Requestionner les approches de santé publique après Ebola

Anthropologists contributed to the response to the 2014-2016 Ebola outbreak in three ways: as Ebola experts, cultural mediators between populations and caregivers, and researchers. This article presents a preliminary review of approaches, contributions and related issues based on a literature review, case studies and debates. The anthropological research discussed in this article concerns four themes: epidemiological contexts of transmission; cultural interpretation of illness and social responses; social construction of stakeholders' experience; critical analysis of public health interventions. In addition to insightful contributions, particularly regarding the socio-political contexts and their interfaces with global public health measures, anthropologists tested forms of communication to facilitate access of public health actors to their results. However, these heterogeneous forms of engagement raise a number of questions, especially when they reflect anthropological interpretations that exclude any critical or reflexive dimension, or when anthropology is considered to be similar to social intervention. Nevertheless, anthropological research provides a major contribution, which could be even greater if transnational networks set up by researchers to analyse the socio-political, economic and biocultural dimensions of emerging epidemics are supported in order to improve "preparedness" for future health crises

A 40-month follow-up of Ebola virus disease survivors in Guinea (PostEbogui) reveals long-term detection of Ebola viral ribonucleic acid in semen and breast milk

Background. With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illustrated by recent epidemics, a good understanding of the extent of viral persistance or ribonucleic acid (RNA) detection in body fluids from survivors is urgently needed. Methods. Ebola viral RNA shedding was studied with molecular assays in semen (n = 1368), urine (n = 1875), cervicovaginal fluid (n = 549), saliva (n = 900), breast milk (n = 168), and feces (n = 558) from EVD survivors in Guinea (PostEbogui cohort, n = 802) at a regular base period until 40 months after inclusion. Results. Twenty-seven of 277 (9.8%) male survivors tested positive for Ebola RNA in at least 1 semen sample. The probability of remaining positive for Ebola RNA in semen was estimated at 93.02% and 60.12% after 3 and 6 months. Viral RNA in semen was more frequent in patients with eye pain (P = .036), joint pain (P = .047), and higher antibody levels to Ebola virus antigens (nucleoprotein [P = .001], glycoprotein [P = .05], and viral protein-40 [P = .05]). Ebola RNA was only rarely detected in the following body fluids from EVD survivors: saliva (1 of 454), urine (2 of 593), breast milk (2 of 168), cervicovaginal secretions (0 of 273), and feces (0 of 330). Ribonucleic acid was detected in breast milk 1 month after delivery but 500 days after discharge of Ebola treatment unit (ETU) in 1 woman who became pregnant 7 months after discharge from the ETU. Conclusions. The frequency and potential long-term presence of viral RNA in semen confirmed that systematic prevention measures in male survivors are required. Our observation in breast milk suggests that our knowledge on viral reservoir in immune-privileged sites and its impact are still incomplete