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Crozier I, Britson KA, Wolfe DN, Klena JD, Hensley LE, Lee JS, Wolfraim LA, Taylor KL, Higgs ES, Montgomery JM, Martins KA. The Evolution of Medical Countermeasures for Ebola Virus Disease: Lessons Learned and Next Steps. Vaccines (Basel) 2022; 10:1213. [PMID: 36016101 PMCID: PMC9415766 DOI: 10.3390/vaccines10081213] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
The Ebola virus disease outbreak that occurred in Western Africa from 2013-2016, and subsequent smaller but increasingly frequent outbreaks of Ebola virus disease in recent years, spurred an unprecedented effort to develop and deploy effective vaccines, therapeutics, and diagnostics. This effort led to the U.S. regulatory approval of a diagnostic test, two vaccines, and two therapeutics for Ebola virus disease indications. Moreover, the establishment of fieldable diagnostic tests improved the speed with which patients can be diagnosed and public health resources mobilized. The United States government has played and continues to play a key role in funding and coordinating these medical countermeasure efforts. Here, we describe the coordinated U.S. government response to develop medical countermeasures for Ebola virus disease and we identify lessons learned that may improve future efforts to develop and deploy effective countermeasures against other filoviruses, such as Sudan virus and Marburg virus.
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Affiliation(s)
- Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA;
| | - Kyla A. Britson
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Oak Ridge Institute for Science and Education (ORISE) Postdoctoral Fellow, Oak Ridge, TN 37831, USA
| | - Daniel N. Wolfe
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.D.K.); (J.M.M.)
| | - Lisa E. Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD 12116, USA;
| | - John S. Lee
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
| | - Larry A. Wolfraim
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Kimberly L. Taylor
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Elizabeth S. Higgs
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.D.K.); (J.M.M.)
| | - Karen A. Martins
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
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Jeremiah Matson M, Ricotta E, Feldmann F, Massaquoi M, Sprecher A, Giuliani R, Edwards JK, Rosenke K, de Wit E, Feldmann H, Chertow DS, Munster VJ. Evaluation of viral load in patients with Ebola virus disease in Liberia: a retrospective observational study. THE LANCET MICROBE 2022; 3:e533-e542. [PMID: 35617976 PMCID: PMC9254266 DOI: 10.1016/s2666-5247(22)00065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Viral load in patients with Ebola virus disease affects case fatality rate and is an important parameter used for diagnostic cutoffs, stratification in randomised controlled trials, and epidemiological studies. However, viral load in Ebola virus disease is currently estimated using numerous different assays and protocols that were not developed or validated for this purpose. Here, our aim was to conduct a laboratory-based re-evaluation of the viral loads of a large cohort of Liberian patients with Ebola virus disease and analyse these data in the broader context of the west Africa epidemic. Methods In this retrospective observational study, whole blood samples from patients at the Eternal Love Winning Africa Ebola treatment unit (Monrovia, Liberia) were re-extracted with an optimised protocol and analysed by droplet digital PCR (ddPCR) using a novel semi-strand specific assay to measure viral load. To allow for more direct comparisons, the ddPCR viral loads were also back-calculated to cycle threshold (Ct) values. The new viral load data were then compared with the Ct values from the original diagnostic quantitative RT-PCR (qRT-PCR) testing to identify differing trends and discrepancies. Findings Between Aug 28 and Dec 18, 2014, 727 whole blood samples from 528 individuals were collected. 