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Charnley GEC, Green N, Kelman I, Malembaka EB, Gaythorpe KAM. Evaluating the risk of conflict on recent Ebola outbreaks in Guinea and the Democratic Republic of the Congo. BMC Public Health 2024; 24:860. [PMID: 38509557 PMCID: PMC10953285 DOI: 10.1186/s12889-024-18300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Reducing Ebola virus transmission relies on the ability to identify cases and limit contact with infected bodily fluids through biosecurity, safe sex practices, safe burial and vaccination. Armed conflicts can complicate outbreak detection and interventions due to widespread disruption to governments and populations. Guinea and the Democratic Republic of the Congo (DRC) have historically reported the largest and the most recent Ebola virus outbreaks. Understanding if conflict played a role in these outbreaks may help in identifying key risks factors to improve disease control. METHODS We used data from a range of publicly available data sources for both Ebola virus cases and conflict events from 2018 to 2021 in Guinea and the DRC. We fitted these data to conditional logistic regression models using the Self-Controlled Case Series methodology to evaluate the magnitude in which conflict increased the risk of reported Ebola virus cases in terms of incidence rate ratio. We re-ran the analysis sub-nationally, by conflict sub-event type and tested any lagged effects. RESULTS Conflict was significantly associated with an increased risk of reported Ebola virus cases in both the DRC and Guinea in recent outbreaks. The effect was of a similar magnitude at 1.88- and 1.98-times increased risk for the DRC and Guinea, respectively. The greatest effects (often higher than the national values) were found in many conflict prone areas and during protest/riot-related conflict events. Conflict was influential in terms of Ebola virus risk from 1 week following the event and remained important by 10 weeks. CONCLUSION Extra vigilance is needed following protests and riot-related conflict events in terms of Ebola virus transmission. These events are highly disruptive, in terms of access to transportation and healthcare and are often in urban areas with high population densities. Additional public health messaging around these types of conflict events, relating to the risks and clinical symptoms may be helpful in reducing transmission. Future work should aim to further understand and quantify conflict severity and intensity, to evaluate dose-response relationships in terms of disease risk.
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Affiliation(s)
- Gina E C Charnley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
- School of Public Health, Imperial College London, London, UK.
- Institute for Global Health, University College London, London, UK.
| | - Nathan Green
- Department of Statistical Science, University College London, London, UK
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
- Institute for Risk and Disaster Reduction, University College London, London, UK
- University of Agder, Kristiansand, Norway
| | - Espoir B Malembaka
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Katy A M Gaythorpe
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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Timsit S, Armand-Lefèvre L, Le Goff J, Salmona M. The clinical and epidemiological impacts of whole genomic sequencing on bacterial and virological agents. Infect Dis Now 2024; 54:104844. [PMID: 38101516 DOI: 10.1016/j.idnow.2023.104844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
Whole Genome Sequencing (WGS) is a molecular biology tool consisting in the sequencing of the entire genome of a given organism. Due to its ability to provide the finest available resolution of bacterial and virological genetics, it is used at several levels in the field of infectiology. On an individual scale and through application of a single technique, it enables the typological identification and characterization of strains, the characterization of plasmids, and enhanced search for resistance genes and virulence factors. On a collective scale, it enables the characterization of strains and the determination of phylogenetic links between different microorganisms during community outbreaks and healthcare-associated epidemics. The information provided by WGS enables real-time monitoring of strain-level epidemiology on a worldwide scale, and facilitates surveillance of the resistance dissemination and the introduction or emergence of pathogenic variants in humans or their environment. There are several possible approaches to completion of an entire genome. The choice of one method rather than another is essentially dictated by the matrix, either a clinical sample or a culture isolate, and the clinical objective. WGS is an advanced technology that remains costly despite a gradual decrease in its expenses, potentially hindering its implementation in certain laboratories and thus its use in routine microbiology. Even though WGS is making steady inroads as a reference method, efforts remain needed in view of so harmonizing its interpretations and decreasing the time to generation of conclusive results.
