title: Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers.
abstract: BACKGROUND
  Although a few international health-care workers who have assisted in the current Ebola outbreak in west Africa have been medically evacuated for treatment of Ebola virus disease, more commonly they were evacuated after potential accidental exposure to Ebola virus. An urgent need exists for a consensus about the risk assessment of Ebola virus transmission after accidental exposure, and to investigate the use of post-exposure prophylaxis (PEP). Experimental vaccines have occasionally been used for Ebola PEP, but newly developed experimental antiviral agents have potential advantages. Here, we describe a new method for risk assessment and management of health-care workers potentially exposed to Ebola virus and report the use of experimental antiviral therapies for Ebola PEP in people.
  
  
  METHODS
  We devised a risk assessment and management algorithm for health-care workers potentially exposed to Ebola virus and applied this to eight consecutive individuals who were medically evacuated to the UK from west Africa between January, and March, 2015. PEP with antiviral agents was given to health-care workers assessed to have had substantial risk exposures to Ebola virus. Participants were followed up for 42 days after potential exposure.
  
  
  RESULTS
  Four of eight health-care workers were classified as having had low risk exposures and managed by watchful waiting in the community. None of these health-care workers developed Ebola virus disease. The other four health-care workers had intermediate or maximum risk exposures and were given PEP with antiviral agents. PEP was well tolerated with no serious adverse effects. None of these four health-care workers, including two with maximum risk exposures from penetrating injuries with freshly used hollow-bore needles, developed Ebola virus disease.
  
  
  CONCLUSIONS
  Standardised risk assessment should be adopted and consensus guidelines developed to systematically study the efficacy and safety of PEP with experimental agents. New experimental antiviral treatments are a viable option for PEP against Ebola.
  
  
  BACKGROUND
  Royal Free London NHS Foundation Trust.
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK. Electronic address: michael.jacobs@ucl.ac.uk.
authors: Michael
authors: M
authors: Jacobs
authors: Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK.
authors: Emma
authors: E
authors: Aarons
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Sanjay
authors: S
authors: Bhagani
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Ruaridh
authors: R
authors: Buchanan
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Ian
authors: I
authors: Cropley
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Susan
authors: S
authors: Hopkins
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Rebecca
authors: R
authors: Lester
authors: Division of Surgery, University College London, London, UK.
authors: Daniel
authors: D
authors: Martin
authors: Department of Pharmacy, Royal Free London NHS Foundation Trust, London, UK.
authors: Neal
authors: N
authors: Marshall
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Stephen
authors: S
authors: Mepham
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors: Simon
authors: S
authors: Warren
authors: Department of Infection, Royal Free London NHS Foundation Trust, London, UK; Research Department of Infection and Population Health, University College London, London, UK.
authors: Alison
authors: A
authors: Rodger
mesh_terms: D000354:Africa, Western; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D000998:Antiviral Agents