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Volume 14, Number 6—June 2008

Managing Potential Laboratory Exposure to Ebola Virus by Using a Patient Biocontainment Care Unit1

Mark G. Kortepeter*Comments to Author , James W. Martin*, Janice M. Rusnak*, Theodore J. Cieslak†, Kelly L. Warfield*, Edwin L. Anderson*, and Manmohan V. Ranadive*
Author affiliations: *US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA; †San Antonio Military Pediatric Center, San Antonio, Texas, USA;

Main Article

Table 1

Admissions into the medical containment suite at the US Army Medical Research Institute of Infectious Diseases, 1972–2004*

Patient no. Date of admission Days in isolation Virus† Reason for admission Therapy‡ Comments§
1 1972 Oct 18 Machupo Cut finger IP
2 1975 Oct 42 Machupo Cut finger IP, IG
3 1976 Oct 21 JEB Fingerstick
4 1977 Sep 14 Machupo Vial leak
5 1977 Sep 14 Machupo Vial leak
6 1978 May 11 Dengue Not specified Modified CC
7 1978 May 8 Dengue Not specified Modified CC
8 1978 Jun 17 Lassa Dropped vial LIG
9 1978 Jun 17 Lassa Dropped vial LIG
10 1978 Jul 8 Lassa Field exposure
11 1978 Nov 14 Lassa Suit seam failed
12 1979 May 20 Lassa Fingerstick IP
13¶ 1979 Jul 21 Lassa Fingerstick IP
14 1979 Nov 20 Lassa Fingerstick IP, Rib
15 1981 May 14 Ebola/Lassa Field exposure Modified CC
16 1982 Oct 14 Junin Defective suit seal Conventional
17 1982 Dec 21 Junin Fingerstick IP
18 1983 Jan 3 Rift Valley fever Waste exposure
19 1983 Apr 14 Junin Defective suit seal Conventional
20 1985 May 4 Junin Fingerstick
21 2004 Feb 21 Ebola Fingerstick

*Modified from Cieslak et al. (8) with permission.
†JEB, Japanese encephalitis virus B; Ebola/Lassa, potential exposure to these viruses.
‡IP, immune plasma from previously infected survivors; IG, immune globulin; LIG, Lassa immune globulin; Rib, ribavirin.
§CC, containment care; modified CC, provided by converting a separate physical facility into a Biosafety Level 4–like suite; conventional, Biosafety Level 3 isolation was permitted for 2 lower risk exposures.
¶Not noted in previous reports (7,8).

