Improving clinical care of patients in Nipah outbreaks: moving beyond ‘compassionate use’

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES
Md Zakiul Hassan , Amanda Rojek , Piero Olliaro , Peter Horby
{"title":"Improving clinical care of patients in Nipah outbreaks: moving beyond ‘compassionate use’","authors":"Md Zakiul Hassan ,&nbsp;Amanda Rojek ,&nbsp;Piero Olliaro ,&nbsp;Peter Horby","doi":"10.1016/j.lansea.2024.100527","DOIUrl":null,"url":null,"abstract":"<div><div>The 2024 Nipah outbreak in Kerala, India—its fifth in six years—and the recurring annual outbreaks in Bangladesh underscore the persistent threat posed by the Nipah virus (NiV) in the region. With a high mortality rate, human-to-human transmission potential, and the widespread presence of <em>Pteropus</em> bats, the natural reservoir, NiV remains a significant epidemic threat. Despite being a WHO priority pathogen, there has been no systematic effort to improve patient care for NiVD, leading to consistently poor outcomes. Current care relies on supportive measures and the ‘compassionate use’ of unapproved drugs like ribavirin and remdesivir. Drugs used ‘off-label’ during outbreaks can become the ‘standard of care’ without robust evidence of their safety or efficacy, complicating the testing of new therapies and perpetuating uncertainty about their true effectiveness. To improve NiVD care, we propose four key strategies: 1) Enhance early case detection, 2) optimize supportive care to improve outcomes and create a standard for future trials, 3) adopt a syndromic approach centered on encephalitis, and 4) explore innovative trial designs tailored to low case numbers as an alternative to ‘compassionate use’. By integrating these strategies, healthcare systems in NiV-endemic regions will be better equipped to manage both current and future outbreaks.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"33 ","pages":"Article 100527"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755010/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Lancet regional health. Southeast Asia","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S277236822400177X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

The 2024 Nipah outbreak in Kerala, India—its fifth in six years—and the recurring annual outbreaks in Bangladesh underscore the persistent threat posed by the Nipah virus (NiV) in the region. With a high mortality rate, human-to-human transmission potential, and the widespread presence of Pteropus bats, the natural reservoir, NiV remains a significant epidemic threat. Despite being a WHO priority pathogen, there has been no systematic effort to improve patient care for NiVD, leading to consistently poor outcomes. Current care relies on supportive measures and the ‘compassionate use’ of unapproved drugs like ribavirin and remdesivir. Drugs used ‘off-label’ during outbreaks can become the ‘standard of care’ without robust evidence of their safety or efficacy, complicating the testing of new therapies and perpetuating uncertainty about their true effectiveness. To improve NiVD care, we propose four key strategies: 1) Enhance early case detection, 2) optimize supportive care to improve outcomes and create a standard for future trials, 3) adopt a syndromic approach centered on encephalitis, and 4) explore innovative trial designs tailored to low case numbers as an alternative to ‘compassionate use’. By integrating these strategies, healthcare systems in NiV-endemic regions will be better equipped to manage both current and future outbreaks.
改善尼帕疫情患者的临床护理:超越“同情使用”。
2024年在印度喀拉拉邦暴发的尼帕病毒(这是六年来的第五次)以及孟加拉国每年反复暴发的尼帕病毒强调了尼帕病毒在该地区构成的持续威胁。由于该病毒的高死亡率、人际传播的可能性以及作为天然宿主的狐蝠的广泛存在,NiV仍然是一个重大的流行病威胁。尽管NiVD是世卫组织的重点病原体,但没有系统的努力来改善NiVD的患者护理,导致结果一直很差。目前的护理依赖于支持性措施和“同情地使用”未经批准的药物,如利巴韦林和瑞德西韦。疫情期间“说明书外”使用的药物可能在没有可靠证据证明其安全性或有效性的情况下成为“护理标准”,使新疗法的测试复杂化,并使对其真正有效性的不确定性长期存在。为了改善NiVD护理,我们提出了四个关键策略:1)加强早期病例发现;2)优化支持性护理以改善结果并为未来的试验创造标准;3)采用以脑炎为中心的综合征方法;4)探索针对低病例数的创新试验设计,作为“同情使用”的替代方案。通过整合这些战略,niv流行地区的卫生保健系统将能够更好地管理当前和未来的疫情。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
2.20
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信