Alpren Persistence Transcript

ALPREN: The main projects I've been involved in, the main theme of my work over the last year, has been semen. [laughter] Because Ebola was found to persist in bodily fluids, particularly immune privileged sites--the sites that don't get much blood supply, much immune cell supply--for far longer than we initially thought when the outbreak started. When I was discharging men from ETC in Aspen, we would say to them, "Look, Ebola has been found in semen for longer than other bodily fluids, and we think probably about three months, so you should use condoms." That's the kind of advice, that was the basic advice. I could have probably put it in a slightly more articulate, official way, but that's kind of how it was said. It quickly became evident that it was potentially present for a lot longer than three months, but probably the chances of actually causing sexual transmission were low. That's really where we're at now. We've had examples of sexual transmission from survivors well over a year, well over fourteen, fifteen months from the time of their infection, but they are very isolated cases and very rare. However, when you've got three, four thousand, however many survivors we've got in Sierra Leone, forty-odd percent of whom are men, most of them are men of sexually active age. They all need testing, they all need counseling, they all need to change their behavior because you don't know which one person--we don't know for sure if having cleared Ebola RNA [ribonucleic acid] from your semen, it stays away. We don't really know what negative means, what not detecting Ebola RNA in semen means. One of the things that I say when I'm teaching about Ebola is--I don't know, do you know how many people work in this campus of CDC?

Q: I have no idea. [laughs]

ALPREN: No? I use the example of Melbourne University, where I teach, where there are about forty thousand undergraduate students. It's a big--it's a big--

Q: We have a large college campus next door with Emory [University], too.

ALPREN: Exactly. So a big university campus, a few tens of thousands of people. Probably most of them, if not all of them--not all of them, ninety-odd percent have had chicken pox, a very common infectious disease. But everyone kind of knows it. We know a lot about chicken pox, but there's stuff we don't know, and there's problems we have with it still. We can't treat it very well. Shingles comes along. Sorry, this is a bit of a longwinded explanation. However, before this Ebola outbreak, there had been just over two thousand recorded cases of Ebola ever. And there have now been less than thirty thousand cases of Ebola recorded. So less Ebola than there has been chicken pox at Melbourne Uni now. We know nothing about this condition. Our level of understanding is low, but accelerating very fast. And that's been reflected in--so many times, the uncertainty about the counseling, even that the politicians or the public health people should be giving the politicians early in the outbreak, and the confusion that happened, not just in West Africa but also in America, in Australia, in Europe, when there were cases. I do think we've learned a lot about communicating uncertainty. That's one thing I do think we've learned a lot about. The speed at which the information is changing, we've gone from saying to male survivors, three months, to six months, to a year, to [shrugs]. [laughs] To a year? Well, there's no RNA in your semen, and that sounds great. Keep in touch. We're not totally sure what that means, but you've had a couple of negative tests, so whoopee. Which is kind of where we're at, at the moment.