Long-term Sequelae in Ebola Virus Disease Survivors Receiving Anti-Ebola Virus Therapies in the Democratic Republic of the Congo: A Prospective Cohort Study - Report - MDSpire

Long-term Sequelae in Ebola Virus Disease Survivors Receiving Anti-Ebola Virus Therapies in the Democratic Republic of the Congo: A Prospective Cohort Study

  • By

  • Angèle Dilu-Keti

  • Tamara Tovar-Sanchez

  • Benjamin Cuer

  • Antoine Nkuba-Ndaye

  • Daniel Mukadi-Bamuleka

  • Eric Panzi-Kalunda

  • Richard Kitenge-Omasumbu

  • Junior Bulabula-Penge

  • Fabrice Mambu-Mbika

  • Placide Mbala-Kingebeni

  • Ahidjo Ayouba

  • Jean-Jacques Muyembe-Tamfum

  • Jean-François Etard

  • Faustin Chenge

  • Eric Delaporte

  • Steve Ahuka-Mundeke

  • for the ‘Les Vainqueurs d’Ebola’ study group

  • Steve Ahuka-Mundeke

  • Ahidjo Ayouba

  • Nella Bisento-Ngafa

  • Julie Boullin

  • Junior Bulabula-Penge

  • Bernice Danga-Yema

  • Eric Delaporte

  • Angèle Dilu Keti

  • François Edidi-Atani

  • Grâce Ekoko

  • Benjamin Hamzé

  • Grâce Hangi

  • Gabriel Kambaba Lungeni

  • Neema Kahindo Barumawaki

  • Fey Kahonga

  • John Kakule Muzombo

  • Callixte Kakule-Sadiki

  • Guillaume Kambale-Kasyamboko

  • Vianey Kambale Kombi

  • Nelson Kambale-Sivihwa

  • Philemon Kambale Tsongo

  • Sahani Kanyere Lwanzo

  • Victoire Katembo Thasi

  • Suzanne Kavira Muhasa

  • Sheila Kavira-Muhesi

  • Eli Kavoyo-Mbayayi

  • Eddy Kinganda-Lusamaki

  • Richard Kitenge Omasumbu

  • Divine Kitsa-Mutsumbirwa

  • Rebecca Kyakimwa Vahaviraki

  • Audrey Lacroix

  • Achilla Luwawu Sadila

  • Robert Makasi Menge

  • Fabrice Mambu-Mbika

  • Rachel Masika Kihigo

  • Immaculée Matimbiya Vihanba

  • Meris Matondo-Kuamfumu

  • Placide Mbala Kingebeni

  • Fyfy Mbelu Matulu

  • Daniel Mukadi-Bamuleka

  • Noella Mulopo-Mukanya

  • Elia Mumbere-Kalemekwa

  • Serge Mumbere Kavalami

  • Jacques Mumbere Mutegana

  • Skoda Mumbere Muyisa

  • Fiz Mussa Bahizi

  • Jean-Jacques Muyembe-Tamfum

  • Antoine Nkuba-Ndaye

  • César Omeonga Kelenda

  • Jeannot Paluku Nzira

  • Defao Paluku-Salambongo

  • Eric Panzi-Kalunda

  • Martine Peeters

  • Raphaël Pelloquin

  • Guillaume Thaurignac

  • Tamara Tovar-Sanchez

  • July 31, 2025

  • 0 min

Share

Long-Term Outcomes in Ebola Survivors Treated with Anti-Ebola Therapies in DRC

Overview

This prospective cohort study of 750 Ebola survivors from the 2018–2020 Democratic Republic of the Congo outbreak reveals a high prevalence (86.7%) of post-Ebola sequelae persisting up to 38 months postdischarge. Neurologic sequelae were notably more frequent in survivors treated with REGN-EB3, while musculoskeletal sequelae were associated with ZMapp treatment, older age, and hemorrhagic symptoms.

Background

Ebola virus disease (EVD) is a severe viral illness with high fatality rates, particularly in the Democratic Republic of the Congo (DRC), which has experienced multiple outbreaks. The 2018–2020 outbreak was the largest in the DRC and the first to involve urban centers and conflict zones, complicating response efforts. Advanced therapeutics including monoclonal antibodies (REGN-EB3, ansuvimab, ZMapp) and remdesivir were used for the first time in this outbreak, improving survival rates. Despite viral clearance, survivors frequently experience long-term sequelae such as neurologic, musculoskeletal, and ocular complications, but data on the impact of specific therapies on these outcomes have been limited.

