2020 Ebola virus disease outbreak in Équateur Province, Democratic Republic of the Congo: a retrospective genomic characterisation

Comparison of EBOV GP IgG antibody reactivity: Results from two immunoassays in the Democratic Republic of the Congo

Ebola virus (EBOV) is a highly infectious pathogen, and its long-term consequences continue to be investigated. With its high fatality rate and potential for reinfection or latent infection, continued development of research tools is of utmost importance. Using a cohort (n = 503) of existing bio-banked specimens from the Democratic Republic of the Congo (DRC) two EBOV glycoprotein (GP) immunoglobulin G (IgG) antibody-detection assays were compared: the gold-standard Filovirus Animal Non-Clinical Group (FANG) and a Multiplex bead-based Immunoassay (MIA) with seven pan-filoviral targets. As not all immunoassays have been shown to detect a vaccine-induced immune response, and previous EBOV serosurveillance has been primarily conducted with singleplex technology, this MIA was assessed as an additional resource. Among the cohort, as sample seroreactivity increased, assay correlation increased (r2=0.80). Correlation was sustained among sub-populations of the cohort-in detecting natural immunity among survivors and vaccine-derived responses. Additionally, when results were binarized by seroreactivity, there was high correlation between the two assays (kappa=0.70) with 71 serodiscordant samples. These data indicate that the MIA is an apt alternative to the singleplex FANG assay in detecting relative seroreactivity and can be used as a potential tool for widespread pan-filovirus serosurveillance in the DRC and similar contexts.

Neonatal Survival Following Spontaneous Maternal Recovery From Ebola Virus Disease in a Resource-Limited Setting in Western Democratic Republic of the Congo

Background: Pregnancy induces physiological decline in maternal immunity. Ebola virus disease (EVD) in pregnancy is associated with obstetrical complications, and vaccination in early pregnancy is recommended, but may not be without risk. Case Presentation: We described neonatal survival after spontaneous maternal EVD recovery. This neonate was born to a 25-year-old mother admitted to an Ebola Treatment Unit (ETU) in July, 2020, after 11 days of symptoms. She was vaccinated with rVSV-ZEBOV three days before symptom onset and her real-time polymerase chain of reaction (RT-PCR) results confirmed EVD and malarial infection two days after, but she refused hospitalization. She was treated at home with PO ASAQ, amoxicillin, paracetamol, albendazole, omeprazole, and papaverine. Eleven days later, due to clinical deterioration and onset of vaginal hemorrhage, she finally accepted to be transferred in ETU. She was Parity 2, fetal age at admission was 5 weeks and 3 days. Upon admission, her EVD PCR measured NP 26.3 and GP 32.9. She did not receive monoclonal therapy against Ebola infection due to stock shortage. She received intravenous, artesunate, ceftriaxone, and papaverine. She experienced spontaneous resolution of EVD 18 days after symptom onset and was discharged. At 40 weeks gestation, seven and a half months after EVD recovery, she delivered a healthy female infant, APGAR 10/10/10, weighing 3450 g. Maternal blood, adnexal, and newborn blood samples were RT-PCR negative, and the mother and the baby were discharged after 14 days. At our last follow-up, in June 2023 (2 years, 3 months after delivery), the mother and the baby were in good health. Conclusion: Neonatal survival following spontaneous maternal recovery from EVD in the first trimester of gestation is rare but possible, even in the context of limited clinical resources for treatment.

The Mpox Response Among Key Populations at High Risk of or Living with HIV in Rwanda: Leveraging the Successful National HIV Control Program for More Impactful Interventions

Mpox, an emerging zoonotic infectious disease, presents a significant public health threat, especially among high-risk groups like female sex workers and men who have sex with men. This commentary reviews and summarizes Rwanda's response to mpox, focusing on its intersection with HIV. Rwanda has adopted an integrated strategy to tackle both mpox and HIV by leveraging lessons and experience from the country's success in the management of HIV and COVID-19, enhancing community engagement and health outcomes. To ensure long-term resilience, Rwanda must continue to invest in surveillance and research, expand vaccination efforts, address stigma, and foster regional impactful partnerships. Investing in fostering scientific and operational research will generate invaluable evidence that could lead to the implementation of evidence-based policymaking and cost-effective interventions.

Determinants of viral haemorrhagic fever risk in Africa's tropical moist forests: A scoping review of spatial, socio-economic, and environmental factors

BACKGROUND

Viral haemorrhagic fevers (VHFs) are identified by international health authorities as priorities for research and development, as they pose a threat to global health and economy. VHFs are zoonotic diseases whose acute forms in humans present a haemorrhagic syndrome and shock, with mortality rates of up to 90%. This work aims at synthetizing existing knowledge on spatial and spatially aggregable determinants that support the emergence and maintenance of VHFs in African countries covered by tropical moist forest, to better identify and map areas at risk.

