Internal medicine

Virus

Disease

Biology

Virology

Ebola virus

Ebolavirus

Computer science

Medicine

Transmission (telecommunications)

Telecommunications

New England Journal of Medicine

During the 2018-2020 Ebola virus disease (EVD) outbreak in North Kivu province in the Democratic Republic of Congo, EVD was diagnosed in a patient who had received the recombinant vesicular stomatitis virus-based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) (Merck).His treatment included an Ebola virus (EBOV)-specific monoclonal antibody (mAb114), and he recovered within 14 days.However, 6 months later, he presented again with severe EVD-like illness and EBOV viremia, and he died.We initiated epidemiologic and genomic investigations that showed that the patient had had a relapse of acute EVD that led to a transmission chain resulting in 91 cases across six health zones over 4 months.(Funded by the Bill and Melinda Gates Foundation and others.)H uman-to-human transmission of Ebola virus (EBOV) typically occurs through direct contact with infectious blood or bodily fluids (e.g., semen or breast milk). 1 EBOV persistence has been well documented in survivors of Ebola virus disease (EVD).Although secondary transmission through contact with infectious bodily fluids is relatively rare, it has been linked to flare-up events. 2 In two survivors of EVD, meningoencephalitis and uveitis syndromes have been associated with infectious EBOV in cerebrospinal fluid and aqueous humor, respectively; neither case led to further transmission. 3,4Here, we report the relapse of acute EVD in a patient who was infected with the EBOV Ituri variant during the 2018-2020 North Kivu EVD outbreak in the Democratic Republic of Congo (DRC). 5he relapse, which occurred 149 days after the patient was discharged from an Ebola treatment unit, sparked a transmission chain of 91 cases. C a se R eport

Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease