebola virus disease survivors—Final report. New England Journal of Medicine, 377(15), 1428–1437. Retrieved February 22, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798881/.CrossRefGoogle Scholar
- Deen, G. F., Knust, B., Broutet, N., Sesay, F. R., Formenty, P., Ross, C., et al. (2015) Ebola RNA persistence in semen of Ebola virus disease survivors—Preliminary report. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1511410. Retrieved January 18, 2018, from http://www.nejm.org/doi/suppl/10.1056/NEJMoa1511410/suppl_file/nejmoa1511410_preliminaryreport.pdf.CrossRefGoogle Scholar
- Diallo, B., Sissoko, D., Loman, N. J., Bah, H. A., Bah, H., Worrell, M. C., et al. (2016). Resurgence of Ebola virus disease in Guinea linked to a survivor with virus persistence in seminal fluid for more than 500 days. Clinical Infectious Diseases, 63(10), 1353–1356. Retrieved January 18, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5091350/.CrossRefGoogle Scholar
- Dokubo, E. K., Wendland, A., Mate, S. E., Ladner, J. T., Hamblion, E. L., Raftery, P., et al. (2018). Persistence of Ebola virus after the end of widespread transmission in Liberia: An outbreak report. The Lancet Infectious Diseases, 18(9), 1015–1024. Retrieved September 22, 2018, from: https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930417-1CrossRefGoogle Scholar
- Fallah, M. P., Skrip, L. A., Dahn, B. T., Nyenswah, T. G., Flumo, H., Glayweon, M., et al. (2016). Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. Lancet Global Health, 4, e678–e679. Retrieved January 18, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30147-4/fulltext.CrossRefGoogle Scholar
- Fischer, W. A., Brown, J., Wohl, D. A., Loftis, A. J., Tozay, S., Reeves, E., et al. (2017). Ebola virus ribonucleic acid detection in semen more than two years after resolution of acute Ebola virus infection. Open Forum Infectious Diseases, 4(3), ofx155. Retrieved January 20, 2018, from https://academic.oup.com/ofid/article/4/3/ofx155/4004818.CrossRefGoogle Scholar
- Green, E., Hunt, L., Ross, J. C. G., Nissen, N. M., Curran, T., Badhan, A., et al. (2016). Viraemia and Ebola virus secretion in survivors of Ebola virus disease in Sierra Leone: A cross-sectional cohort study. Lancet Infectious Diseases, 16(9), 1052–1056. Retrieved February 21, 2018, from https://www.sciencedirect.com/science/article/pii/S1473309916300603#!.CrossRefGoogle Scholar
- Karwah, S. (2014). I survived Ebola for a reason—To help others recover. The Guardian. Retrieved January 19, 2018, from https://www.theguardian.com/commentisfree/2014/oct/12/ebola-survivor-now-i-am-helping-others-fight-the-disease.
- Mate, S. E., Kugelman, J. R., Nyenswah, T. G., Ladner, J. T., Wiley, M. R., Cordier-Lassalle, T., et al. (2015). Molecular evidence of sexual transmission of Ebola virus. New England Journal of Medicine, 373, 2448–2454. Retrieved January 17, 2018, from http://www.nejm.org/doi/full/10.1056/NEJMoa1509773#t=article.CrossRefGoogle Scholar
- Medecins Sans Frontieres. (2017). A tribute to Salome Karwah: “I survived Ebola to help others.” Retrieved January 18, 2018, from https://www.msf.org.uk/article/tribute-salome-karwah-%E2%80%9Ci-survived-ebola-help-others.
- Mukpo, A. (2017). A husband loses his ‘best friend’—Salome Karwah, Ebola hero. NPR. Retrieved January 14, 2018, from https://www.npr.org/sections/goatsandsoda/2017/03/01/515822228/a-husband-loses-his-best-friend-salome-karwah-ebola-hero.
- Preeclampsia Foundation. (2013). Preeclampsia and maternal mortality: A global burden. Retrieved February 23, 2018, from https://www.preeclampsia.org/health-information/149-advocacy-awareness/332-preeclampsia-and-maternal-mortality-a-global-burden.
