Although it is impossible to draw broad conclusions from a single case, doctors said the information was nonetheless useful.
The moment he felt a needle jab his thumb in September on an Ebola ward in Sierra Leone, Dr. Lewis Rubinson knew he was at risk of contracting the deadly disease. What could he do but wait to see if he got sick and hope treatment would pull him through?
Rubinson, an intensive-care specialist and associate professor at the University of Maryland School of Medicine, chose another option, described in an article and editorial published Thursday in The Journal of the American Medical Association.
He was quickly given a shot of an experimental vaccine, a type that had been used in only one other person. The hope was that if he had been exposed to Ebola, the vaccine would stimulate his immune system to fight off the virus.
It is not clear whether the vaccine could have protected him against Ebola, because blood tests indicate he was almost certainly never infected. It is clear, though, that the vaccine stirred up his immune system: He had fever, chills, nausea, muscle pains and a headache. But the symptoms ebbed after a few days, and when it was all over, blood tests suggested he was probably immune to Ebola.
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Although it is impossible to draw broad conclusions from a single case, doctors said the information was nonetheless useful. There is hardly any other data on how the vaccine affects people, and knowing how Rubinson fared may help other health workers potentially exposed to Ebola decide whether to be vaccinated.
“In all likelihood, unfortunately, there will continue to be health-care workers and others who have what are considered to be significant exposures to this potentially lethal virus,” said Dr. Mark Mulligan, a professor of medicine and infectious diseases at Emory University School of Medicine, and senior author of the journal article.
The current outbreak has killed hundreds of doctors and nurses, mostly Africans. Ideally, Mulligan said, health workers would be vaccinated before they begin caring for Ebola patients. But until vaccines are approved and made widely available, he said, emergency treatment as in Rubinson’s case will be the best that doctors can offer to people who may have been exposed on the wards.
The vaccine given to Rubinson was made from another virus, VSV, for vesicular stomatitis virus, which causes a mouth disease in cattle but rarely infects people. VSV has been used successfully in making other vaccines.
The vaccine was created by scientists from Canada and the United States about a decade ago, but its progress was stalled until recently, largely because drug companies have been reluctant to spend the huge sums needed to develop products useful mostly to poor countries.
Anticipating that a health worker might have a possible exposure, say from a needle stick or a breach in protective gear, doctors at Emory obtained a few vials of the vaccine from Canada. The idea would be to give the injection as soon as possible; waiting for symptoms to develop might be too late.
The plane that flew from the United States to pick up Rubinson brought the vaccine, and he was given the shot before takeoff. The vaccine is not approved by the Food and Drug Administration (FDA), and Emory had to request special permission to offer it to him on an emergency basis.
But no one had any idea whether the vaccine would help, or was even safe. Tests had shown it worked in monkeys, but it had been used in a person only once before, in 2009, when a lab worker in Germany was pricked by a needle. That worker never became infected.
The vaccine given to Rubinson came from another batch, produced somewhat differently, and he was the first person to receive it.
Since then, the vaccine has undergone safety testing in healthy people in the United States and other countries, and it is being studied in a clinical trial in Liberia, but no information from that research has been published.
After landing, Rubinson was taken by ambulance to the hospital at the National Institutes of Health in Bethesda, Md. He wrote an essay about his treatment for The American Journal of Tropical Medicine and Hygiene.
“I was under, like, seven blankets,” he said in an interview. “I was freezing, drenched, miserable.”
Although he knew he was almost certainly having a vaccine reaction, he also knew his symptoms matched those of Ebola, and he could not help wondering if he was infected.
“Everything played out exactly like we had thought,” he said. “But when you’re in the midst of it, you start to doubt.”
His misery began to ebb after a few days, and he recovered fully. Blood tests found evidence of immunity to Ebola and a strong reaction to the vaccine — but no signs that he had ever been infected with Ebola.
“I think all those symptoms were from the vaccine,” Mulligan said. “The strongest conclusion is that he had never been infected with Ebola.”
Several other health workers with possible exposures have been given the vaccine since Rubinson was treated, Mulligan said. But he said he could not discuss their cases because of patient-privacy rules.