Recurrence and reinfection—a new paradigm for the management of Ebola virus disease

• Ebola virus may persist in various body fluids, resulting in the reactivation of illness.
• Reinfection with Ebola virus may be possible due to waning or lowered immunity or high viral challenge.
• With over 17 000 survivors in West Africa, precautions should be taken to minimize the risk of new cases and outbreaks.
• Surveillance systems in high-risk countries should be capable of rapid detection and control of new outbreaks.

SummaryEbola virus disease (EVD) is an understudied infection and many aspects of viral transmission and clinical course remain unclear. With over 17 000 EVD survivors in West Africa, the World Health Organization has focused its strategy on managing survivors and the risk of re-emergence of outbreaks posed by persistence of the virus during convalescence. Sexual transmission from survivors has also been documented following the 2014 epidemic and there are documented cases of survivors readmitted to hospital with ‘recurrence’ of EVD symptoms. In addition to persistence of virus in survivors, there is also some evidence for ‘reinfection’ with Ebola virus. In this paper, the evidence for recurrence and reinfection of EVD and implications for epidemic control are reviewed.