CBRNE - Viral Hemorrhagic Fevers Medication
- Author: David C Pigott, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD more...
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. More recent efforts have focused on viral inhibition, including Ebola virus inhibition using selective estrogen receptor modulators.[9, 10]
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. Other potential antiviral therapies against Lassa fever include novel benzimidazole compounds such as ST-193 and other related heterocyclic compounds.
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.
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.[13, 10]
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. 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.
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.[16, 17] 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. Other recent efforts have focused on postexposure prophylaxis for filovirus exposure and have achieved success using a primate model.
Other efforts to create a viable (and marketable) Ebola vaccine have led to the development of an experimental bivalent vaccine that confers protection against both rabies and Ebola virus.
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.
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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|Virus Family||Disease (Virus)||Natural Distribution||Usual Source of Human Infection||Incubation (Days)|
|Argentine HF (Junin)||South America||Rodent||7-14|
|Bolivian HF (Machupo)||South America||Rodent||9-15|
|Brazilian HF (Sabia)||South America||Rodent||7-14|
|Venezuelan HF (Guanarito)||South America||Rodent||7-14|
|Phlebovirus||Rift Valley fever||Africa||Mosquito||2-5|
|Nairovirus||Crimean-Congo HF||Europe, Asia, Africa||Tick||3-12|
|Hantavirus||Hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome||Asia, Europe, worldwide||Rodent||9-35|
|Filovirus||Marburg and Ebola||Africa||Fruit bat||3-16|
|Flavivirus||Yellow fever||Tropical Africa, South America||Mosquito||3-6|
|Dengue HF||Asia, Americas, Africa||Mosquito||Unknown for dengue HF, 3-5 for dengue|