Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers

Jacobs, Michael; Aarons, Emma; Bhagani, Sanjay; Buchanan, Ruaridh; Cropley, Ian; Hopkins, Susan; Lester, Rebecca; Martin, Daniel; Marshall, Neal; Mepham, Stephen; Warren, Simon; Rodger, Alison

doi:10.1016/s1473-3099(15)00228-5

Cited by 68 publications

(60 citation statements)

References 17 publications

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“…Only a few EVD cases after needle sticks have been reported [46,53,[56][57][58][59][60][61][62][63][64][65]. However, parenteral inoculation is clearly established as a potent means of transmission and was associated with a shorter incubation period (6.3 days vs 9.5 days) and a higher overall mortality level (100% vs 88%) during the initial outbreak of EVD, in Yambuku during 1976 [66].…”

Section: Contact With Body Fluids and Cadaversmentioning

confidence: 99%

“…However, parenteral inoculation is clearly established as a potent means of transmission and was associated with a shorter incubation period (6.3 days vs 9.5 days) and a higher overall mortality level (100% vs 88%) during the initial outbreak of EVD, in Yambuku during 1976 [66]. Recently, some HCWs with sharps exposures have been treated with postexposure prophylactic administration of rVSV-ZEBOV vaccine [61,62,65], monoclonal antibodies and/or favipiravir [64], and TKM-100802 [65]; none of the reported cases developed EVD, and no sign of EBOV viremia was detectable, but it is not possible to know whether infection actually occurred.…”

Section: Contact With Body Fluids and Cadaversmentioning

confidence: 99%

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Ebola Virus Shedding and Transmission: Review of Current Evidence

et al. 2016

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Background. The magnitude of the 2013-2016 Ebola virus disease outbreak in West Africa was unprecedented, with >28 500 reported cases and >11 000 deaths. Understanding the key elements of Ebola virus transmission is necessary to implement adequate infection prevention and control measures to protect healthcare workers and halt transmission in the community.Methods. We performed an extensive PubMed literature review encompassing the period from discovery of Ebola virus, in 1976, until 1 June 2016 to evaluate the evidence on modes of Ebola virus shedding and transmission.Findings. Ebola virus has been isolated by cell culture from blood, saliva, urine, aqueous humor, semen, and breast milk from infected or convalescent patients. Ebola virus RNA has been noted in the following body fluids days or months after onset of illness: saliva (22 days), conjunctiva/tears (28 days), stool (29 days), vaginal fluid (33 days), sweat (44 days), urine (64 days), amniotic fluid (38 days), aqueous humor (101 days), cerebrospinal fluid (9 months), breast milk (16 months [ preliminary data]), and semen (18 months). Nevertheless, the only documented cases of secondary transmission from recovered patients have been through sexual transmission. We did not find strong evidence supporting respiratory or fomite-associated transmission.

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Section: Contact With Body Fluids and Cadaversmentioning

confidence: 99%

Section: Contact With Body Fluids and Cadaversmentioning

confidence: 99%

Ebola Virus Shedding and Transmission: Review of Current Evidence

et al. 2016

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“…The risk of infection in individuals was categorised as very low, low, intermediate, or high, using the stratification devised by Jacobs et al [25], applied to the survey free-text answers from returnees, with modification to include breaches in PPE. Using this system, being physically close (<1 m) to an individual with confirmed EVD whilst not wearing PPE, or with a breach in the PPE, constituted very low risk if there was no direct physical contact, low risk if there was direct physical contact, and intermediate risk if the patient had vomiting, diarrhoea, or bleeding.…”

Section: Methodsmentioning

confidence: 99%

“…In transcutaneous exposure (such as a needle stick injury), risk was considered high if the sharp was a freshly used hollow-bore needle and high if the sharp object had been contaminated by contact with a confirmed EVD patient or body fluids. The risk from a percutaneous injury was considered intermediate if the sharp was not known to have been directly contaminated [25]. …”

