Ebola virus infection
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 optimized 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 revolutionized treatment over the past decade.
Summary
Definition
History and exam
Key diagnostic factors
- exposure to Ebola virus in previous 21 days
- fever
- myalgia
- conjunctival injection
Other diagnostic factors
- fatigue
- anorexia
- diarrhea
- vomiting
- severe headache
- abdominal pain or heartburn
- cough, dyspnea, chest pain
- sore throat
- prostration
- tachypnea
- 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
- BUN/serum creatinine
- blood lactate
- ABG
- CBC
- coagulation studies
- urinalysis
- LFTs
- serum amylase level
- blood cultures
- serum blood glucose
- antigen-capture enzyme-linked immunosorbent assay (ELISA)
- IgM and IgG antibodies
- chest x-ray
Treatment algorithm
Contributors
Authors
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
Liverpool
UK
Disclosures
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
Liverpool
UK
Disclosures
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
Liverpool
UK
Disclosures
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
London
UK
Disclosures
CFH declares that she has no competing interests.
Acknowledgements
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.
Disclosures
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
Chief
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Disclosures
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
Houston
TX
Disclosures
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
London
UK
Disclosures
SM declares that he has no competing interests.
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