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New antivirals viable PEP option in HCWs exposed to Ebola
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Researchers from the United Kingdom have demonstrated the potential benefit of experimental antiviral agents as post-exposure prophylaxis for health care workers with possible exposure to Ebola virus, suggesting an urgent need for the development of international consensus guidelines regarding risk assessment and the use of these drugs.
In their study, published in the Lancet Infectious Diseases, the researchers developed an algorithm to evaluate exposure risk and devise suitable treatment strategies for health care workers (HCWs) with possible exposure to Ebola virus. The algorithm was used to assess eight HCWs from Sierra Leone who were evacuated to Royal Free Hospital in the U.K. after potential accidental exposure to the virus between January and March. The participants, aged 24 to 52 years, had no significant comorbid conditions and were provided direct patient care in Ebola treatment units.
Four of the HCWs had sustained needlestick injuries while working among confirmed Ebola cases, and in two instances, the needle had been used in an Ebola patient immediately before the injury. Based on the algorithm and using detailed clinical history from each HCW, the researchers categorized the risks as maximum (n = 2), intermediate (n = 2) and low (n = 4).
Due to the experimental nature of all available antiviral treatments for post-exposure prophylaxis (PEP), the researchers determined that the balance of risks would be in favor of watchful waiting for the four low-risk exposures. As a result, four cases did not undergo PEP and were actively monitored with twice-daily temperature recordings for 21 days. The HCWs with intermediate and maximum risk exposure underwent PEP with the RNA-polymerase inhibitor Avigan (favipiravir, Toyama Chemical) or 10 days, with or without monoclonal antibodies. These participants were followed for 42 days after exposure.
The researchers found that all eight HCWs continued to be clinically well without fever throughout follow-up. No serious adverse events were reported, and the PEP treatment was well-tolerated, they said. None of the HCWs developed Ebola virus disease or had detectable Ebola RNA in their blood. The four HCWs deemed at low-risk exposure were successfully managed with watchful waiting.
“It is possible that none of these health care workers were infected with Ebola virus. Therefore, we cannot know for sure whether or not post-exposure prophylaxis prevented the onset of Ebola virus disease,” researcher Michael Jacobs, PhD, of the Royal Free NHS Foundation Trust, London, said in a news release. “However, two of the workers had needlestick injuries contaminated with fresh blood from patients with Ebola virus disease, putting them at very high risk of transmission.”
According to the researchers, these findings support the development of standardized guidelines for Ebola risk assessment and PEP protocols.
“We are excited to publish the first report of an antiviral-based post-exposure treatment against Ebola virus infection in humans,” Jacobs said in the release. “We believe this work justifies further study of this post-exposure treatment to protect health care workers accidentally exposed to Ebola virus in the field. What is more, a similar approach to treat household contacts of Ebola cases may work to prevent a major route of spread during an epidemic.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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