Nav: Home

Ribavirin for treating Crimean Congo hemorrhagic fever -- latest Cochrane review

June 05, 2018

In a viral haemorrhagic disease where up to 40% of people developing it die, it is remarkable that doctors still do not agree whether the only recognised treatment, an antiviral drug called ribavirin, makes a difference. In a new Cochrane Review a team of authors at LSTM, along with colleagues in London, The Philippines and in Greece, evaluated the evidence to assess the effectiveness of treating Crimean Congo haemorrhagic fever (CCHF).

Crimean Congo haemorrhagic fever is spread by the bite of an infected tick, and is becoming more common, with outbreaks in Turkey, Eastern Europe and the Eastern Mediterranean. Doctors treat the infection in hospital with intravenous fluids, blood and good nursing care. The debates around ribavirin are common amongst clinicians treating the disease, with strong advocates on one side, and others who have policies not to use it, so the authors hoped the review would settle the debate.

The review authors found just one trial with 136 participants, and some observational comparative studies of 612 participants: overall the analysis did not provide a clear answer. When the authors examined studies that were often quoted as showing benefit, they were critically biased. Although fewer people died in groups receiving ribavirin, the apparent effect could be due to the drug, or equally because those getting the drug may have also been less sick, or received high quality nursing and medical care earlier in the disease.

Lead author, LSTM's Dr Samuel Johnson, said: "Some doctors advocate giving ribavirin, and state that not to give it is even unethical. The problem is that the studies claiming to demonstrate benefit from the drug are designed in such a way we cannot separate the effect of the drug from other factors, and thus we do not know if ribavirin is effective at all."

The review clarifies the need for reliable research from a randomised control trial to establish whether ribavirin is effective. "The irony is that the strong beliefs and the widespread use of the drug may make it difficult to actually carry out the research needed" states Dr Johnson. "What we need to know is whether it works, when it works, and how good it is."

But is there any harm in just giving it in case it works? Dr Johnson points out, "Using unreliable research as evidence of benefit if it doesn't work could potentially waste resources and harm patients, we would also need to investigate other options. On the other hand, if ribavirin does work, then it needs to be rolled out to all patients who could benefit, which is currently not the case."

Whilst research into emerging infectious diseases and during outbreaks is difficult, the team hopes that the review provides an opportunity to strengthen the call for greater steps to be taken to facilitate rigorous research providing reliable results in outbreaks of infectious diseases.
-end-


Liverpool School of Tropical Medicine

Related Infectious Diseases Articles:

Critical gaps in our knowledge of where infectious diseases occur
Today Scientists have called for action. The scientific journal Nature Ecology & Evolution have published a joint statement from scientists at Center for Macroecology, Evolution and Climate, University of Copenhagen and North Carolina State University.
'Flying syringes' could detect emerging infectious diseases
Blood-sucking flies can act as 'flying syringes' to detect emerging infectious diseases in wild animals before they spread to humans, according to research published in the journal eLife.
27th European Congress of Clinical Microbiology & Infectious Diseases
Media can register now for the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Vienna, Saturday 22 April to Tuesday 25 April 2017.
Young doctors working in infectious diseases suffering burnout and bullying
One in five physicians working in medical microbiology and infectious diseases is suffering from burnout, bullying and poor work-life balance.
Gut cells are gatekeepers of infectious brain diseases, study finds
Fresh insights into infectious brain conditions help to explain why some people -- and animals -- are more at risk than others.
More than 3 million children under 5 years old will die from infectious diseases next year
A new report outlines the alarming burden of pediatric infectious diseases across the world.
New global migration mapping to help fight against infectious diseases
Geographers at the University of Southampton have completed a large scale data and mapping project to track the flow of internal human migration in low and middle income countries.
More research is needed on how climate change affects infectious diseases
It is time we act proactively to minimize the effect of climate change on our health, say the researchers behind a new review published in Environment International.
A global early warning system for infectious diseases
In the recent issue of EMBO reports, Barbara Han of the Cary Institute of Ecosystem Studies and John Drake of the University of Georgia Odum School of Ecology call for the creation of a global early warning system for infectious diseases.
Ways of reducing the transmission of infectious diseases in transport hubs
Transport plays a major role in the spread of transmissible diseases.

Related Infectious Diseases Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".