Last reviewed: 24 Aug 2022
Last updated: 16 Sep 2022
16 Sep 2022

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.

See Management: approach

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • exposure to Ebola virus in previous 21 days
  • fever
  • myalgia
  • conjunctival injection

Other diagnostic factors

  • fatigue
  • anorexia
  • diarrhoea
  • vomiting
  • severe headache
  • abdominal pain or heartburn
  • cough, dyspnoea, chest pain
  • sore throat
  • prostration
  • tachypnoea
  • maculopapular rash
  • bleeding
  • hepatomegaly
  • lymphadenopathy
  • hiccups
  • tachycardia
  • hypotension
  • neurological signs

Risk factors

  • living or working in, or arrival from, endemic area in previous 21 days
  • contact with infected body fluids
  • occupational exposure
  • butchering or consumption of meat from infected (or potentially infected) animals
  • bioterrorism

Diagnostic investigations

1st investigations to order

  • reverse transcriptase-polymerase chain reaction (RT-PCR)
  • malaria investigations

Investigations to consider

  • serum electrolyte levels
  • serum creatinine and urea
  • blood lactate
  • ABG
  • FBC
  • coagulation studies
  • urinalysis
  • LFTs
  • serum amylase level
  • serum blood glucose
  • blood cultures
  • antigen-capture enzyme-linked immunosorbent assay (ELISA)
  • IgM and IgG antibodies
  • chest x-ray

Treatment algorithm



Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital

Liverpool School of Tropical Medicine




NJB is partially supported by the National Institute of Health Research Health Protection Unit in Emerging and Zoonotic Infections at the University of Liverpool and Public Health England. Views expressed in this topic are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England. NJB is an author of references cited in this topic.

Manuel Fenech, MD, MRCP, DTM&H

Specialist Trainee in Infectious Diseases

Royal Liverpool University Hospital




MF declares that he has no competing interests.

Tom E. Fletcher, MBE, MBChB, MRCP, DTM&H

Wellcome Trust/MoD Research Fellow

Liverpool School of Tropical Medicine




TEF is an author of a number of references cited in this monograph. TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General and the Wellcome Trust. TEF has received research grants from the Medical Research Council and the UK Public Health Rapid Support Team (UK-PHRST).

Catherine F. Houlihan, MSc, MB ChB, MRCP, DTM&H

Clinical Lecturer

University College London

Honorary Clinical Lecturer

London School of Hygiene and Tropical Medicine




CFH declares that she has no competing interests.


Dr Nicholas J. Beeching, Dr Manuel Fenech, Dr Tom E. Fletcher, and Dr Catherine F. Houlihan would like to thank Dr Colin Brown (Infectious Disease Lead, Kings Sierra Leone Partnership) for his helpful comments and insights.


CB declares that he has no competing interests.

Peer reviewers

William A. Petri, Jr, MD, PhD, FACP

Wade Hampton Frost Professor of Epidemiology

Professor of Medicine, Microbiology, and Pathology


Division of Infectious Diseases and International Health

University of Virginia




WAP declares that he has no competing interests.

Luis Ostrosky-Zeichner, MD, FACP, FIDSA, FSHEA

Professor of Medicine and Epidemiology

UT Health Medical School

Medical Director of Epidemiology

Memorial Hermann Texas Medical Center




LO-Z declares that he has no competing interests.

Stephen Mepham, MRCP (UK), FRCPATH, DTM&H, MD

Consultant in Microbiology and Infectious Diseases

Royal Free London NHS Foundation Trust




SM declares that he has no competing interests.

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