CBRNE - Viral Hemorrhagic Fevers Medication

  • Author: David C Pigott, MD, RDMS, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Apr 18, 2011
 

Medication Summary

No specific antiviral therapy is available for Ebola or Marburg virus infection. The use of convalescent serum (ie, sera from patients who have survived infection) is suggested as a possible therapy. Late during the 1995 Kikwit, Zaire, outbreak, 8 Ebola patients received blood transfusions from Ebola survivors. Of these, 7 survived. However, no clear evidence exists that links their survival directly to this therapy.

Lassa fever and HFRS due to Hantavirus infection have been treated effectively with intravenous and oral ribavirin. Because of this, ribavirin has been recommended as a potential treatment for other arenaviruses and bunyaviruses. Treatment is most effective when given early in the clinical course. Ribavirin also is recommended for postexposure prophylaxis.

Recently proposed guidelines for the use of ribavirin for postexposure prophylaxis recommend the use of oral ribavirin exclusively for definitive, high-risk exposures, such as contaminated needlestick injury, mucous membrane or nonintact skin exposure with contaminated blood or body fluids, participation in emergency resuscitative procedures (eg, intubation, suctioning), or prolonged close contact in an enclosed space with infected patients without appropriate personal protective equipment.[8]

Recent research into the development of antiarenaviral drugs has focused on broad screening of small molecules with potential antiviral activity. This high-throughput screening (HTS) strategy has previously identified antiviral drugs and may potentially provide novel inhibitors of viral cell entry in the future.[9]

Development of a Lassa virus vaccine is continuing at the CDC. Yellow fever vaccine is readily available and is both safe and effective. A bivalent vaccine is being developed from the preexisting 17D yellow fever vaccine that would express not only yellow fever glycoproteins but also Lassa glycoproteins, theoretically stimulating a protective immune response against both viruses.[10] A recent study evaluating the safety and efficacy of a tetravalent dengue vaccine demonstrated full seroconversion against all WHO dengue serotypes in flavivirus-naive adults.[11]

Argentine HF (Junin) vaccine is also effective and may protect against Bolivian HF as well. Rift Valley fever and Hantaan (HFRS) vaccines are also available.

Although there is no approved vaccine for either Ebola or Marburg virus, significant progress has been made in developing an effective experimental vaccine using a vesicular stomatitis virus-based vaccine.[12, 13] In March 2009, after a German researcher sustained a needlestick while working with Ebola virus, a decision was made among Ebola experts and researchers to administer an experimental Ebola vaccine that has shown effectiveness in nonhuman primate studies. Initial reports indicate that this effort may have been successful.[14] Other recent efforts have focused on postexposure prophylaxis for filovirus exposure and have achieved success using a primate model.[15]

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Antivirals

Class Summary

The goals in the use of antivirals are to shorten the clinical course, prevent complications, prevent the development of latency and/or subsequent recurrences, decrease transmission, and eliminate established latency.

View full drug information

Ribavirin (Virazole)

 

Nucleoside analog with antiviral activity; may significantly reduce mortality in Lassa fever and Hantavirus infection if treatment begun within 6 d of onset.

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Contributor Information and Disclosures
Author

David C Pigott, MD, RDMS, FACEP  Associate Professor of Emergency Medicine, Co-Director of Emergency Ultrasound, Vice Chair for Academic Development, Associate Scientist, UAB Center for Emerging Infections and Emergency Preparedness, University of Alabama School of Medicine

David C Pigott, MD, RDMS, FACEP is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry L Mothershead, MD  Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Thomas W McGovern, MD, to the development and writing of this article.

References

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Ebola virus. Electron micrograph courtesy of the Centers for Disease Control and Prevention.
Marburg virus. Negative stain image courtesy of the Centers for Disease Control and Prevention.
Mastomys rodent, natural host of Lassa virus. Image courtesy of the Centers for Disease Control and Prevention.
Bunyavirus infection. Ecchymoses encompassing left upper extremity one week after onset of CCHF. Ecchymoses often are accompanied by hemorrhage in other locations: epistaxis, puncture sites, hematemesis, melena, and hematuria. Image provided by Robert Swaneopoel, PhD, DTVM, MRCVS, National Institute of Virology, Sandringham, South Africa.
Apodemus agrarius, the vector of Korean hemorrhagic fever caused by a hantavirus. Photo courtesy of David McClain, MD.
Bunyavirus infection - Hantaan virus. Patient with Korean hemorrhagic fever caused by Hantaan virus demonstrating typical 'sunburn flush' of cheeks, chin, and base of neck. Photo courtesy of John Huggins, PhD.
Bunyavirus infection. A patient with Korean hemorrhagic fever demonstrating conjunctival hemorrhages, facial petechiae, and "sunburn flush" of the cheeks. Photo courtesy of John Huggins, PhD.
Filovirus disease - Ebola fever. Patient with Ebola hemorrhagic fever during 1976 outbreak in Zaire demonstrating palatal petechiae and hemorrhage. Photo courtesy of Joel Breman.
Patient with morbilliform exanthem of dengue fever. Note islands of sparing characteristics for dengue. Photo courtesy Duane Gubler, PhD.
Patient with dengue hemorrhagic fever complicated by ecchymoses. Photo courtesy of Duane Gubler, PhD.
Table. Viral Families Causing Viral Hemorrhagic Fever
Virus FamilyDisease (Virus)Natural DistributionUsual Source of Human InfectionIncubation (Days)
Arenaviridae
ArenavirusLassa feverAfricaRodent5-16
Argentine HF (Junin)South AmericaRodent7-14
Bolivian HF (Machupo)South AmericaRodent9-15
Brazilian HF (Sabia)South AmericaRodent7-14
Venezuelan HF (Guanarito)South AmericaRodent7-14
Bunyaviridae
PhlebovirusRift Valley feverAfricaMosquito2-5
NairovirusCrimean-Congo HFEurope, Asia, AfricaTick3-12
HantavirusHemorrhagic fever with renal syndrome, hantavirus pulmonary syndromeAsia, Europe, worldwideRodent9-35
Filoviridae
FilovirusMarburg and EbolaAfricaUnknown3-16
Flaviviridae
FlavivirusYellow feverTropical Africa, South AmericaMosquito3-6
Dengue HFAsia, Americas, AfricaMosquitoUnknown for dengue HF, 3-5 for dengue
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