EBOLA survivors experience elevated long-term rates of persistent joint pain and objective musculoskeletal sequelae compared to uninfected controls.
In a long-term cross-sectional investigation evaluating participants from the PREVAIL III natural history cohort in Liberia, investigators identified marked differences in physical recovery between individuals who recovered from acute Ebola virus disease and close, uninfected household contacts. Across an evaluation median of 55 months after parent study enrollment, post-acute physical symptoms occurred at substantially higher frequencies among survivors. A documented history of symptoms differentially endorsed by survivors—comprising joint pain, muscle pain, headache, fatigue, urinary frequency, and memory loss—was present in 90.9% of survivors compared to 69.4% of uninfected contacts. The persistent presentation of joint pain and muscle pain suggests that post-viral inflammatory and rheumatic disturbances persist for multiple years following acute infection.
Beyond subjective discomfort, standardized clinical physical evaluations revealed significant objective musculoskeletal abnormalities among survivors. Clinicians recorded abnormal examination findings—specifically encompassing musculoskeletal findings alongside neurologic, chest, and abdominal abnormalities—in 61.3% of survivors compared to 42.9% of seronegative contacts. In the overall analysis cohort of 1,144 participants, 48.7% demonstrated history of at least one objective examination abnormality, reflecting a pronounced physical burden that distinguishes survivors from community members sharing identical domestic and environmental exposures.
Multivariable analyses within the survivor cohort highlighted that a history of post-acute symptoms was significantly linked to ongoing distress and broader systemic complications. Survivors aged 20 to 39 years demonstrated heightened vulnerability to long-term sequelae, conflicting with typical degenerative joint profiles and indicating a distinct post-viral disease process. The persistence of objective musculoskeletal sequelae years after hospital discharge demonstrates that post-viral articular involvement requires comprehensive rheumatologic surveillance. Healthcare professionals evaluating patients with prior filovirus exposure must integrate targeted joint examinations into longitudinal primary and subspecialty care.
Reference
Badio M et al. Long-term psychosocial sequelae of Ebola virus disease among survivors compared with contacts following the 2013-2016 epidemic in Liberia. PLOS Glob Public Health. 2026;6(1):e0005145.
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