Ebola Virus Treatment & Management

  • Author: John W King, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 20, 2010
 

Medical Care

  • Presently, no specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever.
    • Ribavirin, an antiviral drug previously used in other types of viral hemorrhagic fever, has no demonstrable anti-Ebola activity in vitro and has failed to protect Ebola-infected primates.
    • During the 1995 outbreak in Kikwit, DRC, human convalescent plasma was used to treat 8 patients with proven Ebola disease. Only 1 of these patients died. Subsequent studies could not demonstrate survival benefit conferred by convalescent plasma products.
    • Human recombinant interferon alpha-2b used in conjunction with hyperimmune equine IgG delayed but did not prevent death in Ebola-infected cynomolgus macaques.
    • Four laboratory workers in Russia who had possible Ebola exposure were treated with a combination of a goat-derived anti-Ebola immunoglobulin plus recombinant human alpha-2 interferon. One of these patients had a high-risk exposure and developed clinical evidence of Ebola infection. All 4 patients recovered. Equine IgG containing high-titer neutralizing antibodies to Ebola protected guinea pigs and baboons but was not effective in protecting infected rhesus monkeys.
  • Supportive therapy with attention to intravascular volume, electrolytes, nutrition, and comfort care is of benefit to the patient.
    • Such care must be administered with strict attention to barrier isolation.
    • All body fluids (blood, saliva, urine, stool) contain infectious virions and should be handled with great care.
    • Patients who have died of Ebola should be buried promptly and with as little contact as possible.
  • Experimental therapies that are being investigated include the following:
    • DNA vaccines expressing either envelope GP or nucleocapsid protein (NP) genes of Ebola virus have been demonstrated to induce protection in adult mice exposed to Ebola virus. These vaccines were administered by coating gold beads with DNA expressing the genes for either GP or NP, and they were delivered by skin particle bombardment using a PowderJect-XR gene gun. Both vaccines induced measurable antibody responses detected by ELISA and induced cytotoxic T-cell immunity.
    • Another approach has been to raise neutralizing antibodies in goats or horses that are specific for the GP of Ebola. These may be useful in both vaccine design and prophylactic use.
  • Although not FDA-approved for Ebola therapy, other experimental therapies that use available drugs may be considered. Therapies that may reduce the mortality rate without directly effecting viral replication include activated protein C[10] and a recombinant inhibitor of factor VIIa/tissue factor.[11] For now, there is no definitive therapy for Ebola. General medical support is critical and should include replacement of coagulation factors and heparin if disseminated intravascular coagulation develops.
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Surgical Care

  • Surgical intervention generally follows a mistaken diagnosis in which Ebola-associated abdominal signs are mistaken for a surgical abdominal emergency. Such a mistake may be fatal for the patient and for any surgical team members who become contaminated with the patient's blood.
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Consultations

  • Whenever the diagnosis of Ebola or any other viral hemorrhagic fever is considered, the US Centers for Disease Control and Prevention, along with local and state health officials, should be contacted.
  • Prompt consultation with an infectious diseases physician should be made, and strict barrier isolation should be instituted.
  • No attempt should be made to culture the virus, except when performed in a maximum-containment biosafety level 4 laboratory with laboratory personnel wearing positive-pressure suits equipped with high-efficiency particulate air filters and an umbilical-fed air supply.
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Diet

  • Nutrition is complicated by the patient's nausea, vomiting, and diarrhea.
  • Intravascular volume repletion is one of the most important supportive measures.
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Activity

  • Recovery often requires months. Weight gain and return of strength are slow.
  • Ebola virus continues to be present for many weeks after resolution of the clinical illness.
  • Semen from men recovering from Ebola infection has been shown to contain infectious virus, and Ebola has been transmitted by sexual intercourse involving recovering men and their sex partners.
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Contributor Information and Disclosures
Author

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 author of chapter

Coauthor(s)

Rushdah Malik, MD  Fellow, Department of Infectious Diseases, Louisiana State University Health Science Center

Rushdah Malik, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Martin J Wood, MD †  Former Consulting Staff, Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK

Martin J Wood, MD † is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, and Royal College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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Ebola virus. Courtesy of the US Centers for Disease Control and Prevention.
Table 1. History of Ebola Virus Sudan Outbreaksa
YearLocationReported Cases, No.Deaths, No. (%)
1976Sudan284151 (53)
1976Englandb10 (0)
1979Sudan3422 (65)
2000-2001Uganda425224 (53)
2004Sudan1717 (41)
Total761414 (54.4)
Table 2. History of Ebola Virus Zaire Outbreaksa
YearLocationReported Cases, No.Deaths, No. (%)
1976Zaire318280 (88)
1977Zaire11 (100)
1994Gabon5231 (60)
1995DRC315250 (81)
Jan 1996 to Apr 1996Gabon3721 (57)
Jul 1996 to Jan 1997Gabon6045 (74)
1996South Africa (acquired in Gabon)11 (100)
Oct 2001 to Mar 2002Gabon6553 (82)
Oct 2001 to Mar 2002DRC5944 (75)
Dec 2002 to Apr 2003DRC143128 (89)
Nov 2003 to Dec 2004DRC3529 (83)
2007DRC264187 (71)
Total1,3501,070 (79.3)
Table 3. History of Ebola Virus Côte-d’Ivoire Outbreaks (No Deaths Reported)a
YearLocationReported Cases, No.
1994Côte-d’Ivoire1
1995Liberia1
Total2
Table 4. History of Ebola Virus Reston Outbreaks (No Deaths Reported)a
YearLocationProven bCases Reported, No.
1989Virginia, Texas, Pennsylvania0
1990Virginia and Texas4
1989 -1990Philippines3
1992Italy0
1990Alice, Tex0
1996Philippines0
Nov 2008Philippinesc6
Total13
Table 5. History of Ebola Virus Bundibugyo Outbreaka
YearLocationReported Cases, No.Deaths, No. (%)
Dec 2007 to Jan 2008Uganda14937 (25)
Total14937 (25)
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