463 (64%) were first-draw samples and 409 (56%) were from patients positive for Ebola virus (EBOV), species Zaire ebolavirus. Of the 307 first-draw EBOV-positive samples, 127 (41%) were from survivors and 180 (59%) were from non-survivors; 155 (50%) were women, 145 (47%) were men, and seven (2%) were not recorded, and the mean age was 29·3 (SD 15·0) years for women and 31·8 (SD 14·8) years for men. Survivors had significantly lower mean viral loads at presentation than non-survivors in both the reanalysed dataset (5·61 [95% CI 5·34–5·87] vs 7·19 [6·99–7·38] log10 EBOV RNA copies per mL; p<0·0001) and diagnostic dataset (Ct value 28·72 [27·97–29·47] vs 26·26 [25·72–26·81]; p<0·0001). However, the prognostic capacity of viral load increased with the reanalysed dataset (odds ratio [OR] of death 8·06 [95% CI 4·81–13·53], p<0·0001 for viral loads above 6·71 log10 EBOV RNA copies per mL vs OR of death 2·02 [1·27–3·20], p=0·0028 for Ct values below 27·37). Diagnostic qRT-PCR significantly (p<0·0001) underestimated viral load in both survivors and non-survivors (difference in diagnostic Ct value minus laboratory Ct value of 1·79 [95% CI 1·16–2·43] for survivors and 5·15 [4·43–5·87] for non-survivors). Six samples that were reported negative by diagnostic testing were found to be positive upon reanalysis and had high viral loads. Interpretation Inaccurate viral load estimation from diagnostic Ct values is probably multifactorial; however, unaddressed PCR inhibition from tissue damage in patients with fulminant Ebola virus disease could largely account for the discrepancies observed in our study. Testing protocols for Ebola virus disease require further standardisation and validation to produce accurate viral load estimates, minimise false negatives, and allow for reliable epidemiological investigation.
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Affiliation(s)
- M Jeremiah Matson
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA; Marshall University Joan C Edwards School of Medicine, Huntington, WV, USA
| | - Emily Ricotta
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Friederike Feldmann
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | | | | | | | | | - Kyle Rosenke
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Emmie de Wit
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Heinz Feldmann
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Vincent J Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
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Dodd LE, Follmann D, Proschan M, Wang J, Malvy D, van Griensven J, Ciglenecki I, Horby PW, Ansumana R, Jiang JF, Davey RT, Lane HC, Gouel-Cheron A. A meta-analysis of clinical studies conducted during the West Africa Ebola virus disease outbreak confirms the need for randomized control groups. Sci Transl Med 2020; 11:11/520/eaaw1049. [PMID: 31776287 DOI: 10.1126/scitranslmed.aaw1049] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/04/2019] [Indexed: 11/03/2022]
Abstract
Recent Ebola virus disease outbreaks affirm the dire need for treatments with proven efficacy. Randomized controlled clinical trials remain the gold standard but, during disease outbreaks, may be difficult to conduct due to ethical concerns and challenging field conditions. In the absence of a randomized control group, statistical modeling to create a control group could be a possibility. Such a model-based reference control would only be credible if it had the same mortality risk as that of the experimental group in the absence of treatment. One way to test this counterfactual assumption is to evaluate whether reasonable similarity exists across nonrandomized control groups from different clinical studies, which might suggest that a future control group would be similarly homogeneous. We evaluated similarity across six clinical studies conducted during the 2013-2016 West Africa outbreak of Ebola virus disease. These studies evaluated favipiravir, the biologic ZMapp, the antimalarial drug amodiaquine, or administration of convalescent plasma or convalescent whole blood. We compared the nonrandomized control groups of these six studies comprising 1147 individuals infected with Ebola virus. We found considerable heterogeneity, which did not disappear after statistical modeling to adjust for prognostic variables. Mortality risk varied widely (31 to 66%) across the nonrandomized control arms of these six studies. Models adjusting for baseline covariates (age, sex, and cycle threshold, a proxy for viral load) failed to sufficiently recalibrate these studies and showed that heterogeneity remained. Our findings highlight concerns about making invalid conclusions when comparing nonrandomized control groups to cohorts receiving experimental treatments.
