EBOLAVIRUS, NEEDLE STICK INJURY - GERMANY (02): (HAMBURG)
**********************************************************
A ProMED-mail post
<
http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<
http://www.isid.org>
Date: Wed 18 Mar 2009
Source: AAAS, Science - ScienceInsider [edited]
<
http://blogs.sciencemag.org/scienceinsi ... s-aro.html>
Researchers worldwide rally to help scientist exposed to Ebola
--------------------------------------------------------------
The accidental exposure of a scientist to ebolavirus last week [12
Mar 2009] has triggered a series of teleconferences by Ebola
scientists on 2 sides of the Atlantic united around a single goal: to
help save the life of their colleague, an unnamed virologist at the
Bernard Nocht Institute for Tropical Medicine in Hamburg, Germany,
who pricked herself in the finger during an experiment. No approved
treatments exist for ebolavirus infection, but at the sessions,
researchers and physicians discussed the results from a raft of
recent studies, some not yet published, into treatments that could
prevent or slow the disease, which has a mortality rate of up to 90 percent.
In the end, the patient and her doctor opted not for an experimental
drug but for a new type of living vaccine that has never been tested
in humans but has been shown in monkeys to help fight the virus even
when given after exposure. An injury from a virus-laden syringe often
doesn't lead to infection and disease, because the amount of virus
entering the body is small. But the researcher's doctors want to
reduce the risk as much as they can.
Today [18 Mar 2009] was the 6th day after the needle accident, and
the small community of ebolavirus researchers has been anxiously
following news about the researcher's fate.
She is currently doing well, says Stephan Guenther, the head of
virology at the Bernard Nocht Institute. But ebolavirus infection can
have an incubation period anywhere between 4 and 21 days, which means
she could still fall ill. In monkeys, the virus is usually detectable
in the blood starting on day 3, 4, or 5, says Boston University
virologist Thomas Geisbert, who has more experience than any other
researcher with the virus in animals. That may be different in
humans, Geisbert stresses, but still, "the chances that she'll be
okay are getting better every day."
Immediately after the researcher pricked herself last Thursday [12
Mar 2009], Guenther says he tried to assemble the best minds in the
field. During a series of teleconferences -- which included
researchers from the Canadian Science Centre for Human and Animal
Health in Winnipeg, the US Army Medical Research Institute of
Infectious Diseases (USAMRIID) in Fort Detrick, Maryland, and the US
Centers for Disease Control and Prevention in Atlanta, Georgia --
researchers discussed a long list of possible treatment options.
The vaccine that eventually was picked was developed by Heinz
Feldmann and his colleagues at the Winnipeg lab along with Geisbert,
who tested it in macaque monkeys at USAMRIID. The vaccine is based on
vesicular stomatitis virus (VSV), a pathogen of cattle, horses, and
pigs, whose glycoprotein has been replaced with that of an
ebolavirus. In 2003, the researchers showed that a single shot of the
virus offers protection in monkeys (Science, 14 November 2003, p. 1141).
A lot of time was spent last week debating the safety aspects of the
vaccine; because it is a living virus that replicates inside its
hosts, some worry that it could prove risky. And in contrast to
another ebolavirus vaccine based on DNA, it has never been tested in
humans. But its key advantage is that, at least in monkeys, it has
been shown to offer protection even after exposure, says Guenther. In
a 2008 study, Feldmann and Geisbert showed that when given 20 minutes
after a lethal shot of Ebola-Sudan virus, one of the 5 subtypes
[species] of the virus, half of the monkeys got sick, but all
survived. With Ebola-Zaire virus, the subtype [species] to which the
researcher in Hamburg was exposed, 5 out of 8 monkeys survived the
virus. In as-yet-unpublished work, the researchers also gave a
vaccine against Marburg, a close cousin of Ebola, 1 or even 2 days
after exposure, says Geisbert, and they found that it still offered
partial protection. He expects the same will be true for the
ebolavirus vaccine.
Feldmann arranged shipment of the vaccine against Ebola-Zaire virus
from Winnipeg the day the accident happened [12 Mar 2009], and it
reached the lab in Hamburg less than 48 hours after the accident,
says Guenther. (The researcher herself made the decision to have the
vaccine, he says.) Meanwhile, a company called ARCA Biopharma,
headquartered in Colorado, rushed to Hamburg a supply of an
experimental anticoagulant drug called rNAPc2, which studies by
Geisbert and colleagues have also shown to have promise against
ebolavirus. But that has not been used so far, says Guenther.
After she received the vaccine, the researcher began running a fever.
Because it was unclear whether this was due to the onset of
ebolavirus disease or a reaction to the vaccine, she was placed in an
isolation unit, shielded from the world by plastic, says Guenther.
The fever is gone now, and doctors would like to take her out of the
unit and back into a normal hospital ward, says Guenther.
"Psychologically, the isolation is very difficult," he says, and she
could always be put back in should ebolavirus infection symptoms
emerge. But the institute is "struggling a little" with Hamburg
public health authorities reluctant to let the patient out, he says.
Because so few ebolavirus infections have occurred in developed
countries, there's no consensus on the right precautions.
The researcher was working on a study that involved mice, says
Guenther, who says he does not know the exact nature of the
experiment. The last known lab exposure to an ebolavirus, at USAMRIID
in 2004, also involved mice. While a scientist tried to inject one of
the animals using a hypodermic needle that had previously been used
on other mice, researchers wrote in a 2008 paper about the case, "the
animal kicked the syringe, causing the needle to pierce the person's
left-hand gloves, resulting in a small laceration." That researcher
did not become infected, however.
--
Communicated by:
Martin Enserink
Contributing correspondent
Science magazine
Paris, France
<
http://www.science.com>
<
menserin@aaas.org>
[ProMED-mail thanks Martin Enserink for drawing attention to this
report, which adds additional information concerning the incident in
Hamburg, including identification of the ebolavirus involved, the
nature of the vaccine administered and the treatment protocol. So far
the patient remains well.
Prof Charles H Calisher has reminded me of the correct nomenclature
for these viruses. "The genus is _Ebolavirus_. Therefore, any virus
in the genus is 'an ebolavirus', not 'Ebola virus'; there is no such
thing as 'Ebola virus', c.f. 'dengue virus'. The 5 viruses mentioned
are not subtypes, they are viruses within the genus." (I have amended
the ScienceInsider text where appropriate). - Mod.CP]
[A previous (fatal) lab case reported by ProMED-mail is Archive
Number 20040823.2350 Published Date 23-AUG-2004
Subject PRO/AH> Ebola, lab accident death - Russia (Siberia) (04). - Mod.JW]
HIER