Data Highlights

ParameterValue
Number of survivors enrolled750
Median age32 years
Female survivors56.7%
Survivors with any sequelae650 (86.7%)
Neurologic sequelae463 (61.7%)
Musculoskeletal sequelae373 (49.7%)
General sequelae288 (38.4%)
Median time to baseline visit330 days postdischarge
Hazard ratio for neurologic sequelae (REGN-EB3 vs remdesivir)2.14 (95% CI, 1.28–3.57)
Hazard ratio for musculoskeletal sequelae (ZMapp treatment)3.17 (95% CI, 1.81–5.56)
Hazard ratio for musculoskeletal sequelae (age)1.02 (95% CI, 1.00–1.03)
Hazard ratio for musculoskeletal sequelae (acute hemorrhagic symptoms)1.64 (95% CI, 1.14–2.36)
Hazard ratio for ocular sequelae (age)1.04 (95% CI, 1.02–1.06)

Key Findings

  • 86.7% of Ebola survivors experienced post-Ebola sequelae lasting up to 38 months postdischarge.
  • Neurologic sequelae were significantly more frequent in survivors treated with REGN-EB3 compared to remdesivir (HR 2.14).
  • Musculoskeletal sequelae were associated with older age, ZMapp treatment (HR 3.17), and presence of acute-phase hemorrhagic symptoms (HR 1.64).
  • Ocular sequelae incidence increased with age (HR 1.04) and were more frequent in adults.
  • Female sex, older age, metabolic comorbidities, and REGN-EB3 therapy were linked to recurrent neurologic and musculoskeletal sequelae.
  • Despite improved survival with monoclonal antibodies, long-term sequelae remain common and vary by treatment type and patient characteristics.

Clinical Implications

Clinicians should anticipate and monitor for persistent neurologic, musculoskeletal, and ocular sequelae in Ebola survivors, especially those treated with REGN-EB3 and ZMapp. Older patients, females, and those with metabolic comorbidities warrant closer follow-up due to higher risk of recurrent symptoms. Tailored long-term care strategies are essential to manage these sequelae effectively and improve quality of life in survivors.

Conclusion

This large prospective cohort study highlights the high burden of long-term sequelae among Ebola survivors treated with advanced therapeutics in the DRC. Understanding therapy-specific and patient-related risk factors can guide targeted post-Ebola care to address persistent complications.

References

  1. PALM RCT/DRC Ministry of Health/2020 -- Therapeutics for Ebola Virus Disease
  2. FDA/2020 -- Approval of Ebanga and Inmazeb for Ebola Treatment
  3. Les Vainqueurs d’Ebola Study/2023 -- Long-Term Sequelae in Ebola Survivors Receiving Anti-Ebola Therapies

Original Source(s)

Long-term Sequelae in Ebola Virus Disease Survivors Receiving Anti-Ebola Virus Therapies in the Democratic Republic of the Congo: A Prospective Cohort Study

  • by Angèle Dilu-Keti, Tamara Tovar-Sanchez, Benjamin Cuer, Antoine Nkuba-Ndaye, Daniel Mukadi-Bamuleka, Eric Panzi-Kalunda, Richard Kitenge-Omasumbu, Junior Bulabula-Penge, Fabrice Mambu-Mbika, Placide Mbala-Kingebeni, Ahidjo Ayouba, Jean-Jacques Muyembe-Tamfum, Jean-François Etard, Faustin Chenge, Eric Delaporte, Steve Ahuka-Mundeke, for the ‘Les Vainqueurs d’Ebola’ study group, Steve Ahuka-Mundeke, Ahidjo Ayouba, Nella Bisento-Ngafa, Julie Boullin, Junior Bulabula-Penge, Bernice Danga-Yema, Eric Delaporte, Angèle Dilu Keti, François Edidi-Atani, Grâce Ekoko, Benjamin Hamzé, Grâce Hangi, Gabriel Kambaba Lungeni, Neema Kahindo Barumawaki, Fey Kahonga, John Kakule Muzombo, Callixte Kakule-Sadiki, Guillaume Kambale-Kasyamboko, Vianey Kambale Kombi, Nelson Kambale-Sivihwa, Philemon Kambale Tsongo, Sahani Kanyere Lwanzo, Victoire Katembo Thasi, Suzanne Kavira Muhasa, Sheila Kavira-Muhesi, Eli Kavoyo-Mbayayi, Eddy Kinganda-Lusamaki, Richard Kitenge Omasumbu, Divine Kitsa-Mutsumbirwa, Rebecca Kyakimwa Vahaviraki, Audrey Lacroix, Achilla Luwawu Sadila, Robert Makasi Menge, Fabrice Mambu-Mbika, Rachel Masika Kihigo, Immaculée Matimbiya Vihanba, Meris Matondo-Kuamfumu, Placide Mbala Kingebeni, Fyfy Mbelu Matulu, Daniel Mukadi-Bamuleka, Noella Mulopo-Mukanya, Elia Mumbere-Kalemekwa, Serge Mumbere Kavalami, Jacques Mumbere Mutegana, Skoda Mumbere Muyisa, Fiz Mussa Bahizi, Jean-Jacques Muyembe-Tamfum, Antoine Nkuba-Ndaye, César Omeonga Kelenda, Jeannot Paluku Nzira, Defao Paluku-Salambongo, Eric Panzi-Kalunda, Martine Peeters, Raphaël Pelloquin, Guillaume Thaurignac, Tamara Tovar-Sanchez

  • July 31, 2025

Related Content

The Ebola outbreak will lead to devastating violence against women and girls

Ebola at the World Cup? Here’s what we should actually worry about

Ethiopia investigates possible outbreak of new viral hemorrhagic fever after 8 people are infected

  • November 13, 2025