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| A Plan to Use Survivors’ Blood for Ebola Treatment in Africa | |
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| With no proven drugs to treat Ebola and experimental ones in short supply, the health authorities are planning to turn instead to a treatment that is walking around in the outbreak zone in West Africa. | With no proven drugs to treat Ebola and experimental ones in short supply, the health authorities are planning to turn instead to a treatment that is walking around in the outbreak zone in West Africa. |
| That would be the blood of people who have been sickened by the Ebola virus but have since recovered. Their blood should contain antibodies that might help other patients fight off the infection. | That would be the blood of people who have been sickened by the Ebola virus but have since recovered. Their blood should contain antibodies that might help other patients fight off the infection. |
| The World Health Organization is making it a priority to try such convalescent blood or plasma, as it is called, and is talking with the affected countries about how to do it. | The World Health Organization is making it a priority to try such convalescent blood or plasma, as it is called, and is talking with the affected countries about how to do it. |
| This week, the organization issued guidance on how to collect the blood and administer transfusions. | This week, the organization issued guidance on how to collect the blood and administer transfusions. |
| “The concept that this treatment could be efficacious is biologically plausible, as convalescent plasma has been used successfully for the treatment of a variety of infectious agents,” the W.H.O. guidance document says. | “The concept that this treatment could be efficacious is biologically plausible, as convalescent plasma has been used successfully for the treatment of a variety of infectious agents,” the W.H.O. guidance document says. |
| Plausibility, however, is not proof that such treatments would work for Ebola and some virologists doubt it will. The results of studies in monkeys were discouraging, they note. | Plausibility, however, is not proof that such treatments would work for Ebola and some virologists doubt it will. The results of studies in monkeys were discouraging, they note. |
| There will also be logistical problems carrying this out in West Africa, where blood banks are not well developed. One challenge will be to make sure that the donated blood, even if it helps patients recover from Ebola, does not give them H.I.V. or hepatitis. | There will also be logistical problems carrying this out in West Africa, where blood banks are not well developed. One challenge will be to make sure that the donated blood, even if it helps patients recover from Ebola, does not give them H.I.V. or hepatitis. |
| “Major questions need to be answered about the safety and efficacy of convalescent therapies, and the feasibility of implementation in countries with shattered health systems and an acute shortage of medical staff,” the W.H.O. said in a separate statement released a week ago. | |
| Still, with the epidemic spiraling out of control, there is a sense that some treatment needs to be offered, even if only to give sick people hope and a reason to go to medical centers, where they can be stopped from spreading the disease to others. And there are really no other good options. | Still, with the epidemic spiraling out of control, there is a sense that some treatment needs to be offered, even if only to give sick people hope and a reason to go to medical centers, where they can be stopped from spreading the disease to others. And there are really no other good options. |
| “The attraction is, at least on the surface, it is something that could be implemented readily,” said Dr. Daniel Bausch, an expert on Ebola at Tulane University and an adviser to the health organization. | “The attraction is, at least on the surface, it is something that could be implemented readily,” said Dr. Daniel Bausch, an expert on Ebola at Tulane University and an adviser to the health organization. |
| The Bill & Melinda Gates Foundation and the Wellcome Trust are among the organizations championing convalescent plasma and working on how to put it into effect. | The Bill & Melinda Gates Foundation and the Wellcome Trust are among the organizations championing convalescent plasma and working on how to put it into effect. |
| “Blood is donated in West Africa every day of the week for surgery and other things and could be safely tested for viruses,” said Dr. Jeremy Farrar, director of the Wellcome Trust. | “Blood is donated in West Africa every day of the week for surgery and other things and could be safely tested for viruses,” said Dr. Jeremy Farrar, director of the Wellcome Trust. |
| Such therapies have already been used in the current outbreak. Dr. Kent Brantly, an American aid worker who contracted Ebola in Liberia, received a blood transfusion from a boy who had recovered. After Dr. Brantly survived his bout with the disease, some of his plasma was given to another American aid worker, Dr. Rick Sacra, who also recovered. | Such therapies have already been used in the current outbreak. Dr. Kent Brantly, an American aid worker who contracted Ebola in Liberia, received a blood transfusion from a boy who had recovered. After Dr. Brantly survived his bout with the disease, some of his plasma was given to another American aid worker, Dr. Rick Sacra, who also recovered. |
| But it is not known whether the transfusions helped in those cases, since both men also received experimental drugs and excellent supportive care in American hospitals. | But it is not known whether the transfusions helped in those cases, since both men also received experimental drugs and excellent supportive care in American hospitals. |
| Authorities say this approach has been used in Africa, but to a limited extent. There have even been rumors of a black market for the blood of survivors. Dr. Margaret Chan, the director general of the W.H.O., said in a news conference last month that her organization would work to stamp out underground use of blood because such a therapy must be administered properly and safely. | Authorities say this approach has been used in Africa, but to a limited extent. There have even been rumors of a black market for the blood of survivors. Dr. Margaret Chan, the director general of the W.H.O., said in a news conference last month that her organization would work to stamp out underground use of blood because such a therapy must be administered properly and safely. |
| The use of blood or plasma — either from recovered patients or from animals deliberately exposed to a pathogen — dates from the late 1800s, and for decades was a mainstay of treatment for infectious diseases. Emil von Behring, a German physician scientist, won the first Nobel Prize in Physiology or Medicine in 1901 for pioneering the serum approach for diphtheria. | |
