Experimental Drug to Treat Ebola Tested in 3 Patients as Virus Continues to Spread

As of August 15, 2014, the Ebola virus has infected at least 2127 people this year in West Africa, claiming the lives of 1145 and making it the deadliest outbreak of the virus in history. As the death toll continues to rise, experts are scrambling desperately to control the outbreak. In the latest effort to treat victims, a group of ethicists gathered by the World Health Organization (WHO) unanimously concluded that it is ethical to offer experimental drugs that have never been tested on humans to fight the virus, even if their effectiveness or adverse effects are unknown. “The large number of people affected by the 2014 West Africa outbreak, and the high case-fatality rate, have prompted calls to use investigational medical interventions to try to save the lives of patients and to curb the epidemic,” the WHO said on August 12.

The first 2 doses of an experimental drug produced to treat the virus, called ZMapp, created by the San Diego–based biotech firm Mapp Biopharmaceutical Inc., were supplied to 2 American missionaries infected by Ebola, and a third went to a Spanish priest. It has been reported that the Americans appear to be recovering, but the priest, Miguel Pajares, has died. It is unknown whether the drug actually worked or if the surviving patients are recovering on their own. Liberia announced on August 11 that it would soon receive doses of ZMapp and give it to 2 sick doctors, making them the first Africans to receive the treatment. However, Mapp Biopharmaceutical said its supply of the experimental drug has already been exhausted after fulfilling the request. The firm is working on increasing the production of ZMapp, but said that the process will take several months. A number of additional companies, including NewLink Genetics, GlaxoSmithKline, and Bavarian-Nordic are currently working on other treatments as well.

The current epidemic was first identified in Guinea in March and has since spread to Sierra Leone, Liberia, and Nigeria. By August 6, the CDC ramped up its response to the outbreak to level 1, a classification for the most serious public health emergencies. According to Dr. Tom Frieden, director of the CDC, it is estimated that the outbreak won’t be contained for another 3 to 6 months. 

Health Care Response to Ebola Outbreaks

As Ebola continues to spread, the governments of the countries affected by the virus, along with those not affected by the virus, are taking precautions. USA Today reports that health officials in the UK and Hong Kong are quarantining airline passengers traveling from the affected region who show signs of Ebola infection. In an effort to control the virus in Liberia, the country has begun quarantining remote villages at the epicenter of the outbreak. The Kenyan government has even taken the step of closing its borders to anyone traveling from any of the countries affected by the outbreak.

The WHO announced on August 18 that it is urging countries affected by the virus to conduct exit screenings at international airports, seaports, and land crossings. “Any person with an illness consistent with [Ebola] should not be allowed to travel unless the travel is part of an appropriate medical evacuation,” the WHO said. “There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation.”

Incubation takes 2 to 21 days. Early symptoms include sudden onset of fever, intense weakness, muscle pain, headache, and sore throat. Later symptoms include severe vomiting, diarrhea, hemorrhagic rash over the entire body, impaired liver and kidney function, and in some cases, both internal and external bleeding from the eyes, ears, and nose develops.

The Ebola virus is resistant to current antiviral medications. According to the National Library of Medicine, Ebola has a 90% mortality rate, with most patients succumbing to hypotensive shock rather than hypovolemia. Early diagnosis and treatment greatly improve chances for survival. Survivors may experience unusual complications, such as hair loss and sensory changes.

Treatment in the ICU with full viral hemorrhagic fever isolation precautions is necessary. Platelet or blood transfusions may be necessary if serious bleeding problems develop. Because there is no known cure, treatment for Ebola centers on palliative care, including IV hydration with electrolyte replacement and supportive care for shock.

There is currently no licensed vaccine for Ebola, so prevention focuses on avoiding potential infection and early diagnosis. All individuals should avoid areas contaminated with the virus. Health care providers working with patients with possible infection should wear gowns, gloves, and masks when around sick patients.

Will the Ebola Virus Outbreak Come to the US?

Already, one person suffering Ebola hemorrhagic fever (Ebola-HF) had plans to visit the US before the highly infectious disease took his life. On July 30, it was reported that 2 US Peace Corps volunteers were exposed to the virus when they came into contact with a patient who later died from the disease. This report came on the heels of news that 3 American health care workers had also been exposed to the virus: Patrick Sawyer, Dr. Kent Brantly, and Nancy Writebol.

Patrick Sawyer felt well when he boarded a flight from Liberia but was showing symptoms of Ebola when he arrived in Lagos, Africa’s largest city, with a geographically cramped population of 21 million. An outbreak of Ebola in Lagos could have catastrophic consequences and his travels nearly brought the virus to the US. In an interview with KSTP-TV, Decontee Sawyer said her husband planned to visit his children in Coon Rapids, MN in August before the virus took his life on July 25, 2014. Sawyer’s death is the first probable case of Ebola in Nigeria.

However, it’s not as easy to contract Ebola as many think. First of all, a person has to be very sick with the virus to spread it, meaning symptoms must be present. Second, a person also has to be in direct contact with the bodily fluids of someone who is sick to contract the disease. Unlike some other viruses, Ebola does not spread through the air. In the past, previous outbreaks have been controlled by isolating sick patients and those who have come into contact with them. The current outbreak is the worst in history only because it is occurring in a populous region with porous borders and local cultural practices, including washing dead bodies, which aids the spread of the virus. If there were a case in the US, the patient would be isolated, making it very unlikely that it would spread.

Reference

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8. Rosenthal J. Man killed by Ebola virus was set to visit family in Minn. next month. ABC News website. Updated July 28, 2014.  http://kstp.com/news/stories/S3516094.shtml.
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