CDC Panel Recommends Ebola Vaccine for Adults With Exposure Risk

Troy Brown, RN

February 27, 2020

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) unanimously recommended preexposure vaccination with the first-ever US Food and Drug Administration (FDA)–approved vaccine against Ebola virus, species Zaire ebolavirus, for three groups of adults at high risk for Ebola virus exposure.

On Wednesday, the committee voted 14–0, with no abstentions, to recommend preexposure recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV) (Ervebo, Merck & Co) "for adults aged 18 years or older in the US population who are at potential risk of exposure to Ebola virus (species Zaire ebolavirus) and:

  • Are responding to an outbreak of Ebola virus disease; or

  • Work as healthcare personnel at federally-designated Ebola Treatment Centers [ETCs] in the United States; or

  • Work as laboratorians or other staff at biosafety-level 4 facilities in the United States."

The rVSV-ZEBOV vaccine is a live, attenuated one-time vaccine that has demonstrated safety and efficacy against only the Zaire ebolavirus species of the Ebola virus.

The FDA approved rVSV-ZEBOV on December 19, 2019; the European Commission granted marketing approval for the vaccine on November 11, 2019.

The committee was initially expected to take three votes, one on whether to recommend the vaccine for healthy adults, one on recommending it for nonpregnant women, and one on recommending it for nonlactating women, but panel members had differing opinions about the definition of "healthy," and several members said they would like shared decision making between pregnant women and their healthcare provider about the risks and benefits of the vaccine.

Regarding the vaccine's use in pregnant women, several panel members suggested using language similar to that used for other vaccines for these patients.

Recalling similar discussions by a task force he was involved in 10 or 15 years ago related to the use of vaccines in pregnant women, Kevin A. Ault, MD, FACOG, FIDSA, professor and division director, Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, said what they decided at that time "was that we were going to state the data that we had, basically, and tell people what we know and what we don't know, and I think that will apply to this vaccine as well."

Individuals at High Risk for Ebola Exposure

Individuals who respond to Ebola outbreaks are at increased risk for exposure to the virus and should be vaccinated, Mary Choi, MD, MPH, National Center for Emerging and Zoonotic Infectious Diseases, CDC, said in a presentation at the meeting.

"The reasoning that was given for this recommendation was documented history of infections in outbreak responders; that the benefits of vaccination outweigh the risks given the severe disease and [there is] no currently FDA-approved treatment; and that there is always a risk of exposure even with appropriate use of personal protective equipment," she explained.

"As we all know, it's not always what you wear but how you wear it and how you take it off," Choi added.

Regarding the recommendation for vaccination of healthcare personnel at federally designated ETCs, Choi said these workers are also at high risk for exposure, and public health preparedness involves having trained, vaccinated personnel at such facilities. Vaccinating these individuals would provide an additional layer of protection.

Likewise, staff who work at biosafety level 4 laboratories are at high risk for exposure, and vaccination adds an additional layer of protection in these facilities as well, Choi said.

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