Another Wake-up Call on Ebola

Flickr, European Commission DG ECHO

Ebola just claimed its first victim in the United States.

Thomas Eric Duncan, the first person diagnosed with the disease inside the United States, died on Wednesday. Duncan had traveled from his hometown in Liberia to Dallas, Texas, to reunite with family. Four days before leaving, he unknowingly contracted ebola while helping transport a sick pregnant woman to a local hospital. Doctors had hoped that an experimental drug approved by the Food and Drug Administration for emergency use might save Duncan’s life.

Ebola is a rare but deadly virus. As it spreads through the body, it damages the immune system and organs. Symptoms include high fever, headache, aching muscles and joints, weakness, loss of appetite, and stomach pain. Eventually, the virus causes a drastic decrease in the number of blood-clotting cells, which leads to uncontrollable bleeding. Ebola kills up to 90 percent of those it infects.

The outbreak in West Africa has claimed almost 4,000 lives and infected twice as many. The world is clamoring for a vaccine to curb this outbreak and prevent future ones.

“It is conceivable that this epidemic will not turn around even if we pour resources into it. It may just keep going and going and it might require a vaccine,” said Dr. Anthony Fauci, director of the U.S. National Institute for Allergy and Infectious Diseases.

Normally, a vaccine takes anywhere between 10 and 30 years to go from the initial idea to approval for human use. The British pharmaceutical company GlaxoSmithKline is attempting to speed up trials for its potential Ebola vaccine. But even if those trials are successful, the company won’t be able to produce mass quantities of the vaccine for 12 to 18 months.

The rush to get an ebola vaccine to market is understandable. After all, the chief side effect of the virus is death — so those at risk of contracting it are understandably willing to take their chances with an experimental therapy.

But after they’ve quashed this outbreak, public health officials should ensure that any promising ebola vaccines are safe before recommending a wider vaccination campaign to those at low risk of contracting the virus.

The history of other vaccines may be instructive. For instance, some patients have experienced moderate or even severe side effects following inoculations against diseases like tetanus and the flu.

One particularly painful side effect is Shoulder Injury Related to Vaccine Administration, or SIRVA. This injury causes damage to the musculoskeletal parts of the shoulder, including the ligaments, bursa, and tendons.

The causes of SIRVA are varied. For example, if a patient is underweight or has low body mass, the shot can over-penetrate the deltoid muscle. If a patient has previous rotator cuff damage, inoculation can also cause pain due to the inflammation of surrounding tissue from the shot.

And if the administrator of the shot commits an error — by, say, improperly angling the needle or injecting too high up on the shoulder — SIRVA can be the result.

Symptoms from SIRVA last anywhere from months to years. Patients who suffer from SIRVA often report no shoulder pain prior to vaccination but experience discomfort within 24 hours of the shot. Symptoms can include tingling, tenderness, numbing, weakness, and decreased range of motion. In rare cases, shoulder surgery is needed to correct the damage.

An ebola vaccine will likely hit the market soon. When it arrives, public-health officials must ensure that it helps those who need it — and does not result in unnecessary or harmful complications.

For more information on the Ebola outbreak and international efforts to contain it, visit http://www.cdc.gov/vhf/Ebola/outbreaks/2014-west-africa/index.html.

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