- Purpura, L. J., Rogers, E., Baller, A., White, S., Soka, M., Choi, M. J., et al. (2017). Ebola virus RNA in semen from an HIV-positive survivor of Ebola. Emerging Infectious Diseases, 23(4), 714–715. Retrieved January 20, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367423/.CrossRefGoogle Scholar
- Purpura, L. J., Soka, M., Baller, A., White, S., Rogers, E., Choi, M. J., et al. (2016). Implementation of a national semen testing and counseling program for male Ebola survivors—Liberia, 2015–2016. MMWR Morbidity and Mortality Weekly Review, 65(36), 963–966. Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/mm6536a5.htm.CrossRefGoogle Scholar
- Schwartz, D. A. (2015). Pathology of maternal death—The importance of accurate autopsy diagnosis for epidemiologic surveillance and prevention of maternal mortality in developing countries. In D. A. Schwartz (Ed.), Maternal mortality: Risk factors, anthropological perspectives, prevalence in developing countries and preventative strategies for pregnancy-related death (pp. 215–253). New York: Nova Scientific Publishing.Google Scholar
- Schwartz, D. A. (2018). Hypertensive mothers, obstetric hemorrhage and infections: Biomedical aspects of maternal death among indigenous women in Mexico and Central America. In D. A. Schwartz (Ed.), Maternal death and pregnancy-related morbidity among indigenous women of Mexico and Central America: An anthropological, epidemiological and biomedical approach (pp. 35–50). New York: Springer.Google Scholar
- Scott, J. T., Sesay, F. R., Massaquoi, T. A., Idriss, B. R., Sahr, F., & Semple, M. G. (2016). Post-Ebola syndrome, Sierra Leone. Emerging Infectious Diseases, 22(4), 641–646. Retrieved February 21, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806950/.CrossRefGoogle Scholar
- Sissoko, D., Duraffour, S., Kerber, R., Kolie, J. S., Beavogul, A. H., Camara, A.-M., et al. (2017). Persistence and clearance of Ebola virus RNA from seminal fluid of Ebola virus disease survivors: A longitudinal analysis and modelling study. Lancet Global Health, 5(1), 80–88. Retrieved January 19, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30243-1/fulltext.CrossRefGoogle Scholar
- Soka, M. J., Choi, M. J., Baller, A., White, S., Rogers, E., Purpura, L. J., et al. (2016). 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 Global Health, 4, e736–e743. Retrieved January 19, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30175-9/fulltext.CrossRefGoogle Scholar
- Soka, M. J., Choi, M. J., Purpura, L. J., Ströher, U., Knust, B., & Rollin, P. (2017). Screening of genital fluid for Ebola virus—Authors’ reply. Lancet Global Health, 5(1), e33. Retrieved February 24, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30290-X/fulltext.CrossRefGoogle Scholar
- Thorson, A., Formenty, P., Lofthouse, C., & Broutet, N. (2016). Systematic review of the literature on viral persistence and sexual transmission from recovered Ebola survivors: Evidence and recommendations. BMJ Open, 6, e008859. Retrieved January 19, 2018, from http://bmjopen.bmj.com/content/6/1/e008859.CrossRefGoogle Scholar
- Time. (2014). The Ebola fighters. Time magazine. Retrieved January 19, 2018, from http://time.com/4683873/ebola-fighter-time-person-of-the-year-salome-karwah/.
- UN Women. (2017). Maternal health gets a new boost in Liberia. Retrieved February 21, 2018, from http://www.unwomen.org/en/news/stories/2017/7/feature-maternal-health-gets-a-new-boost-in-liberia.
- Vetter, P., Fischer 2nd., W. A., Schibler, M., Jacobs, M., Bausch, D. G., & Kaiser, L. (2016). Ebola virus shedding and transmission: Review of current evidence. Journal of Infectious Diseases, 214(suppl 3), S177–S184. Retrieved February 20, 2018, from https://academic.oup.com/jid/article/214/suppl_3/S177/2388183.CrossRefGoogle Scholar
- Villar, J., Say, L., Gulmezoglu, A. M., Meraldi, M., Lindheimer, M. D., Betran, A. P., et al. (2003). Eclampsia and pre-eclampsia: A health problem for 2000 years. In H. Critchly, A. MacLean, L. Poston, & J. Walker (Eds.), Pre-eclampsia (pp. 189–207). London: RCOG Press.Google Scholar
- Von Drehle, D. (2014). The Ebola fighters. Time Magazine. Retrieved January 19, 2018, from http://time.com/time-person-of-the-year-ebola-fighters/.
- Wong, G., Qiu, X., Bi, Y., Formenty, P., Sprecher, A., Jacobs, M., et al. (2016). More challenges from Ebola: Infection of the central nervous system. Journal of infectious Diseases, 214(suppl 3), S294–S296. Retrieved February 21, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050477/.CrossRefGoogle Scholar
- World Health Organization. (2016). Clinical care for survivors of Ebola virus disease: Interim guidance. Geneva: World Health Organization. Retrieved January 19, 2018, from http://apps.who.int/iris/bitstream/10665/204235/1/WHO_EVD_OHE_PED_16.1_eng.pdf.Google Scholar