rVSV-ZEBOV is the only vaccine approved by the U.S. Food and Drug Administration (FDA) for prevention of Ebola virus disease Marburg and Ebola Virus Infections Marburg and Ebola are filoviruses that cause hemorrhage, multiple organ failure, and high mortality rates. Diagnosis is with enzyme-linked immunosorbent assay, polymerase chain reaction (PCR)... read more . Ad26.ZEBOV/MVA-BN-Filo is a combination of two vaccines, Ad26.ZEBOV and MVA-BN-Filo, and has received Marketing Authorization by the European Commission (EC). The International Coordinating Group (ICG) on Vaccine Provision has established a global Ebola vaccine stockpile in Switzerland for use during outbreaks.
For more information, see Ebola Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations.
(See also Overview of Immunization Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
Preparations
rVSV-ZEBOV is a live-attenuated recombinant viral vaccine. It provides protection against the Zaire ebolavirus species and does not protect against other species of Ebola virus or Marburg virus.
Ad26.ZEBOV/MVA-BN-Filo is a combination of two vaccine vectors that are genetically modified so that they cannot replicate in human cells. These vector vaccines carry the genetic code of several Ebola virus proteins to trigger an immune response:
Ad26.ZEBOV is a recombinant DNA vaccine based on adenovirus type 26 (Ad26).
MVA-BN-Filo is a recombinant DNA vaccine based on modified vaccinia Ankara (MVA).
Indications
rVSV-ZEBOV is indicated for the prevention of Ebola virus disease caused by Zaire ebolavirus species in people 18 years of age and older. The ACIP recommends preexposure vaccination with rVSV-ZEBOV for adults aged 18 years of age and older in the US who are at high risk of occupational exposure to Ebola because they are doing the following:
Responding to an outbreak of Ebola virus disease
Working as health care personnel at federally designated Ebola treatment centers in the US
Working as laboratory personnel or as other staff at biosafety level 4 facilities in the US
Working as laboratory personnel or support staff members at Laboratory Response Network facilities
Ad26.ZEBOV/MVA-BN-Filo is indicated for the prevention of Ebola virus disease caused by the Zaire ebolavirus species in people aged 1 year of age and older.
Contraindications and Precautions
The main contraindication for all three Ebola vaccines is
Severe allergic reaction (eg, anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) to any component of the vaccine
Precautions for all 3 Ebola vaccines are
Anaphylaxis
Thrombocytopenia or any coagulation disorder
Anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more has occurred after administration of these vaccines. After vaccination, people should be observed for at least 15 minutes for early signs of anaphylaxis or anaphylactoid reactions. Appropriate medical treatment and supervision must be available in the event anaphylaxis occurs.
The vaccines should be given with caution to people with thrombocytopenia Thrombocytopenia Platelets are circulating cell fragments that function in the clotting system. Thrombopoietin helps control the number of circulating platelets by stimulating the bone marrow to produce megakaryocytes... read more 
or any coagulation disorder because bleeding or bruising may occur after the vaccines are given.
The main precaution for rVSV-ZEBOV is
Immunocompromise
The safety and effectiveness of rVSV-ZEBOV have not been assessed in immunocompromised people. The effectiveness of this vaccine may be diminished in immunocompromised people. The risk of vaccination with rVSV-ZEBOV, a live-virus vaccine, in immunocompromised people should be weighed against the risk of disease due to Zaire ebolavirus.
Precautions for Ad26.ZEBOV/MVA-BN-Filo are
Immunocompromise
Acute severe febrile illness or acute infection
The safety and immunogenicity of the Ad26.ZEBOV/MVA-BN-Filo vaccine regimen have not been assessed in immunocompromised people, including those receiving immunosuppressive therapy. Immunocompromised people may not respond as well as immunocompetent people to the vaccine regimen.
Vaccination with Ad26.ZEBOV/MVA-BN-Filo should be postponed in people who have an acute severe febrile illness or acute infection, unless the benefit of immediate vaccination outweighs the potential risks. The presence of a minor infection, a low-grade fever, or both should not delay vaccination.
Dose and Administration
The rVSV-ZEBOV vaccine dose is 1.0 mL IM.
The Ad26.ZEBOV/MVA-BN-Filo vaccine dose is 0.5 mL IM, given in a 2-dose series:
Ad26.ZEBOV (red cap vial) is given first.
MVA-BN-Filo (yellow cap vial) is given 8 weeks later.
Adverse Effects
For all 3 vaccines, the most common adverse effects are injection site pain and swelling, myalgias, arthralgias, headache, and fatigue.
For rVSV-ZEBOV, other common adverse effects are injection site redness, feverishness, nausea, arthritis, rash, and abnormal sweating.
For Ad26.ZEBOV/MVA-BN-Filo, other common adverse effects include injection site warmth and chills. In children 1 to 17 years of age, the most common adverse effects reported are
Injection site pain
Fatigue
Decreased activity
Decreased appetite
Irritability
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Advisory Committee on Immunization Practices (ACIP): Ebola ACIP Vaccine Recommendations
