Scientists discovered the woman had cared for her brother in July 2014, who died after suffering Ebola-like symptoms but before being tested for the disease. The woman later experienced a similar illness, but never sought care.
Several weeks after giving birth to a baby in September 2015, the woman developed problems including fatigue and breathing difficulties. Doctors say that because pregnancy lowers the body’s immune defenses, that may have allowed for the Ebola virus to re-emerge.
“The suspicious illness she had following delivery may have been a re-activation of Ebola, but we have no confirmatory tests,” said Dr. Emily Kainne Dokubo, who led the Ebola response in Liberia for the U.S. Centers for Disease Control and Prevention, and the study’s lead author.
Dokubo said it was possible the woman infected her husband and two older sons with Ebola when they took care of her — the disease is normally spread through contact with an infected patient’s blood or other bodily fluids. The case report was published online Monday in the journal Lancet Infectious Diseases.
“There isn’t complete evidence to reconstruct what happened, but this is the most likely scenario,” said Lorenzo Subissi, an epidemiologist at Sciensano, a Belgian research institute, who was not part of the study.
Dokubo said such cases of Ebola re-emergence are exceptional, with only two reported instances: a Scots nurse who developed meningitis caused by Ebola hidden in her brain and an American physician who had lingering virus in his eye. In those two cases, the virus did not spread any further.
“We don’t want there to be a sense of complacency with people thinking that just because the outbreak is over, there’s nothing more to be done,” Dokubo said. “There is a risk of viral persistence and people should seek care immediately so that we can pick up any suspicious cases right away and stop a larger outbreak.”