Guidelines for Treatment of Ebola Patients Are Urgently Needed

Call to action from notedinfectious diseases experts published in the International Journal of InfectiousDiseases

London, United Kingdom, December 9, 2014

Asthe Ebola Virus Diseases (EVD) epidemic continues to rage in West Africa,infectious diseases experts call attention to the striking lack of treatmentguidelines. With over 16,000 total cases and more than 500 new infectionsreported per week, and probable underreporting of both cases and fatalities,the medical community still does not have specific approved treatment in placefor Ebola, according to an editorial published in the International Journal of Infectious Diseases.

Notonly are treatment guidelines lacking, but there are conflicting reports ofmortality rates and few descriptions of actual treatments being used. What isclear is that the treatments in industrialized nations with well-developedpublic health systems differ significantly from those in less-developed nations,especially those with histories of civil wars and little health infrastructure.The few data available indicate that simple fluid replacement and correction ofelectrolyte imbalances will significantly reduce mortality.

Accordingto authors Eskild Petersen, MD, Editor-in-Chief of the International Journal of Infectious Diseases and Professor ofTropical Medicine, Department of Infectious Diseases and Clinical Microbiology,Aarhus University Hospital, Aarhus Denmark, and Boubacar Maiga, MD, PhD, Facultyof Medicine, University of Sciences, Techniques and Technology of Bamako,(USTTB), Bamako, Mali, "Very little data has emerged. One published studyreported a mortality of 72% but astonishingly the study contained noinformation on any treatment. Thus the question remains whether the patientsincluded in that study received any treatment at all."

Theseexperts explain that management of the epidemic has fallen primarily toNon-Governmental Organizations (NGOs), which have not published any treatment resultdata and have been simply reporting confirmed cases and outcomes. Without dataabout the success or failure of specific treatments, treatment may only bepalliation and "Ebola hospitals" may be no more than hospices intended toisolate cases from the community.

Staffingof treatment facilities is a crucial issue and it can be speculated that theNGOs do not have access to physicians and nurses with knowledge and experiencein high-volume fluid replacement and correction of electrolyte imbalance.

Theauthors suggest that the World Health Organization take the leadership anddevelop guidelines for treatment including:

  • Diagnosis of EVD
  • Principles for intravenous fluid replacement
  • Principles for measurement and correction of electrolyte imbalance
  • Diagnosis and treatment of concomitant malaria
  • Guidelines for administration of antibiotics based on suspicion of septicemia
  • HIV testing
  • Implementation of a reporting system for all EVD treatment facilities with weekly survival figure updates reported for each NGO to ensure quality control, transparency, and optimization of treatment algorithms

Petersenand Maiga further propose that one strategy could be twinning with hospitals inindustrialized countries whereby these hospitals adopt an EVD treatment facilityand ensure staffing and training. "This of course would need support fromnational health authorities," they note. "Such a program would ensure thateffective intravenous fluid replacement therapy would be provided, which wouldprobably significantly reduce mortality, ensure confidence in treatmentfacilities from the local population, and thus increase the use of thesefacilities with earlier admissions and higher proportion of cases treated,isolated, and recovered." 


Notes for editors
"Guidelinesfor treatment of patients with Ebola Virus Diseases are urgently needed," byEskild Petersen, MD, and Boubacar Maiga, MD, PhD. DOI:, International Journal of Infectious Diseases,Volume30 (January 2015), published by Elsevier. 

Full text of this study is openly available at Journalists wishing to interview Dr.Eskild Petersen may contact him directly at +45 78452817, +45 2073 3223 (mobile), or

About the International Journalof Infectious Diseases
The International Journal of Infectious Diseases (IJID) is published bythe International Society for Infectious Diseases ( is a peer-reviewed, open access journal that publishes original clinicaland laboratory-based research, together with reports of clinical trials,reviews, and some case reports dealing with the epidemiology, clinicaldiagnosis, treatment, and control of infectious diseases with particularemphasis placed on those diseases that are most common in under-resourcedcountries.

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