Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease

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.)

Mbala-Kingebeni, Placide, Catherine Pratt, Mbusa Mutafali-Ruffin, Matthias G. Pauthner, Faustin Bile, Antoine Nkuba-Ndaye, Allison Black, Eddy Kinganda-Lusamaki, Martin Faye, Amuri Aziza, Moussa M. Diagne, Daniel Mukadi, Bailey White, James Hadfield, Karthik Gangavarapu, Nella Bisento, Donatien Kazadi, Bibiche Nsunda, Marceline Akonga, Olivier Tshiani, John Misasi, Aurelie Ploquin, Victor Epaso, Emilia Sana-Paka, Yannick Tutu Tshia N’kasar, Fabrice Mambu, Francois Edidi, Meris Matondo, Junior Bula Bula, Boubacar Diallo, Mory Keita, Marie R. D. Belizaire, Ibrahima S. Fall, Abdoulaye Yam, Sabue Mulangu, Anne W. Rimion, Elias Salfati, Ali Torkamani, Marc A. Suchard, Ian Crozier, Lisa Hensley, Andrew Rambaut, Ousmane Faye, Amadou Sall, Nancy J. Sullivan, Trevor Bedford, Kristian G. Andersen, Michael R. Wiley, Steve Ahuka-Mundeke, and Jean-Jacques Muyembe Tamfum. 2021. "Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease." New England Journal of Medicine 384 (13):1240-7.

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.)

Free access online on NEJM (Copyright © 2021, Massachusetts Medical Society); author manuscript CC-BY on PubMed.