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Affiliation(s)
- Lori E Dodd
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. .,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dean Follmann
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michael Proschan
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wang
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Denis Malvy
- Inserm, UMR 1219, Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Iza Ciglenecki
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
| | - Peter W Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone.,School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Jia-Fu Jiang
- Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Richard T Davey
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - H Clifford Lane
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Aurelie Gouel-Cheron
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,Anesthesiology and Intensive Care Department, Hopital Bichat-Claude Bernard, Assistance Publique-Hopitaux de Paris, Paris, France
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Fitzpatrick G, Decroo T, Draguez B, Crestani R, Ronsse A, Van den Bergh R, Van Herp M. Operational Research during the Ebola Emergency. Emerg Infect Dis 2018. [PMID: 28628463 PMCID: PMC5512485 DOI: 10.3201/eid2307.161389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings among treatment centers.
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Mérens A, Bigaillon C, Delaune D. Ebola virus disease: Biological and diagnostic evolution from 2014 to 2017. Med Mal Infect 2017; 48:83-94. [PMID: 29224715 DOI: 10.1016/j.medmal.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
The Ebola virus disease outbreak observed in West Africa from March 2014 to June 2016 has led to many fundamental and applied research works. Knowledge of this virus has substantially increased. Treatment of many patients in epidemic countries and a few imported cases in developed countries led to developing new diagnostic methods and to adapt laboratory organization and biosafety precautions to perform conventional biological analyses. Clinical and biological monitoring of patients infected with Ebola virus disease helped to determine severity criteria and bad prognosis markers. It also contributed to showing the possibility of viral sanctuaries in patients and the risk of transmission after recovery. After a summary of recent knowledge of environmental and clinical viral persistence, we aimed to present new diagnostic methods and other biological tests that led to highlighting the pathophysiological consequences of Ebola virus disease and its prognostic markers. We also aimed to describe our lab experience in the care of Ebola virus-infected patients, especially technical and logistical changes between 2014 and 2017.
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Affiliation(s)
- A Mérens
- Laboratoire de biologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - C Bigaillon
- Laboratoire de biologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - D Delaune
- Laboratoire de biologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Cimini E, Viola D, Cabeza-Cabrerizo M, Romanelli A, Tumino N, Sacchi A, Bordoni V, Casetti R, Turchi F, Martini F, Bore JA, Koundouno FR, Duraffour S, Michel J, Holm T, Zekeng EG, Cowley L, Garcia Dorival I, Doerrbecker J, Hetzelt N, Baum JHJ, Portmann J, Wölfel R, Gabriel M, Miranda O, Díaz G, Díaz JE, Fleites YA, Piñeiro CA, Castro CM, Koivogui L, Magassouba N, Diallo B, Ruibal P, Oestereich L, Wozniak DM, Lüdtke A, Becker-Ziaja B, Capobianchi MR, Ippolito G, Carroll MW, Günther S, Di Caro A, Muñoz-Fontela C, Agrati C. Different features of Vδ2 T and NK cells in fatal and non-fatal human Ebola infections. PLoS Negl Trop Dis 2017; 11:e0005645. [PMID: 28558022 PMCID: PMC5472323 DOI: 10.1371/journal.pntd.0005645] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/15/2017] [Accepted: 05/17/2017] [Indexed: 01/08/2023] Open
Abstract
Background Human Ebola infection is characterized by a paralysis of the immune system. A signature of αβ T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze γδ T and NK cells in patients from the Ebola outbreak of 2014–2015 occurred in West Africa, and to assess their association with the clinical outcome. Methodology/Principal findings Nineteen Ebola-infected patients were enrolled at the time of admission to the Ebola Treatment Centre in Guinea. Patients were divided in two groups on the basis of the clinical outcome. The analysis was performed by using multiparametric flow cytometry established by the European Mobile Laboratory in the field. A low frequency of Vδ2 T-cells was observed during Ebola infection, independently from the clinical outcome. Moreover, Vδ2 T-cells from Ebola patients massively expressed CD95 apoptotic marker, suggesting