Main Article

  1. Centers for Disease Control and Prevention and National Institutes of Health. Biosafety in microbiological and biomedical laboratories (BMBL). 5th ed. Washington: US Government Printing Office; 2007 [cited 2007 Aug 27]. Available from
  2. Bray  M, Hatfill  S, Hensley  L, Huggins  JW. Haematological, biochemical and coagulation changes in mice, guinea-pigs and monkeys infected with a mouse-adapted variant of Ebola Zaire virus. J Comp Pathol. 2001;125:24353. DOIPubMedGoogle Scholar
  3. Borio  L, Inglesby  T, Peters  CJ, Schmaljohn  AL, Hughes  JM, Jahrling  PB, Hemorrhagic fever viruses as biological weapons: medical and public health management. JAMA. 2002;287:2391404. DOIPubMedGoogle Scholar
  4. National Briefing/Science and Health. Scientist is isolated after scrape with Ebola. New York Times. 2004 Feb 20 [cited 2007 Aug 27]. Available from
  5. Babiarz  L. Detrick’s “slammer” prepared for worst. Frederick News. 2004 Mar 16:A1.
  6. Preston  R. The hot zone. New York: Doubleday; 1994.
  7. Marklund  LA. Patient care in a biological safety level–4 (BSL-4) environment. Crit Care Nurs Clin North Am. 2003;15:24555. DOIPubMedGoogle Scholar
  8. Cieslak  TJ, Christopher  GW, Eitzen  EM. The “slammer”: isolation and biocontainment of patients exposed to Biosafety Level 4 (BSL-4) pathogens. In: Abstracts of the 37th Annual Meeting of the Infectious Diseases Society of America. Philadelphia, PA; 1999 Nov 18–21. Abstract 693. Alexandria (VA): Infectious Diseases Society of America; 1997.
  9. Luby  JP, Sanders  CV. Green monkey disease (“Marburg virus” disease): a new zoonosis. Ann Intern Med. 1969;71:65760.PubMedGoogle Scholar
  10. Emond  RT, Evans  B, Bowen  ET, Lloyd  G. A case of Ebola virus infection. BMJ. 1977;2:5414.PubMedGoogle Scholar
  11. Formenty  P, Hatz  C, Le Guenno  B, Stoll  A, Rogenmoser  P, Widmer  A. Human infection due to Ebola virus, subtype Côte d’Ivoire: clinical and biologic presentation. J Infect Dis. 1999;179:S4853. DOIPubMedGoogle Scholar
  12. Miller  J. Russian scientist dies in Ebola accident at former weapons lab. New York Times. 2004 May 25.
  13. Rusnak  JM, Kortepeter  MG, Aldis  J, Boudreau  E. Experience in the medical management of potential laboratory exposures to agents of bioterrorism based on risk assessment at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID). J Occup Environ Med. 2004;46:791800. DOIPubMedGoogle Scholar
  14. Rusnak  JM, Kortepeter  MG, Hawley  RJ, Boudreau  E, Aldis  J, Pittman  PR. Management guidelines for laboratory exposures to agents of bioterrorism. J Occup Environ Med. 2004;46:80111. DOIPubMedGoogle Scholar
  15. Rusnak  JM, Kortepeter  MG, Ulrich  R, Poli  M, Boudreau  E. Laboratory exposures to staphylococcal enterotoxin B. Emerg Infect Dis. 2004;10:15449.PubMedGoogle Scholar
  16. Rusnak  J, Boudreau  E, Bozue  J, Petitt  P, Ranadive  M, Kortepeter  M. An unusual inhalational exposure to Bacillus anthracis in a research laboratory. J Occup Environ Med. 2004;46:3134. DOIPubMedGoogle Scholar
  17. Peters  CJ. Marburg and Ebola virus hemorrhagic fevers. In: Mandell GL, Bennett JE, Dolin R., editors. Principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 2057–60.
  18. Smith  PW, Anderson  AO, Christopher  GW, Cieslak  TJ, Devreede  GJ, Fosdick  GA, Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement. Biosecur Bioterror. 2006;4:35165. DOIPubMedGoogle Scholar
  19. Centers for Disease Control. Management of patients with suspected viral hemorrhagic fever. MMWR Morb Mortal Wkly Rep. 1988;37(Suppl 3):116.
  20. Centers for Disease Control and Prevention. Update: management of patients with suspected viral hemorrhagic fever—United States. MMWR Morb Mortal Wkly Rep. 1995;44:4759.PubMedGoogle Scholar
  21. Centers for Disease Control and Prevention. Interim guidance for managing patients with suspected viral hemorrhagic fever in U.S hospitals [cited 2006 Nov 15]. Available from
  22. Stephenson  EH, Larson  EW, Dominik  JM. Effect of environmental factors on aerosol-induced Lassa virus infection. J Med Virol. 1984;14:295303. DOIPubMedGoogle Scholar
  23. Armstrong  LR, Dembry  LM, Rainey  PM, Russi  MB, Khan  AS, Fischer  SH, Management of a Sabia virus-infected patient in a U.S. hospital. Infect Control Hosp Epidemiol. 1999;20:17682. DOIPubMedGoogle Scholar
  24. Centers for Disease Control and Prevention. Severe acute respiratory syndrome: fact sheet on legal authorities for isolation and quarantine [cited 2007 Aug 27]. Available from
  25. Geisbert  TW, Hensley  LE, Jahrling  PB, Larsen  T, Geisbert  JB, Paragas  J, Treatment of Ebola virus infection with a recombinant inhibitor of factor VIIa/tissue factor: a study in rhesus monkeys. Lancet. 2003;362:19538. DOIPubMedGoogle Scholar
  26. Aboul-Fadl  T. Antisense oligonucleotides: the state of the art. Curr Med Chem. 2005;12:2193214. DOIPubMedGoogle Scholar
  27. Warfield  KL, Swenson  DL, Olinger  GG, Nichols  DL, Pratt  WD, Blouch  R, Gene-specific countermeasures against Ebola virus based on antisense phosphorodiamidate morpholino oligomers. PLoS Pathog. 2006;2:e1. DOIPubMedGoogle Scholar
  28. Geisbert  TW, Hensley  LE, Kagan  E, Yu  EZ, Geisbert  JB, Daddario-Dicaprio  K, Postexposure protection of guinea pigs against a lethal Ebola virus challenge is conferred by RNA interference. J Infect Dis. 2006;193:16507. DOIPubMedGoogle Scholar
  29. Nabel  NJ, Sanchez  A, Rollin  PE, Yang  ZY, Nable  GJ. Development of a preventive vaccine for Ebola virus infection in primates. Nature. 2000;408:6059. DOIPubMedGoogle Scholar
  30. Sullivan  NJ, Geisbert  TW, Geisbert  JB, Xu  L, Yang  ZY, Roederer  M, Accelerated vaccination for Ebola virus hemorrhagic fever in non-human primates. Nature. 2003;424:6814. DOIPubMedGoogle Scholar
  31. Sullivan  NJ, Geisbert  TW, Geisbert  JB, Shedlock  DJ, Xu  L, Lamoreaux  L, Immune protection of nonhuman primates against Ebola virus with single low-dose adenovirus vectors encoding modified GPs. PLoS Med. 2006;3:e177. DOIPubMedGoogle Scholar
  32. Martin  JE, Sullivan  NJ, Enama  ME, Gordon  IJ, Roederer  M, Koup  RA, A DNA vaccine for Ebola virus is safe and immunogenic in a phase I clinical trial. Clin Vaccine Immunol. 2006;13:126777. DOIPubMedGoogle Scholar
  33. Lawler  A. Boston University under fire for pathogen mishap. Science. 2005;307:501a. DOIPubMedGoogle Scholar
  34. Barry  MA. Report of pneumonic tularemia in three Boston University researchers, November 2004–March 2005 [cited 2007 Aug 27]. Available from

Main Article

1This article is derived from the lecture “10 Steps in Managing an Ebola Exposure,” presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy, December 15, 2005, Washington, DC, USA, and September 26, 2006, San Francisco, CA, USA.

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