Last reviewed: 2 Feb 2021
Last updated: 08 Sep 2020
26 Nov 2020

FDA approves first treatment for Ebola virus infection

The Food and Drug Administration (FDA) has approved atoltivimab/maftivimab/odesivimab, formerly known as REGN-EB3, for the treatment of Zaire ebolavirus infection in adults and children.

The three monoclonal antibodies in the mixture target the glycoprotein that is on the surface of the Ebola virus. The antibodies bind to the glycoprotein simultaneously and block the attachment and entry of the virus into cells.

The approval is based on results of the PALM trial, a multi-center, open-label, randomized controlled trial, as well as part of an expanded access program conducted in the Democratic Republic of the Congo during the 2018 outbreak. About 33% of patients who received atoltivimab/maftivimab/odesivimab died at 28 days, compared to 51% of patients in the control group.[163]

The most common adverse effects were fever/chills, tachycardia, tachypnea, and vomiting.

The FDA also approved the first vaccine for Ebola virus infection in late 2019.

See Management: emerging

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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


Senior Lecturer (Honorary Consultant)

Liverpool School of Tropical Medicine and Royal Liverpool University Hospital




NJB is an author of several references cited in this monograph. 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. He is affiliated with the Liverpool School of Tropical Medicine. Views expressed in this monograph 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.

Specialist Trainee in Infectious Diseases

Royal Liverpool University Hospital




MF declares that he has no competing interests.

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).

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 reviewersVIEW ALL

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.

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.

Consultant in Microbiology and Infectious Diseases

Royal Free London NHS Foundation Trust




SM declares that he has no competing interests.

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