Author: Margaret Kalekye

The World Health Organization (WHO) has released its first-ever comprehensive guidelines for the clinical management of filovirus diseases, including all forms of Ebola and Marburg virus disease.

The guidelines come as the Democratic Republic of Congo (DRC) battles an outbreak caused by the Bundibugyo strain of the Ebola virus. The number of confirmed cases has risen to 837, including 196 deaths.

There is currently no approved treatment or vaccine for this strain of Ebola. According to WHO, it could take up to nine months for a vaccine to become available.

Neighbouring Uganda has reported 19 cases, 14 of which involved people who had recently travelled from the DRC. The country has also recorded two deaths linked to the outbreak.

The new guidelines highlight the importance of early supportive care to improve patient survival and health outcomes, outlining 16 evidence-based recommendations.

“These new guidelines are a perfect example of how WHO leverages science to better protect and care for people during outbreaks and health emergencies,” WHO Director-General Dr Tedros Adhanom Ghebreyesus says. “The current Bundibugyo virus outbreak is a stark reminder of the need for diligent, holistic and person-focused medical care, to save lives and preserve human dignity. We encourage governments and authorities to integrate these new recommendations into preparedness and outbreak response, to ensure high-quality care for everyone.”

Developed through global expert consultations and based on the most up-to-date scientific evidence and clinical knowledge, the guidelines translate lessons learned from recent Ebola and Marburg disease outbreaks into practical recommendations for improved patient care.

WHO has previously issued several guidelines on clinical care and therapeutics specific to Ebola virus disease.

The new guidelines have been developed primarily to guide health workers when caring for patients, to harmonise clinical approaches, and enable health facility administrators and policy makers to better plan, prepare for and respond to filovirus disease outbreaks through adequate provision of medical supplies, biomedical equipment, laboratory support, and human resources.

The practical recommendations aim to support frontline health workers in identifying clinical deterioration, managing dehydration and shock, improving patient monitoring, delivering critical supportive interventions safely, and providing structured follow-up for patients who recovered from Ebola and Marburg diseases. Some of the key recommendations include:

• Using prioritised clinical laboratory tests to monitor patients with filovirus disease, to identify and manage treatable problems (such as hypoglycaemia, metabolic disruptions);
• Quickly and accurately treating dehydration in patients with filovirus disease using oral and intravenous rehydration;
• Promoting early and precise use of intravenous fluids and vasoactive medications to treat shock in patients with filovirus disease (low blood pressure caused by the infection, which if not properly addressed leads to organ failure), guided by serial monitoring of vital signs and markers of perfusion;
• Ensuring that if other bacterial infections, including bacterial sepsis, are present in patients with filovirus disease, appropriate treatment with antibiotics is initiated;
• Providing structured after-care to patients who have survived filovirus disease to promote well-being, and to prevent further infections linked to viral persistence in people who recovered from the disease.

“For Bundibugyo virus disease, as with other filovirus diseases, early recognition, rapid referral and optimised supportive care remain fundamental components of patient care. Optimised supportive care can reduce complications and provide the foundation on which all other clinical interventions are delivered”, WHO says.