WHO recommends monoclonal antibodies for the treatment of Ebola virus infection
The World Health Organization (WHO) has published its first guideline on the use of therapeutics for Ebola virus infection. The new guideline complements its existing optimised supportive care guidance.
The monoclonal antibodies atoltivimab/maftivimab/odesivimab (also known as REGN-EB3) or ansuvimab (also known as mAb114) are strongly recommended for patients with confirmed Zaire ebolavirus infection, and neonates ≤7 days of age with unconfirmed infection who are born to mothers with confirmed Zaire ebolavirus infection. The recommendation is based on moderate-certainty evidence that these agents probably reduce mortality compared with standard of care.
The therapeutics may be used in older people, pregnant and breastfeeding women, and children and newborns, and should be administered as soon as possible after diagnosis as a single dose intravenous infusion.
Ebola virus infection is a severe, often fatal, illness. However, advances in supportive care and therapeutics have revolutionised treatment over the past decade.
Initial stages of Ebola virus infection are non-specific, which makes the differential diagnosis broad; therefore, clinical suspicion of the infection with prompt isolation is very important in the context of a history of exposure.
Management is centred around early recognition of infection, coupled with effective isolation and optimised supportive care in a hospital setting.
Case fatality rates range from 25% to 90%, but the average rate was approximately 50% in the 2014 outbreak in West Africa (the largest outbreak to date), and 66% in the 2018-2020 outbreak in the Democratic Republic of the Congo (the second largest outbreak to date). Survivors often have prolonged ill health with significant disability.
As there is the possibility of infected people travelling, all countries should have tested and practised protocols ready for screening and managing patients.
Vaccines are available to protect against infection and help control the spread of outbreaks.
A severe, often fatal, zoonotic infection caused by infection by a virus of the Filoviridae family (genus Ebolavirus). There are currently six known species: Zaire ebolavirus, Sudan ebolavirus, Tai Forest ebolavirus, Bundibugyo ebolavirus, Reston ebolavirus, and Bombali ebolavirus. Of these, only four are known to cause disease in humans - Zaire, Sudan, Tai Forest, and Bundibugyo ebolavirus. Ebola virus infection is part of the group of conditions known as viral haemorrhagic fevers, and was formerly known as Ebola haemorrhagic fever.
History and exam
- serum electrolyte levels
- serum creatinine and urea
- blood lactate
- coagulation studies
- serum amylase level
- serum blood glucose
- blood cultures
- antigen-capture enzyme-linked immunosorbent assay (ELISA)
- IgM and IgG antibodies
- chest x-ray
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