Supportive therapy with regard to intravascular volume, electrolytes, nutrition, and comfort care benefits the patient. Isolation as a strict barrier in a private room is the method used. This is because urine, feces, sputum, and blood, along with items that come in contact with the patient or body fluids such as laboratory equipment, must be disinfected with 0.5% sodium hypochlorite solution. Even Patients who have died from the Ebola virus should be buried immediately with minimal contact.
NRTI inhibitors of the cell-encoded S-adenosylhomocysteine hydrolase (SAH) enzyme have been shown to inhibit Zaire ebolavirus replication in adults. Inhibition of SAH indirectly inhibits the transmethylation reaction required for viral replication. Smith et al found that in rhesus macaques infected with lethal doses of Ebola virus, treatment with initial interferon beta after exposure led to a significant increase in survival time, although it did not reduce mortality significantly. These findings suggest that early post-exposure to interferon-beta therapy may be a promising adjunct in the treatment of Ebola virus infection.
During the 1995 Ebola outbreak in Kikwit, DRC, cured human plasma was used to treat 8 patients with proven Ebola disease, and only 1 patient died. Future studies could not demonstrate the survival benefit provided by plasma products. The survival of these patients suggests that passive immunity may be of benefit in some patients.
A recombinant human monoclonal antibody directed against the envelope glycoprotein (GP) Ebola virus has been shown to have neutralizing activity. This Ebola virus-neutralizing antibody may be useful in vaccine development or as a passive prophylactic agent. The DNA vaccine revealing either the GP envelope or the nucleocapsid protein (NP) gene from the Ebola virus has been shown to cause protection in adult mice exposed to the virus.
Early studies in cynomolgus macaques administered a cocktail of 3 different murine monoclonal antibodies (mAbs; ZMab) aimed against Ebola virus envelope glycoprotein epitopes demonstrated post-exposure prophylactic activity 1-2 days after Ebola virus. That result fits in with the mix. Of the 3 chimerized anti-Ebola mAbs virus (MB-003) which has a constant human region produced in genetically modified tobacco plants. When administered as post-exposure prophylaxis 2 days after viral challenge, MB-003 was active in both mice and rhesus macaques.
The focus of mAb research is now shifting towards the treatment of infection. In that case, 43% of rhesus macaques treated with MB-003 after the onset of Ebola virus infection survived versus none of the untreated controls. Established infection was defined as fever and positive Ebola virus reverse-transcription polymerase chain reaction (RT PCR) results. Similarly, ZMab resulted in a 50% survival rate in cynomolgus macaques when started on day 4 after viral challenge.
Recently, the optimal combination of human mAbs was produced in genetically modified tobacco plants and had specificity for 3 different Ebola glycoprotein virus epitopes saved 100% of rhesus macaques even when administered at an advanced stage of disease 5 days after viral challenge (ZMapp, Mapp biopharmaceutical, Inc., San Diego, CA, USA, and Defyrus, Inc., Toronto, Canada) In addition, two patients with Ebola in the United States who had recently received ZMapp through the newly investigated emergency drug approval (US. FDA) had decreased viral load and survived. Furthermore, another 3 out of 4 individuals treated with ZMapp survived. These results suggest that ZMapp may be useful for the treatment of chronic infections in humans.
Recovery often takes months, and a delay can be expected before normal activities return. Slow weight gain and regain strength. The Ebola virus continues to be present for weeks after clinical disease resolution. Even sperm from people recovering from Ebola infection have been shown to contain a contagious virus, and Ebola has been transmitted through sexual intercourse which involves restoring men and partners to intimate relationships. Anyone exposed to an infected patient should be watched closely for early signs of Ebola virus disease.
Prevention of health personnel
Recent guidance recommended that healthcare personnel treating patients infected with the Ebola virus (i.e., doctors, nurses, other physicians) wear personal protective equipment (PPE) that does not expose the skin. This includes a surgical hood covering the head and neck and a disposable full face shield (not glasses), in addition to either an N95 respirator or powered non-mask air-purifying respirator.
It is even recommended that doctors train strictly in wearing and doffing PPE gradually and showing competence. A trained monitor should monitor whenever a doctor puts on and removes the equipment.
During patient care, PPE does not have to be adjusted, and workers’ gloved hands should be disinfected frequently using an alcohol-based hand rub (ABHR), especially after body fluids have been treated.
Work continues on a vaccine for Ebola virus infection in primates. Sullivan et al reported on a combination DNA vaccine capable of coding for Ebola protein followed by booster vaccination with a recombinant adenoviral vector expressing Ebola GP (Z).
In this study, cynomolgus macaques were injected with 3 doses of DNA vaccine, 1 dose every 4 weeks. Twelve weeks later, the macaques were vaccinated with a recombinant adenoviral vector. After that 12 weeks, the unvaccinated monkeys and the vaccinated macaques were injected with a lethal dose of the Ebola virus. All monkeys were not vaccinated against death, whereas no monkeys were vaccinated against death.
This work shows that primates can be vaccinated against the Ebola virus and can develop both a cell-mediated response (thought to be a result of the DNA vaccine) and a humoral antibody response (thought to be the result of a recombinant adenoviral vaccine).
Another attempt to design a vaccine that works on primates uses a strategy that has worked in mice and guinea pigs. Geisbert et al -virion Ebola preparations.
Ebola is passed from person to person through direct contact with an infected patient’s blood or other bodily fluids. Airborne transmission of Reston ebolavirus is known to occur among primates; thus, although most cases in humans occur after direct contact with patients or their blood or body fluids, airborne transmission of the Ebola virus cannot be stopped.
Control of infection inside and outside medical facilities relies on protective barrier using double gloves, fluid-tight gowns, face shields with eye protection, and covers for feet and shoes.
Whenever a diagnosis of Ebola or other viral hemorrhagic fever is considered, local and state health officials should be contacted. Consultation with an infectious disease doctor must be carried out immediately, and strict isolation of the barrier must be implemented to avoid its widespread spread.