Antimalarials could help in Ebola outbreaks, study shows

An MSF staff member adjusts goggles for Dr. Joel Montgomery, Team Lead for CDC’s Ebola Response Team in Liberia, before entering an Ebola treatment unit (ETU) in Monrovia. (Credit: CDC Global/Flickr)

A drug that treats malaria could help ease the burden on overwhelmed health-care facilities during Ebola outbreaks, according to a study published last week in the journal PLOS ONE.

The drug, artesunate/amodiaquine (ASAQ), is both a preventive drug and a treatment for malaria, which is endemic in Liberia, Sierra Leone and Guinea – the countries hit hardest by the Ebola outbreak in 2014. A fever from malaria looks similar to a fever from Ebola, but researchers found that in areas where they administered this drug, they were able to keep more malaria-related fevers out of the overwhelmed health centers.

The study was conducted during the outbreak in Monrovia, Liberia, during the Ebola outbreak in 2014. Researchers administered two rounds of the preventive antimalarial and evaluated its success with interviews of 222 participating households.

“This has never been done during an Ebola outbreak before,” said Amanda Tiffany, an epidemiologist and one of the authors of the study, in an interview with Humanosphere.

She explained that ASAQ had already been used in Liberia to treat malaria. Normally, health officials don’t use the same drug for both prevention and treatment in a given area – that would increase the risk of drug resistance in the parasite – but ASAQ was the only preventive drug available in Monrovia in the quantities needed.

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“It wasn’t the ideal thing to do,” Tiffany said, “but that’s what we did. We had to weigh the pros and the cons.”

The authors found that the monthly incidence of malaria fever cases declined from 4.3 percent prior to the intervention to 1.5 percent soon afterward. While 96 percent of households attended both rounds of drug administration, actual treatment compliance was low – 52 percent of households used the drugs in round one, and just 22 percent used them in round two. Many participants said they had instead saved the drugs for use in future malaria episodes.

The authors noted that longer-term interventions may be needed to make sure patients use the drug for prevention as intended. But the takeaway is that standardizing ASAQ distribution during future Ebola epidemics could reduce the strain on health-care facilities and lead to more lives saved.

During the 2014 Ebola outbreak, Doctors Without Borders (MSF) admitted 9,470 people to Ebola management centers in Liberia, but just 5,170 patients were confirmed with Ebola; 2,956 patients died.

One anthropologist working with MSF during Monrovia’s outbreak, Pierre Trbovic, wrote of the challenges on the organization’s blog in 2014.

“Once I entered the high-risk zone, I understood why we couldn’t admit any more patients,” wrote Trbovic. “Everyone was completely overwhelmed. There are processes and procedures in an Ebola treatment center to keep everyone safe, and if people don’t have time to follow them, they can start making mistakes.”

MSF, the World Bank and others have invested in the effort to rebuild the damaged health systems in the countries ravaged by Ebola. With such an unpredictable disease, it will be crucial for these systems to utilize every known method available to reduce the risks of overcrowding – and consequent lives lost – in future outbreaks.

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Lisa Nikolau

Lisa Nikolau is a Madrid-based reporter for Humanosphere, covering gender equality, indigenous rights and poverty in Latin America and worldwide. Find her on Twitter at @lisanikolau, email lisa.nikolau@humanosphere.org or see her latest work at www.lisanikolau.com