Section: Methodsmentioning

confidence: 99%

Ebola exposure, illness experience, and Ebola antibody prevalence in international responders to the West African Ebola epidemic 2014–2016: A cross-sectional study

et al. 2017

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BackgroundHealthcare and other front-line workers are at particular risk of infection with Ebola virus (EBOV). Despite the large-scale deployment of international responders, few cases of Ebola virus disease have been diagnosed in this group. Since asymptomatic or pauci-symptomatic infection has been described, it is plausible that infections have occurred in healthcare workers but have escaped being diagnosed. We aimed to assess the prevalence of asymptomatic or pauci-symptomatic infection, and of exposure events, among returned responders to the West African Ebola epidemic 2014–2016.Methods and findingsWe used snowball sampling to identify responders who had returned to the UK or Ireland, and used an online consent and questionnaire to determine their exposure to EBOV and their experience of illness. Oral fluid collection devices were sent and returned by post, and samples were tested using an EBOV IgG capture assay that detects IgG to Ebola glycoprotein. Blood was collected from returnees with reactive samples for further testing. Unexposed UK controls were also recruited.In all, 300 individuals consented, of whom 268 (89.3%) returned an oral fluid sample (OFS). The majority had worked in Sierra Leone in clinical, laboratory, research, and other roles. Fifty-three UK controls consented and provided samples using the same method.Of the returnees, 47 (17.5%) reported that they had had a possible EBOV exposure. Based on their free-text descriptions, using a published risk assessment method, we classified 43 (16%) as having had incidents with risk of Ebola transmission, including five intermediate-risk and one high-risk exposure. Of the returnees, 57 (21%) reported a febrile or diarrhoeal illness in West Africa or within 1 mo of return, of whom 40 (70%) were not tested at the time for EBOV infection.Of the 268 OFSs, 266 were unreactive. Two returnees, who did not experience an illness in West Africa or on return, had OFSs that were reactive on the EBOV IgG capture assay, with similar results on plasma. One individual had no further positive test results; the other had a positive result on a double-antigen bridging assay but not on a competitive assay or on an indirect EBOV IgG ELISA. All 53 controls had non-reactive OFSs. While the participants were not a random sample of returnees, the number participating was high.ConclusionsThis is the first study, to our knowledge, of the prevalence of EBOV infection in international responders. More than 99% had clear negative results. Sera from two individuals had discordant results on the different assays; both were negative on the competitive assay, suggesting that prior infection was unlikely. The finding that a significant proportion experienced “near miss” exposure events, and that most of those who experienced symptoms did not get tested for EBOV at the time, suggests a need to review and standardise protocols for the management of possible exposure to EBOV, and for the management of illness, across organisations that deploy staff to outbreaks.

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“…Review of these episodes changed how sharps were accounted for within the facility and no further similar events occurred. The most significant event was when a member of the KTTU nursing staff became infected with EVD and aeromedical evacuation back to the UK was arranged for her and colleagues in whom she had been in close contact 10. A case review of the events leading up to this case could find no obvious problem with her PPE use, but as a precaution the duration an HCW could remain in the red zone was reduced to 90 min.…”

Section: Understanding and Mitigating The Riskmentioning

confidence: 99%

Formulating and improving care while mitigating risk in a military Ebola virus disease treatment unit

et al. 2016

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This paper describes the development of the UK military's Ebola Virus Disease Treatment Unit (EVD TU) that was deployed to Sierra Leone as part of the UK response to the West African Ebola virus disease (EVD) epidemic in 2014 and 2015. It highlights specific challenges faced within this unique Field Hospital environment. The military EVD TU was initially established to provide confidence to international healthcare workers coming to Sierra Leone to assist in the international response to the EVD epidemic and formed a key part of the action plan by the UK's Department for International Development. It was designed and staffed to provide a high level of care to those admitted with suspected or confirmed EVD and was prepared to admit the first patient within 6 weeks of the original activation order by the Ministry of Defence. This article outlines the main hazards perceived at the outset of the operation and the methods used to mitigate the risk to the healthcare workers at the EVD TU. The article examines the mechanisms that enabled the hospital to respond positively to challenges that emerged during the deployment, while simultaneously reducing the risk to the healthcare workers involved in care delivery.

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Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers

Cited by 68 publications

References 17 publications

Ebola Virus Shedding and Transmission: Review of Current Evidence

Ebola Virus Shedding and Transmission: Review of Current Evidence

Ebola exposure, illness experience, and Ebola antibody prevalence in international responders to the West African Ebola epidemic 2014–2016: A cross-sectional study

Formulating and improving care while mitigating risk in a military Ebola virus disease treatment unit

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