| Convalescent therapies were used, apparently with some success, in the Spanish flu pandemic of 1918. And such treatments are still used for rabies, snake bites, hepatitis A and B, and other diseases. But for some viral diseases, like hepatitis C and the human immunodeficiency virus, it has not been shown to work. | |
| Many of the treatments used today are made by pooling the plasma of many donors and processing it to get high concentrations of the desired antibodies. That is probably not going to be feasible in Africa because of a lack of technology and the large-scale facilities to do it, according to executives in the plasma products industry. | Many of the treatments used today are made by pooling the plasma of many donors and processing it to get high concentrations of the desired antibodies. That is probably not going to be feasible in Africa because of a lack of technology and the large-scale facilities to do it, according to executives in the plasma products industry. |
| The simplest approach would be to use whole blood donated by one person and transfused into another. That has some risk of side effects, like allergic reactions, though not much if the blood types of donor and recipient match. | The simplest approach would be to use whole blood donated by one person and transfused into another. That has some risk of side effects, like allergic reactions, though not much if the blood types of donor and recipient match. |
| A better approach, experts say, would be to transfuse only plasma, the clear part of the blood that contains the antibodies. Plasma can be obtained by letting the blood cells settle and drawing off the plasma. | A better approach, experts say, would be to transfuse only plasma, the clear part of the blood that contains the antibodies. Plasma can be obtained by letting the blood cells settle and drawing off the plasma. |
| Even better would be to use apheresis machines, which collect only the plasma from the donor. People can donate plasma alone much more frequently than they can donate whole blood, which can be an advantage if there are not many survivors willing to donate. Experts say it would be feasible to bring in such machines for use in the better-equipped treatment centers in West Africa. | Even better would be to use apheresis machines, which collect only the plasma from the donor. People can donate plasma alone much more frequently than they can donate whole blood, which can be an advantage if there are not many survivors willing to donate. Experts say it would be feasible to bring in such machines for use in the better-equipped treatment centers in West Africa. |
| One challenge could be testing donated blood to make sure it is truly free of Ebola virus, as well as of H.I.V., hepatitis B, hepatitis C and syphilis. | One challenge could be testing donated blood to make sure it is truly free of Ebola virus, as well as of H.I.V., hepatitis B, hepatitis C and syphilis. |
| Albert Farrugia, vice president for global access at the Plasma Protein Therapeutics Association, a trade group, said there are ways to inactivate viruses in donated plasma that might be feasible to deploy in Africa. One such approach treats the plasma with solvents and detergents in a plastic bag. | Albert Farrugia, vice president for global access at the Plasma Protein Therapeutics Association, a trade group, said there are ways to inactivate viruses in donated plasma that might be feasible to deploy in Africa. One such approach treats the plasma with solvents and detergents in a plastic bag. |
| Convalescent blood or plasma has been tried for Ebola since the virus first emerged in 1976. That year, a woman in the Democratic Republic of Congo, known then as Zaire, received plasma from a person who had recovered from the related Marburg virus, however, she still died, according to the health organization. | Convalescent blood or plasma has been tried for Ebola since the virus first emerged in 1976. That year, a woman in the Democratic Republic of Congo, known then as Zaire, received plasma from a person who had recovered from the related Marburg virus, however, she still died, according to the health organization. |
| In November of that year, a researcher in Britain who was working with material from the African outbreak accidentally pricked himself and got sick. He received two transfusions of serum from survivors in Africa, as well as the antiviral drug interferon. He eventually recovered. | In November of that year, a researcher in Britain who was working with material from the African outbreak accidentally pricked himself and got sick. He received two transfusions of serum from survivors in Africa, as well as the antiviral drug interferon. He eventually recovered. |
| In the 1995 outbreak in Kikwit, also in Congo, seven of eight people who received convalescent whole blood survived, a survival rate far better than the 20 percent for the outbreak as a whole. Still, the patients got a higher than usual standard of care that may have accounted, in part, for the better survival rate. | In the 1995 outbreak in Kikwit, also in Congo, seven of eight people who received convalescent whole blood survived, a survival rate far better than the 20 percent for the outbreak as a whole. Still, the patients got a higher than usual standard of care that may have accounted, in part, for the better survival rate. |
| Testing in primates has not found serum to be effective against Ebola. After one of their negative studies, United States government researchers wrote in a 2007 paper: “Given these discouraging results and the risks of transmitting infection, whole-blood transfusions, even under desperate epidemic conditions, seem unwarranted.” | Testing in primates has not found serum to be effective against Ebola. After one of their negative studies, United States government researchers wrote in a 2007 paper: “Given these discouraging results and the risks of transmitting infection, whole-blood transfusions, even under desperate epidemic conditions, seem unwarranted.” |
| But now there are desperate conditions and plans are moving ahead. One of the authors of that paper, Dr. Thomas W. Geisbert, now with the University of Texas Medical Branch in Galveston, said that as long as the blood was adequately screened for viruses, the transfusions should do no harm, even if they do not help. | But now there are desperate conditions and plans are moving ahead. One of the authors of that paper, Dr. Thomas W. Geisbert, now with the University of Texas Medical Branch in Galveston, said that as long as the blood was adequately screened for viruses, the transfusions should do no harm, even if they do not help. |
| The W.H.O. says trying such therapies will have a benefit beyond Ebola by developing the capacity in West Africa to do transfusions in general. That could help in treating injuries, other disease like malaria and yellow fever, and complications of childbirth. | The W.H.O. says trying such therapies will have a benefit beyond Ebola by developing the capacity in West Africa to do transfusions in general. That could help in treating injuries, other disease like malaria and yellow fever, and complications of childbirth. |