Experience with Ribavirin for Treatment and Postexposure Prophylaxis of Hemorrhagic Fever Viruses: Crimean Congo Hemorrhagic Fever, Lassa Fever, and Hantaviruses

摘要

The increase in research laboratories with biosafe-ty level-4 (BSL-4) capabilities may be associated with increased research with hemorrhagic fever (HF) viruses. The yellow fever vaccine and an investigational formalin-inactivated Rift Valley fever vaccine are the only vaccines for at-risk laboratory workers available in the United States against HF viruses. Ribavirin is a nucleoside analogue that has been demonstrated to have antiviral activity against a wide range of viruses, including many HF viruses. While intravenous (TV) ribavirin is not FDA-approved and oral ribavirin is approved only for treatment of hepatitis C in the United States, ribavirin has been used for treatment and postexposure prophylaxis for Crimean Congo hemorrhagic fever (CCHF), Lassa fever (LF), and hantaviruses, based mainly on in vitro sensitivity testing and efficacy studies in animals, but only on a limited number of studies and/or anecdotal experience in humans. The literature on both IV and oral ribavirin for treatmentand postexposure prophylaxis for CCHF, LF, and hantaviruses is reviewed to aid occupational healthcare providers in the evaluation and recommendation of ribavirin to laboratory workers with exposures or illness from these HF viruses, which are associatedwith a significant morbidity and mortality.