title: Evaluating large-scale blood transfusion therapy for the current Ebola epidemic in Liberia.
abstract: BACKGROUND
  To combat the 2014-2015 Ebola virus disease (EVD) epidemic in West Africa, the World Health Organization urged the rapid evaluation of convalescent whole blood (CWB) and plasma (CP) transfusion therapy. However, the feasibility and likely impacts of broad implementation of transfusions are yet unknown.
  
  
  METHODS
  We extended an Ebola virus transmission model published by the Centers for Disease Control and Prevention to include hospital-based convalescent donations and transfusions. Using recent epidemiological estimates for EVD in Liberia and assuming that convalescent transfusions reduce the case-fatality rate to 12.5% (range, 7.5%-17.5%), we projected the impacts of a countrywide ramp-up of transfusion therapy.
  
  
  RESULTS
  Under the 10% case-hospitalization rate estimated for Liberia in September 2014, large-scale CP therapy is expected to save 3586 lives by October 2015 (3.1% mortality reduction; 95% confidence interval [CI], .52%-4.5%). Under a higher 30% hospitalization rate, CP transfusions are expected to save 151 lives (0.9% of the total; 95% CI, .21%-11%).
  
  
  CONCLUSIONS
  Transfusion therapy for EVD is a low-cost measure that can potentially save many lives in West Africa but will not measurably influence the prevalence. Under all scenarios considered, CP transfusions are predicted to achieve greater reductions in mortality than CWB.
authors: School of Public Health, University of Illinois at Chicago Department of Medicine, Loyola University Medical Center, Maywood, Illinois.
authors: Alexander
authors: A
authors: Gutfraind
authors: Department of Integrative Biology, University of Texas at Austin Santa Fe Institute, New Mexico.
authors: Lauren Ancel
authors: LA
authors: Meyers
mesh_terms: D001803:Blood Transfusion / Q000379:methods; D029043:Ebolavirus / Q000276:immunology*; D058872:Epidemics; D019142:Hemorrhagic Fever, Ebola / Q000276:immunology* / Q000628:therapy* / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008962:Models, Theoretical
keywords: Ebola virus disease; convalescent blood; dynamic model; polyclonal antibody therapy; transfusion
references: Health Policy Plan. 1999 Dec;14(4):354-62
references: 10787651
references: PLoS Curr. 2014 Nov 06;6:
references: 25685630
references: Proc Natl Acad Sci U S A. 2012 Oct 30;109(44):18030-5
references: 23071322
references: Lancet. 2011 Mar 5;377(9768):849-62
references: 21084112
references: Epidemics. 2014 Dec;9:70-8
references: 25480136
references: Expert Rev Clin Immunol. 2014 Jun;10(6):781-90
references: 24742338
references: Euro Surveill. 2014 Sep 11;19(36):
references: 25232919
references: Nat Biotechnol. 2014 Sep;32(9):849-50
references: 25203010
references: Immunotherapy. 2013 Nov;5(11):1221-33
references: 24188676
references: Appl Health Econ Health Policy. 2011;9(1):29-37
references: 21174480
references: Methods Mol Biol. 2009;525:1-27, xiii
references: 19252861
references: Ann Intern Med. 2014 Nov 18;161(10):749-50
references: 25141813
references: Nature. 2014 Oct 2;514(7520):47-53
references: 25171469
references: Science. 2014 Nov 21;346(6212):991-5
references: 25414312
references: Proc Natl Acad Sci U S A. 2012 Mar 27;109(13):5034-9
references: 22411795
references: PLoS Curr. 2014 Sep 02;6:
references: 25642364
references: N Engl J Med. 2015 Aug 20;373(8):776
references: 26287857
references: J Theor Biol. 2004 Jul 7;229(1):119-26
references: 15178190
references: Biologicals. 2010 Jan;38(1):53-8
references: 20022523
references: Sci Rep. 2013 Nov 28;3:3365
references: 24284388
references: Epidemiol Infect. 2007 May;135(4):610-21
references: 16999875
references: Nat Rev Microbiol. 2004 Sep;2(9):695-703
references: 15372080
references: Immunotherapy. 2013 May;5(5):441-3
references: 23638738
references: MMWR Suppl. 2014 Sep 26;63(3):1-14
references: 25254986
references: J Infect Dis. 2007 Nov 15;196 Suppl 2:S400-3
references: 17940976
references: J Infect Dis. 1999 Feb;179 Suppl 1:S18-23
references: 9988160
references: N Engl J Med. 2015 Jan 1;372(1):40-7
references: 25372658
references: N Engl J Med. 2014 Oct 16;371(16):1481-95
references: 25244186
references: Br Med J. 1977 Aug 27;2(6086):541-4
references: 890413
references: Biometrics. 2006 Dec;62(4):1170-7
references: 17156292
references: Lancet. 2014 Oct 11;384(9951):1347-8
references: 25277678