Caring for Ebola Disease Survivors in the United States

For Health Care Providers

Key points

  • Orthoebolaviruses can persist for several months after acute infection in specific sites where the virus is shielded from the body's immune system.
  • The risk of healthcare personnel acquiring Ebola disease from patients with persistent infection appears to be low and is likely to decrease over time.
  • Healthcare personnel should not withhold care from Ebola disease survivors.
  • Enhanced infection control practices might be needed when performing specific procedures that could expose healthcare personnel to certain body fluids and tissues.

Data background

Most available data on Ebola disease comes from people infected with Ebola virus (species Orthoebolavirus zairense). Three other orthoebolaviruses are known to cause disease in humans: Bundibugyo virus, Sudan virus, and Taï Forest virus. We expect data gathered from people with Ebola virus to be applicable to these other orthoebolaviruses.

A healthcare provider examines a male Ebola survivor who is sitting on a hospital bed.
A healthcare provider examines an Ebola disease survivor in Uganda, 2000.

Orthoebolavirus persistence

After acute infection, orthoebolaviruses can persist for several months in sites where the virus is shielded from the immune system. These "immunologically privileged sites" include the testes, interior of the eyes, placenta, and central nervous system (CNS). People who recover from orthoebolavirus infection can experience complications after acute disease.1The timing of onset, severity, and duration of complications are variable and can include:

  • Joint pain
  • Headaches
  • Muscle aches
  • Memory loss
  • Vision loss (including uveitis and permanent blindness)
  • Non-specific fatigue
  • Paresthesia or dysesthesia
  • Hearing loss or tinnitus
  • Insomnia
  • Depression
  • Anxiety or post-traumatic stress disorder
  • Sexual dysfunction
  • Hair loss
  • Orchitis
  • Pericarditis
  • Suppurative parotitis

Ebola disease might recur in some people who recover from the illness. The phenomenon is not fully understood as there are limited reported instances of viral relapse. Relapse might be due to persistence of the virus in the brain after clinical recovery.2

Risk of virus transmission due to persistent virus infection

The risk of a healthcare provider acquiring Ebola disease from patients with persistent infection in an immunologically privileged site is unknown but appears to be low and is expected to decrease with time after recovery. Nevertheless, when caring for a patient who has recovered from Ebola disease, healthcare providers should maintain appropriate infection prevention and control (IPC) measures when exposure to potentially infectious body fluids or tissues is possible.

Neurologic illness or ocular symptoms in a person who recovered from acute disease could indicate persistent orthoebolavirus replication in the central nervous system or eye, respectively. Patients who recovered from an orthoebolavirus infection and show new or recurrent neurologic or ocular symptoms should be assessed for complications associated with potential virus persistence.

People who have recovered from acute Ebola disease and are experiencing a new fever should be assessed for common community-acquired infections (e.g., malaria, influenza, common cold, typhoid fever, gastroenteritis), as well as relapse of infection. If the clinical presentation suggests relapse of infection in an Ebola disease survivor, healthcare personnel should use appropriate infection control practices recommended for caring for patients with viral hemorrhagic fevers until relapse is ruled out.

