# Resilience and residuals beyond containment — The hidden burden of Bundibugyo Ebola virus survivorship sixteen years on: A cross-sectional observational study

## TL;DR

This study finds that survivors of Bundibugyo Ebola virus experience long-term health and psychosocial effects, even 16 years after infection.

## Contribution

The study provides the first long-term data on health outcomes of Bundibugyo Ebola virus survivors.

## Key findings

- Survivors showed persistent neurological and musculoskeletal symptoms like headaches and visual disturbances.
- Elevated basophils and urinary ketones suggest chronic inflammation and metabolic shifts.
- Despite normal vital signs, 57.5% of survivors reported ongoing stigma.

## Abstract

Long-term effects of Ebola disease (EBOD) are well documented for Ebolavirus (EBOV), but limited data exist for Bundibugyo virus disease (BVD) caused by Bundibugyo Ebola virus (BDBV), a genetically distinct strain.

We conducted a cross-sectional observational study involving 40 laboratory-confirmed BVD survivors and 23 age- and sex-matched unexposed community controls to evaluate the long-term clinical, biochemical, immunological, and psychosocial sequelae associated with BDBV infection. Participants underwent comprehensive clinical evaluations, laboratory testing, and standardised mental health assessments. Statistical comparisons used rank-sum, chi-squared, and correlation analyses.

Survivors exhibited persistent multisystem symptoms, with neurological and musculoskeletal complaints most frequent, headaches (35 %) and visual disturbances (22.5 %). Laboratory findings showed elevated basophils (40 %) and urinary ketones (5 %), indicating possible chronic inflammation and metabolic shifts. Respiratory rates were significantly reduced in survivors (p < 0.001), while other vital signs and biochemical markers were largely within normal ranges. Despite high resilience, 70 % with normal anxiety scores and 62.5 % with normal depression scores, 57.5 % reported persistent stigma. Survivors also exhibited unique physiological correlations, suggestive of post-infectious homeostatic changes.

BVD survivors experience long-term multisystem sequelae and physiological remodeling. These findings support the need for virus-specific post-BVD care and sustained follow-up to inform survivor health policy.

•Sixteen years post-infection, Bundibugyo Ebola virus survivors show persistent respiratory and psychosocial symptoms.•Cardiometabolic and thermoregulatory parameters remain largely within normal ranges.•Subtle biochemical changes suggest low-grade inflammation and metabolic stress.•Findings highlight the need for long-term clinical follow-up of filovirus survivors.

Sixteen years post-infection, Bundibugyo Ebola virus survivors show persistent respiratory and psychosocial symptoms.

Cardiometabolic and thermoregulatory parameters remain largely within normal ranges.

Subtle biochemical changes suggest low-grade inflammation and metabolic stress.

Findings highlight the need for long-term clinical follow-up of filovirus survivors.