Background: Although a few international health-care workers who have assisted in the current Ebola outbreak in west Africa have been medically evacuated for treatment of Ebola virus disease, more commonly they were evacuated after potential accidental exposure to Ebola virus. An urgent need exists for a consensus about the risk assessment of Ebola virus transmission after accidental exposure, and to investigate the use of post-exposure prophylaxis (PEP). Experimental vaccines have occasionally been used for Ebola PEP, but newly developed experimental antiviral agents have potential advantages. Here, we describe a new method for risk assessment and management of health-care workers potentially exposed to Ebola virus and report the use of experimental antiviral therapies for Ebola PEP in people. Methods: We devised a risk assessment and management algorithm for health-care workers potentially exposed to Ebola virus and applied this to eight consecutive individuals who were medically evacuated to the UK from west Africa between January, and March, 2015. PEP with antiviral agents was given to health-care workers assessed to have had substantial risk exposures to Ebola virus. Participants were followed up for 42 days after potential exposure. Findings: Four of eight health-care workers were classified as having had low risk exposures and managed by watchful waiting in the community. None of these health-care workers developed Ebola virus disease. The other four health-care workers had intermediate or maximum risk exposures and were given PEP with antiviral agents. PEP was well tolerated with no serious adverse effects. None of these four health-care workers, including two with maximum risk exposures from penetrating injuries with freshly used hollow-bore needles, developed Ebola virus disease. Interpretation: Standardised risk assessment should be adopted and consensus guidelines developed to systematically study the efficacy and safety of PEP with experimental agents. New experimental antiviral treatments are a viable option for PEP against Ebola. Funding: Royal Free London NHS Foundation Trust.
Bibliographical noteFunding Information:
This work was funded by the Royal Free London NHS Foundation Trust, without external grants. The pharmaceutical biotech companies Toyama Chemical Company (Japan) and Beijing MabWorks Biotech (China) provided investigational medicines free of charge. These companies had no input in selection or clinical management of the patients, or this article. We thank Gary Kobinger (National Microbiology Laboratory of the Public Health Agency of Canada) for advice on monoclonal antibody therapy; Paul Cosford (Public Health England) for support with community monitoring after patient discharge; Steve Powis and Steve Shaw (both Royal Free London NHS Foundation Trust) for governance support concerning experimental therapeutics; and staff on the Infectious Diseases, Patient at Risk, High Level Isolation Unit Laboratory and Production Pharmacy Teams at the Royal Free London NHS Foundation Trust.
© 2015 Elsevier Ltd.
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