the involvement of apoptotic mechanisms in Vδ2 T-cell loss. Interestingly, Vδ2 T-cells from survivors expressed an effector phenotype and presented a lower expression of the CTLA-4 exhaustion marker than fatalities, suggesting a role of effector Vδ2 T-cells in the protection. Furthermore, patients with fatal Ebola infection were characterized by a lower NK cell frequency than patients with non fatal infection. In particular, both CD56bright and CD56dim NK frequency were very low both in fatal and non fatal infections, while a higher frequency of CD56neg NK cells was associated to non-fatal infections. Finally, NK activation and expression of NKp46 and CD158a were independent from clinical outcome. Conclusions/Significances Altogether, the data suggest that both effector Vδ2 T-cells and NK cells may play a role in the complex network of protective response to EBOV infection. Further studies are required to characterize the protective effector functions of Vδ2 and NK cells. Human Ebola infection presents a high lethality rate and is characterized by a paralysis of the immune response. The definition of the protective immune profile during Ebola infection represents a main challenge useful in vaccine and therapy design. In particular, the protective/pathogenetic involvement of innate immune cells during Ebola infection in humans remains to be clarified. Nineteen Ebola-infected patients were enrolled at the time of admission to the Ebola Treatment Center in Guinea, and the profiling of innate immunity was correlated with the clinical outcome. Our results show that both effector Vδ2 T-cells and NK cells were associated with survival, suggesting their involvement in the complex network of protective response to EBOV infection.
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Affiliation(s)
- Eleonora Cimini
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Domenico Viola
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Mar Cabeza-Cabrerizo
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany
| | - Antonella Romanelli
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Nicola Tumino
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Alessandra Sacchi
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Veronica Bordoni
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Rita Casetti
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Federica Turchi
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Federico Martini
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Joseph A Bore
- European Mobile Laboratory Consortium, Hamburg, Germany
| | | | - Sophie Duraffour
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany
| | - Janine Michel
- European Mobile Laboratory Consortium, Hamburg, Germany.,Robert Koch Institute, Berlin, Germany
| | - Tobias Holm
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany
| | - Elsa Gayle Zekeng
- European Mobile Laboratory Consortium, Hamburg, Germany.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Lauren Cowley
- European Mobile Laboratory Consortium, Hamburg, Germany.,National Infection Service, Public Health England, Porton Down and Colindale, United Kingdom
| | - Isabel Garcia Dorival
- European Mobile Laboratory Consortium, Hamburg, Germany.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Juliane Doerrbecker
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,Centre for Experimental and Clinical Infection Research (TWINCORE), Institute for Experimental Virology, Hannover, Germany
| | - Nicole Hetzelt
- European Mobile Laboratory Consortium, Hamburg, Germany.,Robert Koch Institute, Berlin, Germany
| | - Jonathan H J Baum
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany
| | - Jasmine Portmann
- European Mobile Laboratory Consortium, Hamburg, Germany.,Federal Office for Civil Protection, Spiez Laboratory, Switzerland
| | - Roman Wölfel
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bundeswehr Institute of Microbiology, Munich, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany
| | - Martin Gabriel
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany
| | | | | | - José E Díaz
- Hospital Militar Central Dr. Carlos J. Finlay, Havana, Cuba
| | - Yoel A Fleites
- Hospital Militar Central Dr. Carlos J. Finlay, Havana, Cuba
| | | | | | | | - N'Faly Magassouba
- Laboratoire des Fièvres Hémorragiques en Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Boubacar Diallo
- World Health Organization, Geneva, Switzerland. (Boubacar is separate: World Health Organization, Conakry, Guinea)
| | - Paula Ruibal
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany.,Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Lisa Oestereich
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany
| | - David M Wozniak
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany
| | - Anja Lüdtke
