New Tools in the Ebola Arsenal

New England Journal of Medicine
November 22, 2018  Vol. 379 No. 21
http://www.nejm.org/toc/nejm/medical-journal

Perspective
New Tools in the Ebola Arsenal
Inger K. Damon, M.D., Ph.D., Pierre E. Rollin, M.D., Mary J. Choi, M.D., M.P.H., Ray R. Arthur, Ph.D., and Robert R. Redfield, M.D.
… Although investigational therapeutics were not used in the previous outbreak in Equateur, some experts believe that the investigational protocol to enable use of vaccines for evaluation of protection of patients’ contacts and those contacts’ contacts may have facilitated engagement of affected communities. Final data on the effectiveness of the vaccination program in Equateur is not yet available. In North Kivu, the recombinant VSV-Ebola glycoprotein vaccine is currently being used under an expanded-access protocol to vaccinate patients’ contacts and their contacts, to provide a ring of vaccine-elicited protection, as well as for at-risk front-line workers and health care workers. As of September 25, more than 12,029 people had been vaccinated. Understanding community concerns and attitudes about the use of investigational agents will be critical if the use of these treatments is to be integrated into response efforts…
As of September 23, investigational agents had been administered to 38 patients — MAb114 (22), remdesivir (9), and ZMapp (7). Nineteen of these patients had been discharged, 12 had died, and 7 had remained hospitalized; those who died were in advanced stages of disease when treatment was initiated.4 Criteria such as viral load (at presentation and throughout treatment) and interval between disease onset and treatment will need to be analyzed. One aspect that will be important to understand is how, or whether, these therapeutics affect clearance of virus from immune-privileged sites, such as the eye, and from seminal fluids…