For only the second time, an experimental Ebola vaccine has been used to treat someone exposed to the deadly virus.
A case study of a Maryland physician exposed to Ebola in Africa, published last week in the Journal of the American Medical Association, has put a renewed spotlight on the race to fight a disease that, even as the world’s attention has largely moved away from the year-old outbreak, continues to spread in West Africa and still prompts concerns in Chicago.
The most recent instance of a traveler returning to Chicago from West Africa with a fever and other Ebola-like symptoms happened last week, the Chicago Sun-Times has learned. The patient was admitted to Northwestern Memorial Hospital, where Ebola was provisionally ruled out, and sent home to complete the 21-day monitoring period for the virus.
That marked the seventh time someone with suspected symptoms of exposure returning from Liberia, Sierra Leone or Guinea — countries where the outbreak centered — has been sent to one of the four hospitals in Chicago’s Ebola Resource Network for screening.
None turned out to have Ebola, and none spent more than three days in the hospital, according to Dr. Julie Morita, acting commissioner of the Chicago Department of Public Health, who would not provide any specifics on the most recent suspected case.
“Every time we have a patient that we evaluate, our systems are getting better,” Morita said. “What we know is we need to have a heightened level of preparedness as long as there is disease activity going on in West Africa. All it takes is one person.”
That’s why experts say the case study the American Medical Association journal reported Thursday is significant. It found that an investigational vaccine called VSVΔG-ZEBOV was successful in targeting the body’s immune response to block Ebola.
But the case study involved just one person, who had a possible but unconfirmed Ebola infection. The vaccine’s effectiveness as a post-exposure remedy remains unproven.
The Maryland case involved a September 2014 incident in which Dr. Lewis Rubinson, then 44, was stuck with a needle that punctured a thumb through his gloves while he was working on contract with the World Health Organization in an Ebola unit in Sierra Leone.
Rubinson was medically evacuated within 43 hours; given the VSVΔG-ZEBOV vaccine in-flight and developed Ebola-like symptoms that dissipated over the course of a week at the National Institutes of Health in Bethesda, Maryland. He was discharged on day 9 to complete the 21-day monitoring at home, has fully recovered and returned to work.
“I knew my risk of infection was not 100 percent, probably closer to 10 percent, but I wanted to get the risk as close to zero as possible,” said Rubinson, now 45, who is director of the critical care resuscitation unit at the University of Maryland’s shock trauma center.
Though it’s not clear the treatment offers protection from Ebola and while it left Rubinson feeling miserable, he said in an interview Friday, “If I really had Ebola, I’d take that wallop from the vaccine any day. If it saves me, sign me up.”
The vaccine had been given to someone exposed to Ebola only once before, in 2009, to a laboratory worker in Germany who also suffered a needle stick and recovered.
Dr. John Segreti, an epidemiologist on Rush University Medical Center’s Ebola planning committee, said the Maryland success “is just one case report. Larger studies are needed.”
Testing of VSVΔG-ZEBOV as a preventive vaccine continues, with phase 3 trials — the last of three steps — starting last month in Liberia, along with trials of a second drug that similarly has shown promise as a preventive measure, the chimpanzee adenovirus type 3 Ebola vaccine.
Dr. Mark Mulligan, author of the JAMA study and director of the Hope Clinic at Atlanta’s Emory University, where the first Ebola patients evacuated from West Africa were treated, said a vaccine is needed in addition to the “personal protective equipment” used by health workers who could be exposed to Ebola.
“Although news reports lately indicate the epidemic is diminishing in West Africa, it’s not over yet,” he said.
University of Chicago Medical Centers epidemiologist Dr. Emily Landon, who heads its Ebola team , said the protective equipment for health workers, though effective, is “incredibly resource-intensive, requiring redundant staffing.”
“An effective vaccine would liberate us from having to be quite so careful and normalize the care of Ebola patients,” Landon said. “I would not recommend my staff undergo experimental Ebola vaccine unless they were part of a trial. However, God forbid, if somebody were exposed in spite of the [protective equipment], we’d probably consider it.”
Added Rush’s Segreti: “If we had a vaccine, we would probably offer immunization to our core team — the ones who would most likely be exposed to Ebola. I don’t think a vaccine would have as much impact here in the U.S., but it would have a huge impact in West Africa.”
Ebola has infected 23,800 people and killed nearly 10,000, according to the World Health Organization. It’s claimed two lives on U.S. soil — that of Thomas Eric Duncan, visiting from Liberia, who died in September, and Maryland physician Martin Salia, who died in November after contracting the disease while working in Sierra Leone.
Eight other cases have been successfully treated, six involving American workers in West Africa. The other two were nurses who cared for Duncan at a Dallas hospital.