A research, the first of its kind, published in the British Medical Journal (BMJ) on April 14th, 2016, states that after studying the active follow-up of patients discharged from the Kerry Town Ebola Treatment Center, four of those patients were found dead. The deaths, due to Ebola, took place within six weeks, with two due to late complications, one due to prior tuberculosis and one after full recovery.

In a follow-up study, 151 Ebola virus survivors with negative blood tests were examined over a period of ten months to examine the frequency of fatal occurrence.

The patients who died included a 25-year-old woman who ‘felt fine’ two days after her discharge but then fell ill and started experiencing abdominal swelling, diarrhea, swelling of the legs and face, and looked pale and jaundiced. Her family also reported her being unable to walk and only being able to crawl at the time of discharge. A postmortem swab by the burial team found the results to be negative for Ebola virus.

The second patient was a 32-year-old woman who died one day after discharge. She, too, like the first patient, was unable to walk and had a severe headache and couldn’t talk or use her limbs. Her blood platelet count was normal. However she did have high blood pressure. She, too, had a negative result for Ebola virus after the postmortem swab.

The third patient was a 17-year-old boy who died five weeks after discharge. One week before his death, he was unable to swallow solids and had pain and difficulty while doing so.

The last patient was a six-year-old boy who died one week after discharge but had trouble breathing and was found to be coughing, and suffering from fluctuating pyrexia. Antibiotics were making no difference to his condition and after close inspection, although the duration was short, the possibility of tuberculosis emerged. He eventually died in his sleep. A postmortem swab again revealed negative results for Ebola virus.

To estimate the level of exposure to Ebola, household members were asked, in their own words, to describe how they felt to get a clearer picture and a better idea of what exactly happened when the Ebola virus struck. Questions were asked concerning patient symptoms, who was taking care of them, who was helping them with various activities and tasks, what their living conditions were and who they were sharing beds with, along with other details.

Maximum contact level was also examined for each household member, along with certain exposure guidelines and definitions. These included direct touching or coming into contact with the body of the person who had died from Ebola, as well as the body fluids emanated from a patient through diarrhea, vomiting or bleeding. Direct contact with wet symptoms was also taken into account such as sharing beds, providing care, embracing and carrying the patients. Washing the patient’s clothes and sharing meals were also factored in.

Out of the 151 participants included in the study, eight were residing outside the Western area. One of the survivors did not want to be a part of the study while 16 were unavailable and could not be contacted. Thus, the final assessment was carried out on 123 patients.

For assessment, two survivors of the Ebola virus were consulted to develop questionnaires and were involved in the process of interpretation and results. Postmortem results indicated borderline positive results for Ebola.

A high case fatality rate was found in the youngest and oldest age groups, resulting in a U-shaped pattern of death. Further analysis of other variables revealed that there was no association with household level socio-economic factors, apart from the number of people present in the household. What this points out is that although socio-economic status has been linked with developing Ebola virus, once an individual is ill, socio-economic factors have little or no role to play as far as mortality is concerned.

As all households whose members suffered and eventually died from Ebola were not included, the sample could be under-represented. However, at the same time, a large household would bring with it its own set of problems and complications such as being unable to take care of the affected member.

This is the first study involving active follow-ups of deaths from Ebola. The study was set to investigate the risk factors of death from the disease. Though there was no consistent trend found with the case fatality rate, the extent of exposure to bodily fluids had a strong correlation with the risk of developing Ebola.

Permission to carry out the study was granted by the Sierra Lone Ethics and Scientific Review Committee and the Ethics Committee of the London School of Hygiene and Tropical Medicine’s data repository. The study was funded by Save the Children and the Wellcome Trust’s Enhancing Research Activity in Epidemic Situations program.