METHODOLOGY/PRINCIPAL FINDINGS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-ScR) guidelines, extension for scoping reviews, we searched the PubMed, Embase, CAB Abstracts, and Scopus databases. English and French peer-reviewed documents were retrieved using Boolean logic and keyword search terms. The analysis of 79 articles published between 1993 and 2023 offers a comprehensive overview of the complex interactions among abiotic, biotic, demographic, socio-economic, cultural, and political risk factors in driving the emergence and maintenance of VHFs in African countries covered by tropical moist forests. Human-to-human transmission is mainly driven by socio-economic, political, and demographic factors, whereas zoonotic spillover is determined by almost all groups of factors, especially those of an anthropogenic nature.

CONCLUSIONS/SIGNIFICANCE

Many questions remain unanswered regarding the epidemiology of VHFs in tropical forests. By elucidating spatially relevant determinants which have already been studied, this review seeks to advance VHFs hotspot predictions, risk mapping for disease surveillance and control systems improvement.

Coulborn R, Ahuka-Mundeke S. Evaluation of centralised and decentralised models of care during the 2020 Ebola Virus Disease outbreak in Equateur Province, Democratic Republic of the Congo: A brief report

Background

Traditionally in the Democratic Republic of the Congo (DRC), centralised Ebola treatment centres (ETCs) have been set exclusively for Ebola virus disease (EVD) case management during outbreaks. During the 2020 EVD outbreak in DRC's Equateur Province, existing health centres were equipped as decentralised treatment centres (DTC) to improve access for patients with suspected EVD. Between ETCs and DTCs, we compared the time from symptom onset to admission and diagnosis among patients with suspected EVD.

Methods

This was a cohort study based on analysis of a line-list containing demographic and clinical information of patients with suspected EVD admitted to any EVD health facility during the outbreak.

Results

Of 2359 patients with suspected EVD, 363 (15%) were first admitted to a DTC. Of 1996 EVD-suspected patients initially admitted to an ETC, 72 (4%) were confirmed as EVD-positive. Of 363 EVD-suspected patients initially admitted to a DTC, 6 (2%) were confirmed and managed as EVD-positive in the DTC. Among all EVD-suspected patients, the median (interquartile range) duration between symptom onset and admission was 2 (1-4) days in a DTC compared to 4 (2-7) days in an ETC (p<0.001). Similarly, time from symptom onset to admission was significantly shorter among EVD-suspected patients ultimately diagnosed as EVD-negative.

Conclusions

Since <5% of the EVD-suspected patients admitted were eventually diagnosed with EVD, there is a need for better screening to optimise resource utilization and outbreak control. Only one in seven EVD-suspected patients were admitted to a DTC first, as the DTCs were piloted in a limited and phased manner. However, there is a case to be made for considering decentralized care especially in remote and hard-to-reach areas in places like the DRC to facilitate early access to care, contain viral shedding by patients with EVD and ensure no disrupted provision of non-EVD services.

Detection of Bombali Virus in a Mops condylurus Bat in Kyela, Tanzania

Bombali virus (BOMV) is a novel Orthoebolavirus that has been detected in free-tailed bats in Sierra Leone, Guinea, Kenya, and Mozambique. We screened our collection of 349 free-tailed bat lungs collected in Côte d'Ivoire and Tanzania for BOMV RNA and tested 228 bat blood samples for BOMV antibodies. We did not detect BOMV-specific antibodies but found BOMV RNA in a Mops condylurus bat from Tanzania, marking the first detection of an ebolavirus in this country. Our findings further expand the geographic range of BOMV and support M. condylurus' role as a natural BOMV host.

Optimizing the timing of an end-of-outbreak declaration: Ebola virus disease in the Democratic Republic of the Congo

Following the apparent final case in an Ebola virus disease (EVD) outbreak, the decision to declare the outbreak over must balance societal benefits of relaxing interventions against the risk of resurgence. Estimates of the end-of-outbreak probability (the probability that no future cases will occur) provide quantitative evidence that can inform the timing of an end-of-outbreak declaration. An existing modeling approach for estimating the end-of-outbreak probability requires comprehensive contact tracing data describing who infected whom to be available, but such data are often unavailable or incomplete during outbreaks. Here, we develop a Markov chain Monte Carlo-based approach that extends the previous method and does not require contact tracing data. Considering data from two EVD outbreaks in the Democratic Republic of the Congo, we find that data describing who infected whom are not required to resolve uncertainty about when to declare an outbreak over.