Table 7.
Treatment and prevention of viruses causing severe infection.
| Viral pathogen | Antivirals | Other treatment | Prevention |
|---|---|---|---|
| Avian Influenza (A/H5, A/H6, A/H7, A/H9, A/H10) | NAIs (oseltamivir, zanamivir) | Infection control, contact precautions with infected poultry | |
| Coxsackie virus A24, Echo virus 13 | None | Early intensive physical therapy (for AFP) | None |
| Crimean-Congo hemorrhagic fever virus | Oral or IV ribavirin | Supportive care | Post-exposure prophylaxis with ribavirin |
| Cytomegalovirus (CMV) | Immunocompromized: IV ganciclovir, oral valganciclovir (foscarnet if suspected ganciclovir resistance) | Immunocompetent: Supportive care Immunocompromised: CMV immune globulin |
For immunocompromized hosts: viral load monitoring, pre-emptive treatment and secondary prophylaxis |
| Dengue virus, Japanese encephalitis virus | Ribavirin | Mainly supportive care Minocycline, IFNα, IVIG, Plasma exchange have been used, but no clinical trials |
Avoid mosquito bites, insecticides Live attenuated tetravalent vaccine for Dengue virus (Dengvaxia®, Sanofi Pasteur Inc.) approved only for seropositive individuals (9–16 years old) in endemic areas Vaccine for Japanese encephalitis virus |
| Ebola virus | Redmesivir (investigational trials) | mAb114, REGN-EB3 (investigational trials) | Avoid infected animals, infection control |
| Echo viruses: 18, 30, EV A71, EV D68 | Pleconaril (for severe enteroviral infections) | None | |
| Epstein-Barr virus (EBV) | None | Supportive care, corticosteroids for impending airway obstruction | None |
| Herpes simplex virus 1,2 (HSV-1, 2) | Nucleoside analogs (acyclovir, valacyclovir, famciclovir) | Corticosteroids for encephalitis with severe brain edema | Sex education, chronic suppressive therapy |
| Human adenoviruses (HAdVs) | Cidofovir (and the pro-drug brincidofovir) | Supportive care, pooled IVIG for immunocompromized patients with severe disease | Infection control, Live oral vaccine for HAdV type 4&7 (available only for some closed populations, e.g., military) |
| MERS-CoV and SARS-CoV* | Lopinavir/ritonavir, IFNa, remdesivir (ribavirin is being tested for MERS-CoV) | Supportive care, Convalescent plasma, immunomodulators, cell therapies, corticosteroids | Infection control Vaccines are under development for MERS-CoV |
| Human herpesvirus 6 (HHV-6) | Ganciclovir for immunocompetent patients Foscarnet or ganciclovir for immunocompromized hosts with severe infections |
Supportive care | None |
| Human parainfluenza viruses (HPIVs) | None | Supportive care Corticosteroids for croup Conflicting results for ribavirin and IVIG |
Infection control |
| Human polyomavirus (BK, JC virus) | None | Supportive, reduction of immunosuppression JC virus: ART in HIV patients |
None |
| Measles | Ribavirin may be used in severe cases—not enough data for its efficacy | Supportive care, vitamin A | Vaccination, infection control, post-exposure prophylaxis in unvaccinated contacts (vaccine or human immunoglobulin) |
| Poliovirus/cVDPV | Early intensive physical therapy | Vaccine (IPV, OPV) | |
| Rabies Lyssavirus | None | Supportive care | Vaccine |
| Respiratory syncytial virus (RSV A,B) | Ribavirin, palivizumab | Supportive care Glucocorticoids for immunocompromized patients |
Infection control Palivizumab prophylaxis in infants and children when indicated |
| SARS-CoV-2 | Remdesivir | Dexamethasone (strong recommendation for hospitalized patients requiring oxygen or under MV), antithrombotic treatment Under investigation or EUA by FDA: Baricitinib, anti-SARS-CoV-2 monoclonal antibodies, convalescent plasma, anakinra, cell therapies, convalescent plasma, IVIG and other interleukin inhibitors, kinase inhibitors, interferon |
Infection control Vaccination Repurposed agents are tested for SARS-CoV-2 (e.g., BCG vaccine, Hydroxychloroquine/Chloroquine) |
| Seasonal influenza (Influenza virus A: A/H1N1pdm09, A/H3N2, Influenza virus B: B/Yamagata, B/Victoria) | NAIs (oseltamivir, zanamivir, peramivir) Inhibitor of influenza cap-dependent endonuclease (baloxavir) |
IVIG, convalescent plasma (further studies needed) | Infection control, annual tetravalent vaccination Post-exposure prophylaxis with oseltamivir or zanamivir when indicated |
| Varicella-zoster virus (VZV) | Nucleoside analogs (acyclovir, valacyclovir, famciclovir) | Corticosteroids for VZV vasculopathy | Vaccination, infection control, post-exposure prophylaxis with vaccination, immunoglobulin or antiviral therapy |
| Variola virus (smallpox)** | Tecovirimat | Supportive care | Vaccination |
| Supportive treatment and infection control only for the following viruses: | |||
| Human bocavirus (HBoV) Human metapneumovirus (HMPV) Human rhinoviruses (HRhVs 1–4) HCoVs HHV-7 Murray Valley encephalitis virus Powassa virus Saint Louis encephalitis virus Tick-borne encephalitis virus West Nile virus |
Zika virus La Crosse / California encephalitis virus Toscana virus Rift Valley Fever virus Colorado tick fever Lassa virus Marburg virus Hantavirus (New World strains causing HCPS) Mimivirus (APMV) Nipah Virus |
||
*
No new cases reported since 2004.
**
No new cases reported since 1977.
AFP, acute flaccid paralysis; APMV, acanthamoeba polyphaga mimivirus; ART, anti-retroviral therapy; BCG, Bacillus Calmette-Guerin; cVDPV, circulating vaccine-derived poliovirus; EV, enterovirus; EUA, emergency use authorization; HCPS, Hantavirus Cardiopulmonary Syndrome; IFNα, interferon-α; IPV, inactivated poliovirus vaccine; IV, intravenous; IVIG, intravenous immunoglobulin; MERS-CoV, middle east respiratory syndrome-related coronavirus; MV, mechanical ventilation; NAI, neuraminidase inhibitor; OPV, oral polio vaccine; SARS-CoV-2, severe acute respiratory syndrome-related coronavirus 2; SARS-CoV, severe acute respiratory syndrome-related coronavirus.