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Survivors' Blood Holds Promise, But Draws Critics, As Ebola Treatment
As reported by The Los Angeles Times, the World Health Organization is endorsing blood transfusions from Ebola survivors as a treatment for those currently infected. The idea behind blood transfusion is similar to vaccination by other means, though (at least as discussed here) administered only after a patient has been infected: "The blood plasma of people who have recovered from Ebola contains antibodies that were successful in fighting off the virus. If these antibodies are pumped into an infected person, they might help the recipient fight the disease as well."
The article mentions that while there is little evidence to back the efficacy in preventing Ebola, "Transfusions were used to treat a small number of patients during the 1995 Kikwit Ebola outbreak in Zaire, now known as the Democratic Republic of Congo, according to Dr. Oyewale Tomori, a professor of virology at Redeemer's University in Nigeria. A study published in the Journal of Infectious Diseases after the outbreak reported that eight patients received transfusions, and only one of them died."
The idea of blood transfusions has critics, too: Dr. William Shaffner of Vanderbilt University is skeptical, saying he was surprised that the WHO would make transfusions a priority in the ongoing crisis because they are labor-intensive, making it difficult to serve a large number of patients. "You can't do this en masse," Schaffner said. "This is going to be a desperate attempt to provide something for a relatively small number of patients." Finding suitable donors may also prove more challenging than WHO officials expect, he warned. Malnutrition and other health concerns could make it more difficult to draw blood from people. "These are people who have recovered from Ebola," Schaffner said. "When are they hale and hearty enough to actually do a donation?"
The idea of blood transfusions has critics, too: Dr. William Shaffner of Vanderbilt University is skeptical, saying he was surprised that the WHO would make transfusions a priority in the ongoing crisis because they are labor-intensive, making it difficult to serve a large number of patients. "You can't do this en masse," Schaffner said. "This is going to be a desperate attempt to provide something for a relatively small number of patients." Finding suitable donors may also prove more challenging than WHO officials expect, he warned. Malnutrition and other health concerns could make it more difficult to draw blood from people. "These are people who have recovered from Ebola," Schaffner said. "When are they hale and hearty enough to actually do a donation?"
I am wondering for some time.
I think recovered patience are not contagious anymore, and can likely not be infected again.
Why not hire them en mass as desperately needed hospital staff.
Even if it is just for basic care of the infected patients.
What a great name. Sounds like what William Shatner would introduce himself as after a few drinks...
Have gnu, will travel.
As reported by The Los Angeles Times, the World Health Organization is endorsing blood transfusions from Ebola survivors as a treatment for those currently infected.
Notice they said "treatment" and not "cure". The antibodies will be used up but may give the body enough time to fight off the infection. It is not about impunity it is about survival.
Couldn't this approach be used for any infectious disease for which there's no effective cure but there are some survivors? Are there just no Western diseases that fit the profile? I suppose you need both a person sick with a deadly infection and a recent survivor of a same infection (with the same blood type). So it may just be the case that we simply don't experience that scenario enough to develop this solution. But I'm curious if this approach has been used outside of Ebola in Africa.
I stole this Sig
While it is true that there are any number of ways that the implementation of this could go horribly wrong in West Africa, the hard fact remains that they really don't have any other options. There's no "blue pill fairy" that's going to swoop down and save them. This isn't some episode of TNG where they can just technobabble their way out of the problem.
This may be a crazy hair brained idea but it seems to be the best thing they have going.
We ran out of the magical ebola drug after just 2 patients. Waiting on Big Pharma is probably not a good idea.
A Pirate and a Puritan look the same on a balance sheet.
There's a serious ethical problem with allocating scarce healthcare resources, particularly those in theatre to ideas that have no evidence of being worth trying.
It has been done during the 1995 Kikwit Ebola outbreak in Zaire. They tried it on eight patients and only one died. I have found no indication that any health care workers were infected. Notice the transfusions were done in Zaire. Also notice the ebola funding has increased quite rapidly.
As to numbers, There have only been 4,000 cases so far. Maybe a few hundred could be treated with transfusions and have their lives saved. Why deny them that? This is not an immunization treatment and therefore will only be used on already sick people. Restricting the practice to medical facilities that can handle the procedure will restrict if not eliminate infections of health care workers. Fewer people will be treated but it will be much safer.
If you save one patient with a blood transfusion but kill 2 others who accidentally get infected you're not really doing a good thing.
It you treat a few hundred people under restricted conditions and they live then it is a good thing.
Couldn't this approach be used for any infectious disease for which there's no effective cure but there are some survivors? Are there just no Western diseases that fit the profile? I suppose you need both a person sick with a deadly infection and a recent survivor of a same infection (with the same blood type). So it may just be the case that we simply don't experience that scenario enough to develop this solution. But I'm curious if this approach has been used outside of Ebola in Africa.
It's not used much today, because we've largely conquered the disease agents that such an approach works against. Typically, it works well against infectious agents which are highly vulnerable to a Humoral (antibody-mediated) immune response. Co-incidentally, this also means most vaccines work extremely well against those same disease agents. Unfortunately, Ebola doesn't yet have a commercially available vaccine, but I would expect such a vaccine to work well.
There are only a few examples in the West where we still use this approach -- one that I can think of, is the use of anti-HepB sera in infants born to infected mothers, and for emergency prophylaxis of needlestick injuries involving Hepatitis B exposure. For the bulk of the population, Hepatitis B vaccination works well enough (and is far cheaper).