Table 1. Ebola virus persistence in different clinical specimens, available data to date (August 2026).
Anatomic compartment Body fluid(s) or tissue(s) Latest reported time point at which Ebola virus RNA, antigen, or infectious virus was detected in clinical specimens*
Detected Ebola virus RNA or antigen Isolated infectious Ebola virus
Eye Aqueous humor 14 weeks after illness onset by RT-PCR 3 14 weeks after illness onset by virus isolation 3
Conjunctival swab 22 days after illness onset by RT-PCR 4 No published data
Central nervous system Cerebrospinal fluid 10 months after illness onset by RT-PCR 5 No published data
Testes Seminal fluid 40 months after illness onset by RT-PCR 6 82 days after illness onset by virus isolation 4
Breast Breast milk 16 months (500 days) after discharge from treatment center by RT-PCR 7 15 days after illness onset by virus isolation 8
Urinary tract Urine 64 days after illness onset by RT-PCR 9 26 days by virus isolation 10
Genito-urinary tract Vagina 36 days after illness onset by RT-PCR 11 No published data
Joints Synovial fluid Unknown
Gastrointestinal tract Rectal swab 29 days after illness onset by RT-PCR 4 No published data
Saliva 8 days after illness onset by RT-PCR 8 4-8 days after illness onset by virus culture 8
Vomit No published data No published data
Feces 12 days after illness onset by RT-PCR 8 No published data
Lower respiratory tract N/A Viral antigens detected in alveolar macrophages; viral inclusions observed in intra-alveolar macrophages, with free virus particles within alveolar spaces in fatal cases 12 No published data
Other Sweat (underarm) 44 days after illness onset by RT-PCR 9  No published data
Skin (on the hand) 6 days after illness onset by RT-PCR 8 No published data
Amniotic fluid At least 32 days after disappearance of virus from maternal blood by RT-PCR 13 No published data
Placenta 68 days after illness onset by RT-PCR 14 No published data
Cord blood >32 days after disappearance of virus from maternal blood by RT-PCR 13 No published data
Nasal blood 10 days after illness onset by RT-PCR 8 No published data

*Detection of Ebola virus RNA or antigen indicates that viral genetic material or proteins are present in a specimen but does not necessarily indicate the presence of viable, infectious virus. Recovery of infectious Ebola virus in laboratory culture confirms that replication-competent virus was present in the specimen at the time of collection, suggesting potential for virus transmission.

Clinical assessment of Ebola disease survivors

Healthcare personnel should not withhold care when seeing a patient who has recovered from an orthoebolavirus infection. Use standard precautions and routine waste management practices when caring for a patient who has fully recovered from Ebola disease and is seeking medical care but does not have symptoms of a potential relapse and an immunologically privileged site is not being accessed. There is no current evidence that routine clinical care poses risk to healthcare personnel when contact with intact skin, sweat, tears, conjunctivae, saliva, or cerumen is involved.

There is no evidence that women who become pregnant after they recover from Ebola disease pose special risk to healthcare providers. They should receive routine prenatal care; standard precautions and routine waste management practices should be used during all patient care activities, including labor and delivery.

The absence of neurologic symptoms suggests that the virus is not present in the CNS, and regional anesthesia, like spinal blocks and epidurals, should not pose a risk to hospital staff. Standard precautions and routine waste management practices should be followed. Available evidence indicates that people do not manifest orthoebolavirus viremia when they have fully recovered and are not febrile, and they do not pose a risk of exposure through phlebotomy.

Special considerations for immunologically privileged sites

Special considerations are recommended when healthcare personnel perform specific procedures that could expose them to certain body fluids and tissues of people who have recovered from acute disease. These procedures include

  • Obtaining and handling cerebral spinal fluid from patients with CNS symptoms
  • Performing invasive ophthalmologic procedure on an affected eye in a patient with ocular disease (e.g., uveitis or cataract)
  • Procedures involving potential exposure to semen or the testes, prostate gland, or seminal vesicles

For these and other patient care activities that might involve contact with certain body fluids and tissues, healthcare facilities and clinicians should:

  • Arrange expert consultation in advance or on an urgent basis as needed with the state/local health department and/or CDC.
  • Assess capabilities of the facility and the ability to correctly implement recommended infection prevention and control practices, including appropriate cleaning and disinfection of environmental surfaces and handling of waste that might be contaminated with an orthoebolavirus.
  • Assess readiness, training, and competence of all staff potentially involved in patient care, including diagnostic laboratory and imaging personnel, environmental services staff, and healthcare providers, and their willingness to participate knowing the possibility of virus persistence
  • Determine appropriate personal protective equipment (PPE) based on potential exposure risk during the procedure(s) and related patient care, and ensure training on PPE use. Care delivery can be arranged either at the original facility or, at the discretion of jurisdictional public health authorities and in consultation with CDC, at an appropriate referral facility.
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National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
About This Page
Published: March 12, 2025
Updated: September 11, 2026

This page was last updated on this date. Updates may include minor edits, image changes, or other modifications to page content.

Reviewed: September 11, 2026

The information on this page was last reviewed by subject matter experts to ensure accuracy.

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