Ribavirin post-exposure prophylaxis for Andes virus exposure: a viewpoint

EBioMedicine, vol. 130, pp. 106386

Abstract

Andes virus (ANDV) is unique among hantaviruses because person-to-person transmission is possible. This raises questions on the relevance of post-exposure prophylaxis (PEP), particularly following high-risk household, healthcare-associated, or laboratory exposures, considering its high case fatality rate. Ribavirin has demonstrated antiviral activity against hantaviruses in vitro and in animal models, although clinical evidence supporting its use for ANDV remains extremely limited. This viewpoint summarises the currently available evidence regarding ribavirin as PEP after potential ANDV exposure. We discuss the knowledge gaps that may limit the applicability of ribavirin PEP, to make informed decisions on the use of ribavirin in the setting of PEP. Potential dosing strategies are visualised by modelling and simulation, and potential dose and duration are discussed. Although the biological rationale for ribavirin PEP appears compelling, absence of controlled human studies and potential toxicity currently limit its role to highly selected exposure scenarios and use shortly after exposure.

Authors 15

1. Roger J. M. Brüggemann

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Pharmacy, Pharmacology and Toxicology, and Radboudumc Community for Infectious Diseases, and Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands

2. Albert Vollaard

   National Institute for Public Health and the Environment

   Affiliation as printed

   Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

3. Sacha de Stoppelaar

   Amsterdam UMC Location University of Amsterdam · National Institute for Public Health and the Environment · Amsterdam University Medical Centers

   Affiliation as printed

   Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Department of Internal Medicine, Infectious Diseases Department, Amsterdam University Medical Center, Amsterdam, the Netherlands

4. J. G. Coen van Hasselt Aachen Leiden Academic Centre for Drug Research

   Leiden University

   Affiliation as printed

   Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands

5. David Marinus Burger

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Pharmacy, Pharmacology and Toxicology, and Radboudumc Community for Infectious Diseases, and Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands

6. Job J. Engel

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Internal Medicine, and Radboud Institute of Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, the Netherlands

7. Jeroen J. A. van Kampen

   Erasmus MC

   Affiliation as printed

   Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands

8. Matthew McCall

   Radboud University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands

9. Loek Smits

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Internal Medicine, and Radboud Institute of Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, the Netherlands

10. Hetty Jolink Aachen

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Leiden University Center of Infectious Diseases, Subdepartment Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands

11. Leo G. Visser Aachen

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Leiden University Center of Infectious Diseases, Subdepartment Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands

12. Frank L. van de Veerdonk

    Radboud University Nijmegen · Radboud University Medical Center

    Affiliation as printed

    Department of Internal Medicine, and Radboud Institute of Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, the Netherlands

13. Karin Ellen Veldkamp Aachen

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Leiden University Center of Infectious Diseases, Subdepartment Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden

14. Chantal P. Rovers

    Radboud University Nijmegen · Radboud University Medical Center

    Affiliation as printed

    Department of Internal Medicine, and Radboud Institute of Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, the Netherlands

15. Rob J.W. Arts corresponding

    Radboud University Nijmegen · Radboud University Medical Center

    Affiliation as printed

    Department of Internal Medicine, and Radboud Institute of Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: rob.jw.arts@radboudumc.nl