What it doesn't work well against, are infectious agents that don't respond well to natural antibody defenses. For instance, most anti-HIV antibodies do not defend well against HIV, anti-HepC antibodies do not protect against Hepatitis C, nor do anti-TB antibodies protect against Tuberculosis. For those agents, an effective response depends on cell-mediated immunity.
I am wondering for some time
Truth is that nobody has any clue as to how to contain this ebola epidermic in West Africa
The fact that WHO came out with this "blood transfusion" idea tells us that they have run out of ideas on what to do next
Liberia is issuing a total clamp down on its local population for 3 days, starting September 18th - which in theory can allow the medical personnel to check who is sick, who is not, who to isolate, and whatnot - but which will not work in the reality since there are so many unknowns, so many other things that nobody has yet to considered that will come into play when the things actually transpire
Muchas Gracias, Señor Edward Snowden !
... give the patient more time to produce his own antibodies. ... the experimental treatment used on some western patients is basically antibodies.
Right on both counts.
- Much of why Ebola is so often fatal is that it produces a glycoprotein that interferes with immune system signaling, reducing and delaying the immune system's antibody-mediated specific responses. (Meanwhile the cell damage and foreign protein stimulate the GENERAL responses, which causes self-damage to the body and aids in spreading the infection.) Details on Wikipedia Keeping the virus population and the glycoprotien concentration down by supplying ready-to-go antibodies holds down cell death from infection, self-destruction, and signaliing interference, giving the immune system more time and ability to respond.
- The drug in question is a mix of three monoclonal antibodies, manufactured by stock genetic engineering techniques.
Injections of extracted antibodies, or blood containing them, has a long history in medicine. They have been used against bacteria, viruses, and poisons such as snake venom. Typically they are made by extracting a blood fraction containing antibodies from an animal which has been recently immunized - and is currently hyper-reactive to - the target disease agent or venom. (This gets a load of mixed antibodies which is heavy with those specific to the target.) They may also be extracted from a human survivor of a disease of interest, or a human in general. (These you might hear being called "human imune globin" or "gamma globulin".)
Downsides include allergic reactions to the animal used (typically a horse) or person providing the globulin, infection with blood-borne diseases (such as Hepatitis C), and reaction against the patient by some antibody in the serum.
Antiseura fell out of use for bacteria with the rise of antibiotics (even for diseases, such as menningitis, where antiseurm treatment had higher success rates). Antiviral drugs and the rise of a number of human viral diseases are pushing it down in preference for viral disease treatments - though better blood tests for viral infections is improving its safety. Nothing, of course, has replaced it for antivenom. It's still used for things like Hepatitis A, Measles, rabies exposure, supplement for certain immune difficiencies, and modulating immune system rejection of liver transplants.
With both the rise of antibiotic and antiviral drug resistance and the development of monoclonal antibody culture (prodcing just the desired antibodies to a target on an industrial scale, with negligible risk of dangerous contamination), expect more use of antiseura in medicine - like this "new experimental ebola drug".
Meanwhile, using antibodies extracted from ebola survivors - or transfusions if a matching donor is available - is the same system and might work just fine. And the technology is simple and cheap enough to be available even in third world countries.
Of course you need to wait until the survivor has recovered enough to have built up antibodies and enough blood to spare. Ideally you should also wait until the virus has cleared. (For instance, with Ebola, semen remains infective for at least two months, so blood likely does. as well.) But if the patient is already infected and likely to die without treatment, that's not an issue.
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
Neither the summary or the linked article use the term, but what they're using is known as "convalescent serum". As the parent poster stated above, it's been in use for over a century now, but has only fallen out of fashion in modern times -- mainly because it has been superseded by vaccines and anti-infectives that are cheaper, more reliable, more convenient, and easier to mass-produce.
Trivia note: While Type-O may be the universal blood donor, the ideal serum donor is Type AB.
It has been done during the 1995 Kikwit Ebola outbreak in Zaire. They tried it on eight patients and only one died. I have found no indication that any health care workers were infected.
Just in case anyone is curious, here is the actual paper: http://jid.oxfordjournals.org/...
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.
Any chance this is astroturfing for the company with the Ebola drug? The natural antibodies are a fierce competition to what is now a multi billion dollar market.
Probably not. Shaffer is probably just the mandatory idiot(relatively) to provide 'the other side' of the story.
As for a 'multi billion dollar market', not quite. It's worth a few tens of millions of dollars a year at most. Ebola, for all it's deadliness isn't very transmissive in humans and averages less than a hundred deaths a year - and only a few more infections. It's flashy and attention getting, but pretty much every major infection disease that most people survive kills more on an annual basis. Malaria reliably kills tens of thousands every year. Lots of money there in comparison.
Breaking down his arguments:
labor-intensive: Due to the small number of patients and Africa's poor wealth, labor intensive isn't as big of a deal-breaker as it would be in the USA. They typically have labor, just not much else.
'difficult to serve a large number of patients' - Well, it's a good thing that not a lot of people catch it, right?
'suitable donors' - given survival rates, a very valid concern, but if you can get the death rate down it becomes much easier. Especially if you can get a native doctor or three who have been infected and recovered. Continued exposure will maintain immune response.
'Malnutrition and other health concerns' - Like said elsewhere, it's not like you have much choice. Just make sure you feed your surviving patient X properly so they can donate blood on schedule.
'When are they healthy enough to donate blood' - I'd go with 'When their doctor says so'.
I don't read AC A human right