Persistent symptoms common after Ebola and chikungunya across Africa, review finds

Survivors of Ebola virus disease and chikungunya across Africa frequently experience persistent symptoms lasting weeks to years after their acute infection, according to a systematic review published in BMC Infectious Diseases. The review examined post-acute infection syndromes following non-COVID infections, a family of conditions that has gained global attention through long COVID. Although many pathogens most closely linked to these syndromes are endemic to Africa, evidence from the continent has remained scarce. The peer-reviewed article is being shared early to provide faster access and will be replaced by the final Version of Record.

Researchers searched Medline, Embase and grey literature up to 7 November 2025 for studies conducted in Africa that reported symptoms four or more weeks after acute infection. Case reports, case series, conference abstracts, secondary research, comments and correspondence were excluded. Two reviewers independently screened the records and extracted data on study characteristics, symptom prevalence, clinical presentation and associated factors. Because substantial heterogeneity was observed across the included studies, the findings were summarised descriptively rather than pooled statistically, and the review was registered on the Open Science Framework.

Of 1,368 records, 65 studies were included, most carrying a moderate to low risk of bias. Forty-two studies examined Ebola virus disease and 19 examined chikungunya. The authors describe the evidence base as scarce, heterogeneous and geographically concentrated, and note that many pathogens most closely linked to post-acute infection syndromes are endemic to Africa, a gap they frame as having implications for both health equity and global health security.

Prevalence estimates varied widely. Between 17.5 percent and 98.6 percent of Ebola survivors reported persistent symptoms, while the range after chikungunya stretched from 12.1 percent to 78.6 percent. The authors refrained from combining these estimates into a single headline prevalence, summarising the results descriptively in view of the substantial heterogeneity across studies. Despite the spread of figures, the reported prevalence of persistent symptoms among survivors was high.

The clinical picture differed between the two diseases. After Ebola, musculoskeletal pain, ocular complications, headache and fatigue predominated. After chikungunya, arthralgia was the hallmark of post-chikungunya disease. Across the included studies, a substantial symptom burden persisted years after the acute infection.

Across studies, three factors emerged most frequently as being associated with persistent sequelae: female sex, older age and greater severity of the acute illness. The review reports these as the factors most frequently associated with persistent sequelae in the included studies, not as proven causes of persistent illness.

An exploratory, non-systematic supplementary search additionally identified sex-specific consequences among female survivors, including menstrual irregularities and adverse pregnancy outcomes. Because this supplementary component was not conducted systematically, the authors present it as a signal for future targeted research rather than a firm estimate of how commonly these reproductive health complications occur.

The review also highlights a fundamental interpretive limitation: most included studies lacked comparison groups. The authors caution that the absence of comparison groups in most studies complicates attribution of the persistent symptoms to the infection itself. The high reported prevalence is therefore best understood as a measure of the documented symptom burden among survivors rather than a definitive causal estimate.

Despite these caveats, the authors argue that the implications for health systems are clear. Health systems in Africa must adapt to provide long-term survivor care, embedding follow-up into existing chronic care platforms. As pathogens endemic to the continent carry pandemic potential and expand geographically, the review concludes that understanding their chronic consequences is both a matter of health equity and an urgent global health security priority.

Subject of Research: Post-acute infection syndromes following Ebola and chikungunya in Africa

Article Title: Beyond long COVID: post-acute infection syndromes across Africa, a systematic review

Article References: Muller, S., Sharma, R., Heldt, K., Isaaka, L., Hanefeld, J., & Agweyu, A. (2026). Beyond long COVID: post-acute infection syndromes across Africa, a systematic review. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14618-3

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14618-3

Keywords: long COVID, post-acute infection syndromes, Ebola virus disease, chikungunya, systematic review, Africa, arthralgia, fatigue, ocular complications, survivor care, global health security, Beyond