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Ebola vaccine rVSV-Zebov ( ervebo °) in an outbreak of Ebola virus disease Major reduction in incidence among those at risk for this often-fatal infection

BRAVO The evaluation data on Ebola vaccine rVSV-­ Zebov show that, during an outbreak of Ebola virus disease, vaccinating those who have been in contact with infected patients great- ly reduces the number of new cases, from day 10 after vaccination onwards.The report- ed adverse effects are acceptable given the severity of the disease, and include those common to all vaccines, as well as joint and skin disorders. The vaccine must be kept frozen, which complicates its use. In practice, this vaccine is a useful complement to the strict protective and hygiene measures that must be implemented around a patient infect- ed with Ebola virus. ERVEBO° - Ebola vaccine rVSV-Zebov solution for intramuscular injection • at least 72 million pfu (plaque-forming units) of live atten- uated rVSVdeltaG-Zebov-GP (recombinant vesicular sto- matitis virus expressing a Zaire Ebola virus surface glyco- protein) per vial in 1 ml of solution, corresponding to one dose of vaccine ■ Ebola vaccine ■ Indication : “ active immunization of individuals 18 years of age or older to protect against EbolaVirus Disease caused by Zaire Ebola virus ”. [EU centralised procedure]

of the fever after 6 to 11 days usually means that the patient will survive.The convalescent period is long and sometimes associated with sequelae, in- cluding neurological and hepatic disorders. In fatal cases, death occurs between 6 and 16 days after the onset of symptoms, in a context of generalised haemorrhage and multiorgan failure (1-5). Most outbreaks of Ebola virus disease have oc- curred in Africa, including in the Democratic Repub- lic of the Congo, Sierra Leone, Liberia and Guinea. The Zaire strain of the virus was usually involved. The proportion of infected patients who died (the case fatality rate) ranged from 30% to 90%, depend- ing on the outbreak (1,2,4). Transmitted through exposure to body fluids and excreta. According to epidemiological studies, Ebola virus is mainly transmitted from person to person through contact between a healthy person’s skin or mucous membranes and an infected person’s body fluids (including blood, tears, saliva, semen, amniotic fluid or breast milk) or excreta (faeces, urine, vomit or sweat), or through injuries with contaminated equipment. Airborne transmission seems unlikely. In non-fatal cases, the Ebola virus appears to persist in certain organs (including the testicles, eyes and central nervous system) and some body fluids (including semen), occasionally up to 2 years after the infection. In pregnant women, the virus persists in the placenta, amniotic fluid and breast milk, as well as in the fetus (1-4). Healthcare professionals are at particularly high risk of acquiring the infection. Between 1 January 2014 and 31 March 2015, during the epidemic in Guinea, Sierra Leone and Liberia, the incidence of Ebola virus infection per 1000 health workers was evaluated at 30 for doctors, 43 for nurses and 40 for laboratory technicians, versus 1.4 for non-health workers (4). In addition to health workers, anyone else in close contact with infected patients or who handles in- fected cadavers is also at high risk of contracting and spreading the virus. Infected patients do not appear to be contagious during the incubation period, when the virus is not detectable in blood (1,2).

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Ebola virus disease, in brief

Ebola virus disease is caused by a virus belonging to the filovirus family. The main reservoir of this virus is a bat found in the forests of equatorial Africa. The infection is sometimes transmitted to other mammals, including humans (1,2). A serious and often fatal infection. After an incu- bation period of 2 to 21 days, Ebola virus disease presents with non-specific flu-like symptoms, in- cluding fever.This is followed by signs of multiorgan damage, including respiratory, gastrointestinal, hepatic, renal, neurological and cutaneous disorders. About half of patients develop bleeding. Resolution

Full review (5 pages) available to subscribers at english.prescrire.org ▶ Translated from Rev Prescrire December 2020 Volume 40 N° 446 • Pages 885-887

Prescrire Int • February 2021

P rescrire I nternational S pecial E dition 2021 • P age 3