CBRNE - Viral Hemorrhagic Fevers Medication

Updated: Mar 16, 2017
  • Author: David C Pigott, MD, RDMS, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Medication

Medication Summary

The US Food and Drug Administration (FDA) has not approved any antiviral therapy or vaccine for Ebola or Marburg virus infection. Supportive therapy should be the primary focus for clinicians treating patients with suspected or confirmed filovirus infection, including treatment for hypovolemia, electrolyte, metabolic and hematologic abnormalities, shock, multiorgan failure, and disseminated intravascular coagulation.

Large-volume intravenous (IV) fluids have been used in resuscitation of patients with Ebola virus disease (EVD) evacuated from West Africa. Broad-spectrum antimicrobials have also been used in patients with evidence of septic shock.

Several experimental therapeutics and vaccines are in development for the treatment of EVD. ZMapp, a biopharmaceutical agent comprising three monoclonal antibodies against Ebola virus surface glycoproteins, was developed in a joint Canadian-US effort in 2014, and has shown efficacy in nonhuman primate trials. [19] Although it was used experimentally in 7 patients in 2014 (two of whom died), the utility of ZMapp in these patients was unclear. A multicenter randomized study of ZMapp versus standard therapy did not show clear efficacy, although there was a trend suggesting benefit in patients who received ZMapp. [20]

Lassa fever and hemorrhagic fever with renal syndrome (HFRS) due to Hantavirus infection have been treated effectively with IV 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. [21]

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. [22, 23]

Development of a Lassa virus vaccine is continuing at the US Centers for Disease Control and Prevention (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. [24] A  study evaluating the safety and efficacy of a tetravalent dengue vaccine demonstrated full seroconversion against all World Health Organization (WHO) dengue serotypes in flavivirus-naive adults. [25]

Argentine hemorrhagic fever (HF) vaccine (Junin virus 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 effective experimental Ebola vaccines using multiple viral vector strategies, including vesicular-stomatitis virus (VSV-EBOV) and chimpanzee adenovirus (cAd3-EBO-Z). Human trials in Africa and Europe have yielded safe, immunogenic vaccines against both Ebola and Marburg, based on post-vaccine testing of antibody and T-cell response of trial participants. [26, 27]

 

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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.

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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