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany.,Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Beate Becker-Ziaja
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany
| | - Maria R Capobianchi
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Giuseppe Ippolito
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Miles W Carroll
- European Mobile Laboratory Consortium, Hamburg, Germany.,National Infection Service, Public Health England, Porton Down and Colindale, United Kingdom.,University of Southampton, South General Hospital, Southampton, United Kingdom
| | - Stephan Günther
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany
| | - Antonino Di Caro
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.,European Mobile Laboratory Consortium, Hamburg, Germany
| | - César Muñoz-Fontela
- European Mobile Laboratory Consortium, Hamburg, Germany.,Department of Virology, Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, Germany.,Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Chiara Agrati
- Department of Epidemiology and Pre-clinical research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
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Overlooking the importance of immunoassays - Authors' reply. THE LANCET. INFECTIOUS DISEASES 2016; 16:1110. [PMID: 27676345 DOI: 10.1016/s1473-3099(16)30339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/21/2022]
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Overlooking the importance of immunoassays. THE LANCET. INFECTIOUS DISEASES 2016; 16:1109-1110. [PMID: 27676344 DOI: 10.1016/s1473-3099(16)30338-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/11/2016] [Indexed: 11/20/2022]
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The Liberia Men's Health Screening Program for Ebola virus: win-win-win for survivor, scientist, and public health. LANCET GLOBAL HEALTH 2016; 4:e672-3. [PMID: 27596040 DOI: 10.1016/s2214-109x(16)30207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 11/24/2022]
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Cnops L, Van den Eede P, Pettitt J, Heyndrickx L, De Smet B, Coppens S, Andries I, Pattery T, Van Hove L, Meersseman G, Van Den Herrewegen S, Vergauwe N, Thijs R, Jahrling PB, Nauwelaers D, Ariën KK. Development, Evaluation, and Integration of a Quantitative Reverse-Transcription Polymerase Chain Reaction Diagnostic Test for Ebola Virus on a Molecular Diagnostics Platform. J Infect Dis 2016; 214:S192-S202. [PMID: 27247341 DOI: 10.1093/infdis/jiw150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The 2013-2016 Ebola epidemic in West Africa resulted in accelerated development of rapid diagnostic tests for emergency outbreak preparedness. We describe the development and evaluation of the Idylla™ prototype Ebola virus test, a fully automated sample-to-result molecular diagnostic test for rapid detection of Zaire ebolavirus (EBOV) and Sudan ebolavirus (SUDV). METHODS The Idylla™ prototype Ebola virus test can simultaneously detect EBOV and SUDV in 200 µL of whole blood. The sample is directly added to a disposable cartridge containing all reagents for sample preparation, RNA extraction, and amplification by reverse-transcription polymerase chain reaction analysis. The performance was evaluated with a variety of sample types, including synthetic constructs and whole blood samples from healthy volunteers spiked with viral RNA, inactivated virus, and infectious virus. RESULTS The 95% limits of detection for EBOV and SUDV were 465 plaque-forming units (PFU)/mL (1010 copies/mL) and 324 PFU/mL (8204 copies/mL), respectively. In silico and in vitro analyses demonstrated 100% correct reactivity for EBOV and SUDV and no cross-reactivity with relevant pathogens. The diagnostic sensitivity was 97.4% (for EBOV) and 91.7% (for SUDV), the specificity was 100%, and the diagnostic accuracy was 95.9%. CONCLUSIONS The Idylla™ prototype Ebola virus test is a fast, safe, easy-to-use, and near-patient test that meets the performance criteria to detect EBOV in patients with suspected Ebola.
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Affiliation(s)
| | - Peter Van den Eede
- Janssen Diagnostics, Janssen Pharmaceutica, Beerse Biocartis, Mechelen, Belgium
| | - James Pettitt
- National Institute of Allergy and Infectious Diseases Integrated Research Facility, National Institutes of Health, Frederick, Maryland
| | - Leo Heyndrickx
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
| | | | - Sandra Coppens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
| | - Ilse Andries
- Janssen Diagnostics, Janssen Pharmaceutica, Beerse
| | | | | | | | | | | | | | - Peter B Jahrling
- National Institute of Allergy and Infectious Diseases Integrated Research Facility, National Institutes of Health, Frederick, Maryland
| | | | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
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