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Media Myth On Ebola Convalescent Antibodies
Recombinomics Commentary
Octoerber 23, 2014 21:00

The patient’s 103-degree fever might warrant “a little more investigation,” Adalja said. A chart showed he did not arrive with a fever but left with one.

By Duncan’s second ER visit, the care was “impeccable,” the doctor said. Dallas physicians immediately signaled concern about Ebola and “spared no measure to try to keep him alive.”

After it became clear that Duncan was suffering from Ebola, another option would have been to give him a transfusion from an Ebola survivor in the hopes that antibodies in the blood could help him fight the disease.
But Duncan did not receive a transfusion because the blood types did not match, the hospital said.

Dr. Kent Brantly, the first American flown back to the U.S. for treatment of Ebola, confirmed that account, saying he spoke with a doctor caring for Duncan and was willing to donate blood. But their blood types were incompatible, he said Friday in an interview with Abilene Christian University’s alumni magazine.

The above account on the failure to treat Duncan with convalescent plasma is alarming.  The WHO has cited the use of convalescent blood or plasma to treat patients and posted a detailed 2014 report on its Ebola website entitled “Use of Convalescent Whole Blood or Plasma Collected from Patients Recovered from Ebola Virus Disease for Transfusion, as an Empirical Treatment during Outbreaks”.  The report addresses ABO mismatches:

When it is not possible to test the patient’s ABO group or if ABO matched CWB/CP is not available then:
and recommends using whole blood if the donor is type O (universal donor) and to use plasma if the donor is type AB, A, or B (since plasma has had the blood cells removed).
Indeed, Kent Brantly was treated with convalescent antibodies from a recovered case (14M) in Liberia and he was the donor for three cases treated in Nebraska (Rick Sacra and Ashoka Mukpo) was well as the health care worker in Texas, Nina Pham.  Media reports characterize one or more of these treatments as a plasma infusion, suggesting an ABO mismatch (which would preclude a whole blood transfusion, but not a plasma transfusion).

This failure to treat with convalescent antibody follows a failure to admit when Eric Duncan made his initial visit to Texas Health Presbyterian Hospital on the evening of September 25.  Although he had a low grade fever when he arrived, when he left 4 hours later he had a fever of 103 F (and was sent home with antibiotics and Tylenol).

Texas Health Presbyterian Hospital has been cited for the past three years for having a high frequency of ER discharges which returned within 30 days, and Eric Duncan fit that pattern when he returned on September 28 after a contact called 911, which led to ambulance transport.  By then Eric Duncan also had diarrhea and vomiting but his blood was not sent out for Ebola testing until the next day, Monday, September 29 (and media reports indicated his nephew call the CDC on Monday due to a lack of progress).

Although Eric Duncan was lab confirmed on Tuesday, September 30 by the CDC in Atlanta and the Texas State Lab in Austin, he was not treated with convalescent antibodies even though Kent Brantly was willing to donate.  Moreover, experimental drug treatment was delayed until Duncan suffered organ failure and was placed on life support (involving intubation and dialysis).

The withheld antibodies and late treatment may have contributed to the patient’s deterioration, which was likely associated with an increased viral load, which may have played a role in the infection of Nina Pham.

More detail on the apparent failure to follow WHO advise on the use of convalescent plasma on recipients which do not match the donor and why the treatment of Eric Ducan was characterized as “impeccable” would be useful .

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