Ebola outbreak: Doctor's use of Canada's experimental vaccine offer clues

The case of a doctor who received the Canadian-developed Ebola vaccine after pricking his glove treating patients in Sierra Leone offers clues to its use in controlling the outbreak.

No evidence of Ebola virus infection detected in U.S. physician

The case of a doctor who received the Canadian-developed Ebola vaccine after pricking his glove treating patients in Sierra Leone offers clues to its use in controlling the outbreak.

In Thursday’s online issue of JAMA, U.S. and Canadian researchers describe how Lewis Rubinson, a 44-year-old U.S. physician, had an accidental needlestick injury in September at an Ebola treatment unit that was considered to pose a significant risk of infection.  

The patient gave written consent to receive the experimental Ebola vaccine, VSV-Zebov.

A clinical trial to test its safety and efficacy to prevent Ebola is ready to launch Saturday in Basee Guinée, the region of Guinea that currently has the most cases, the World Health Organization said.

"The Ebola epidemic shows signs of receding but we cannot let down our guard until we reach zero cases," Marie-Paule Kieny, who leads WHO’s Ebola Research and Development effort, said in a release. "An effective vaccine to control current flare-ups could be the game-changer to finally end this epidemic and an insurance policy for any future ones."

The trial aims to assess if the vaccine protects contacts who are immunized and if these individuals create a buffer to prevent further spread.

The Canadian government is supporting the trial by providing training and support to African research teams, the UN health agency said.

While the safety and efficacy of the vaccine can’t be learned from Rubinson’s single case, the clinical and laboratory data "are informative at a time when there is a need to garner all information available on Ebola vaccines," Dr. Mark Mulligan of Emory University in Atlanta and his co-authors concluded.

In December, Rubinson wrote a personal account of his symptoms, fears and comments on Ebola politics for the American Journal of Tropical Medicine and Hygiene. 

Importance of preventive measures

The JAMA study fills in details of how he developed a fever, nausea malaise, muscle pain and chills about 14 hours after receiving the vaccine on board a jet for medical evacuation.

"The clinical syndrome and laboratory evidence were consistent with vaccination response and no evidence of Ebola virus infection was detected," the study’s authors said.

Thomas Geisbert of the University of Texas Medical Branch in Galveston wrote a journal editorial published with the study.

This is the second time the VSV-Zebov vaccine has been used to treat potential exposure to the virus. The first was in 2009 for a lab worker in Germany, who had less severe adverse events, Geisbert said.

While it’s impossible to know with absolute certainty whether the experimental vaccine had any influence on Rubinson’s survival, the incident serves as an example of how important it is to have safe and effective countermeasures available in large enough quantities to be used by both medical workers and affected populations, he said.

Geisbert called the need for antiviral treatments unquestionable but said use of preventative vaccines and personal protective equipment the most effective way to prevent and control outbreaks by protecting those at high risk, including medical staff and lab workers.

Mulligan’s team included Gary Kobinger and Judie Alimonti from the Public Health Agency of Canada in Winnipeg, which provided the vaccine, as well as doctors and scientists from the U.S. National Institutes of Health, U.S. Centers for Disease Control and Prevention and U.S. Army Medical Research Institute of Infectious Diseases. 


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