Screening for Eye Disease in Ebola Virus Disease Survivors: Program Implementation During an Active Outbreak in the North Kivu and Ituri Provinces, Democratic Republic of the Congo

Abstract

First identified in the Democratic Republic of the Congo (DRC, formerly Zaire) in 1976, Ebola virus disease (EVD) outbreaks have afflicted thousands of Congolese over the past several decades. The nation's largest outbreak of EVD in 2018-2020 was complicated by security challenges as well as large case numbers across an expansive geographic region. These factors provided challenges for logistical considerations as well as clinical coverage. In conjunction with the EVD survivor care program spearheaded by the Ministry of Health in DRC, the DRC Intitut National de Recherche Biomédicale, (DRC Institut National de Recherche Biomedicale, DRC National Institute of Biomedical Research) and others, we launched a multidimensional effort to provide ophthalmic care to EVD survivors. During the engagement period, 237 EVD survivors were screened, 56% of which were women. The 237 EVD survivors constituted ∼75% of the total EVD survivors who were discharged at the time of the intervention. The mean time from EVD symptom onset to evaluation was 4.6 months ± 1.8 SD (range: 24 d to 8.5 mo). Ninety-seven (41%) of EVD survivors screened reported ocular symptoms during or after acute illness, such as itchy eyes (49%), eye pain (25%), and tears (24%). Ophthalmic findings, including retinal scarring, active uveitis, dry eye disease, cataracts, and glaucoma, were also identified. The need for continued monitoring and longitudinal care for EVD survivors is evident from the expanding body of literature pertaining to post-acute sequelae, including ophthalmic manifestations. Initiatives for such care should be conducted across and in conjunction with multidisciplinary stakeholders for contextualization and effectiveness.