By Gene Emery
(Reuters Health) - Treating Ebola victims with blood plasma donated by Ebola survivors failed to significantly increase the odds of recovering from the deadly virus, according to a field test of the experimental treatment.
The conclusion is based on the cases of 84 people treated with plasma in Conakry, Guinea, in the hope that the antibodies in the fluid would help patients fight off the virus the way they did in the surviving donors.
The death rate was 31% with the plasma, compared to 38% in a control group of 418 sufferers treated at the same medical center who did not receive survivor plasma, according to the results online January 6 in the New England Journal of Medicine.
When the researchers adjusted for other factors that can affect survival, such as the age of the victims, the effect of plasma therapy was even less impressive.
"Of course you would like to dream and see a very strong reduction in mortality, but we didn't see this," chief author Dr. Johan van Griensven of the Institute of Tropical Medicine in Antwerp, Belgium, told Reuters Health.
A key limitation of that study is that it's not known how many virus-fighting antibodies were in the plasma of the donors. Because Ebola virus disease, or EVD, is so dangerous, that analysis needs to be done in laboratories with special safety equipment, which are not available in affected countries, the researchers write.
"We might have anticipated there would be an effect" with plasma from survivors, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, who was not connected with the research.
The fact that no benefit was seen "does not mean antibodies to Ebola are not going to be a good treatment," he cautioned. The plasma donors might not have been fully recovered, he noted, so the fluid might not have been rich in antibodies.
There were hints that some groups did benefit, though.
Children younger than five years old, known to have a poor prognosis, had the highest risk of death in the control group, but four of the five patients in this age group treated with convalescent plasma survived, van Griensven and his colleagues write. Although pregnant women with EVD also have a poor prognosis, six of the eight pregnant women treated with convalescent plasma survived, they add.
In another Ebola study, published as a letter to the Journal, researchers with the World Health Organization report that men treated in Guinea, Liberia and Sierra Leone had a lower survival rate than women.
The disease killed 67.1% of the infected men versus 63% of the women.
The difference persisted even after adjusting for age, symptoms, and the amount of time it took for the person to seek medical help after falling ill, said coauthor Dr. Christl Donnelly of Imperial College London.
"People hadn't found that before. But because we had such a large epidemic we can see it consistently," she told Reuters Health.
Men were no more likely to become infected with EVD than women. But they did, typically, wait 12 hours longer to seek help than women. That's 12 additional hours they were capable of spreading the virus to others, the researchers note.
Yet, Donnelly said, that 12-hour delay didn't seem responsible for the higher death rate among males.
Schaffner is not so sure. "Twelve hours is 12 hours. Maybe that's not so trivial. This can, at certain stages, be a rapidly moving infection. This is intriguing, interesting and worth another look."
As of Dec. 27, according to the WHO, 28,637 people have been infected with Ebola in the recent outbreak; 11,315 of those died. The most recent epidemic began two years ago in Guinea. On Dec. 29, WHO declared the country to be free of the disease. If no new cases emerge by Jan. 14, the epidemic will be considered over.