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Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease

OPEN The New England journal of medicine | 1 Apr 2021

P Mbala-Kingebeni, C Pratt, M Mutafali-Ruffin, MG Pauthner, F Bile, A Nkuba-Ndaye, A Black, E Kinganda-Lusamaki, M Faye, A Aziza, MM Diagne, D Mukadi, B White, J Hadfield, K Gangavarapu, N Bisento, D Kazadi, B Nsunda, M Akonga, O Tshiani, J Misasi, A Ploquin, V Epaso, E Sana-Paka, YTT N'kasar, F Mambu, F Edidi, M Matondo, J Bula Bula, B Diallo, M Keita, MRD Belizaire, IS Fall, A Yam, S Mulangu, AW Rimion, E Salfati, A Torkamani, MA Suchard, I Crozier, L Hensley, A Rambaut, O Faye, A Sall, NJ Sullivan, T Bedford, KG Andersen, MR Wiley, S Ahuka-Mundeke and JJ Muyembe Tamfum
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.).
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