Treatment of Ebola Hemorrhagic Fever with Blood Transfusions from Convalescent Patients

Abstract

Between 6 and 22 June 1995, 8 patients in Kikwit, Democratic Republic of the Congo, who met the case definition used in Kikwit for Ebola (EBO) hemorrhagic fever, were transfused with blood donated by 5 convalescent patients. The donated blood contained IgG EBO antibodies but no EBO antigen. EBO antigens were detected in all the transfusion recipients just before transfusion. The 8 transfused patients had clinical symptoms similar to those of other EBO patients seen during the epidemic. All were seriously ill with severe asthenia, 4 presented with hemorrhagic manifestations, and 2 became comatose as their disease progressed. Only 1 transfused patient (12.5%) died; this number is significantly lower than the overall case fatality rate (80%) for the EBO epidemic in Kikwit and than the rates for other EBO epidemics. The reason for this low fatality rate remains to be explained. The transfused patients did receive better care than those in the initial phase of the epidemic. Plans should be made to prepare for a more thorough evaluation of passive immune therapy during a new EBO outbreak.

How Ebola and Marburg viruses battle the immune system

“…Support for the involvement of antibodies takes several forms. Foremost, passive immunotherapy with convalescent sera or monoclonal antibodies has been shown to mitigate or prevent MARV and ZEBOV disease in guinea pigs and mice [69][70][71][72] , delay viraemia and death in non-human primates 27 and possibly improve clinical outcomes in humans 73,74 . Moreover, B-cell-deficient mice were impaired in their ability to eliminate ZEBOV 75 .…”

Codon-optimized filovirus DNA vaccines delivered by intramuscular electroporation protect cynomolgus macaques from lethal Ebola and Marburg virus challenges

“…19 In past human outbreaks, convalescent sera were used to treat infected patients of sporadic outbreaks of filoviruses with suggestive evidence for increased survival. 44,45 In the current outbreak, a cocktail of 3 MAbs (ZMapp, Mapp Biopharmaceutical, Inc., San Diego, CA), which is produced in tobacco plants, 46 has been used to treat infected medical workers.…”

Ebola: learn from the past

“…One of the plasma units was given to a laboratory technician accidentally infected in the United Kingdom; he survived 4 . Almost 20 years later, during the Kikwit outbreak in 1995, eight patients received transfusions of whole blood from survivors; seven lived 5 .…”