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Affiliation(s)
- Sarah Timsit
- Service de Virologie, Hôpital Saint-Louis, APHP, Paris, France; Service de Bactériologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Laurence Armand-Lefèvre
- Service de Bactériologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France; IAME UMR 1137, INSERM, Université Paris Cité, Paris, France
| | - Jérôme Le Goff
- Service de Virologie, Hôpital Saint-Louis, APHP, Paris, France; INSERM U976, Insight Team, Université Paris Cité, Paris, France
| | - Maud Salmona
- Service de Virologie, Hôpital Saint-Louis, APHP, Paris, France; INSERM U976, Insight Team, Université Paris Cité, Paris, France.
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3
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Kinganda-Lusamaki E, Whitmer S, Lokilo-Lofiko E, Amuri-Aziza A, Muyembe-Mawete F, Makangara-Cigolo JC, Makaya G, Mbuyi F, Whitesell A, Kallay R, Choi M, Pratt C, Mukadi-Bamuleka D, Kavunga-Membo H, Matondo-Kuamfumu M, Mambu-Mbika F, Ekila-Ifinji R, Shoemaker T, Stewart M, Eng J, Rajan A, Soke GN, Fonjungo PN, Otshudiema JO, Folefack GLT, Pukuta-Simbu E, Talundzic E, Shedroff E, Bokete JL, Legand A, Formenty P, Mores CN, Porzucek AJ, Tritsch SR, Kombe J, Tshapenda G, Mulangu F, Ayouba A, Delaporte E, Peeters M, Wiley MR, Montgomery JM, Klena JD, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Mbala-Kingebeni P. 2020 Ebola virus disease outbreak in Équateur Province, Democratic Republic of the Congo: a retrospective genomic characterisation. THE LANCET. MICROBE 2024; 5:e109-e118. [PMID: 38278165 PMCID: PMC10849974 DOI: 10.1016/s2666-5247(23)00259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The Democratic Republic of the Congo has had 15 Ebola virus disease (EVD) outbreaks, from 1976 to 2023. On June 1, 2020, the Democratic Republic of the Congo declared an outbreak of EVD in the western Équateur Province (11th outbreak), proximal to the 2018 Tumba and Bikoro outbreak and concurrent with an outbreak in the eastern Nord Kivu Province. In this Article, we assessed whether the 11th outbreak was genetically related to previous or concurrent EVD outbreaks and connected available epidemiological and genetic data to identify sources of possible zoonotic spillover, uncover additional unreported cases of nosocomial transmission, and provide a deeper investigation into the 11th outbreak. METHODS We analysed epidemiological factors from the 11th EVD outbreak to identify patient characteristics, epidemiological links, and transmission modes to explore virus spread through space, time, and age groups in the Équateur Province, Democratic Republic of the Congo. Trained field investigators and health professionals recorded data on suspected, probable, and confirmed cases, including demographic characteristics, possible exposures, symptom onset and signs and symptoms, and potentially exposed contacts. We used blood samples from individuals who were live suspected cases and oral swabs from individuals who were deceased to diagnose EVD. We applied whole-genome sequencing of 87 available Ebola virus genomes (from 130 individuals with EVD between May 19 and Sept 16, 2020), phylogenetic divergence versus time, and Bayesian reconstruction of phylogenetic trees to calculate viral substitution rates and study viral evolution. We linked the available epidemiological and genetic datasets to conduct a genomic and epidemiological study of the 11th EVD outbreak. FINDINGS Between May 19 and Sept 16, 2020, 130 EVD (119 confirmed and 11 probable) cases were reported across 13 Équateur Province health zones. The individual identified as the index case reported frequent consumption of bat meat, suggesting the outbreak started due to zoonotic spillover. Sequencing revealed two circulating Ebola virus variants associated with this outbreak-a Mbandaka variant associated with the majority (97%) of cases and a Tumba-like variant with similarity to the ninth EVD outbreak in 2018. The Tumba-like variant exhibited a reduced substitution rate, suggesting transmission from a previous survivor of EVD. INTERPRETATION Integrating genetic and epidemiological data allowed for investigative fact-checking and verified patient-reported sources of possible zoonotic spillover. These results demonstrate that rapid genetic sequencing combined with epidemiological data can inform responders of the mechanisms of viral spread, uncover novel transmission modes, and provide a deeper understanding of the outbreak, which is ultimately needed for infection prevention and control during outbreaks. FUNDING WHO and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Eddy Kinganda-Lusamaki
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo; TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Shannon Whitmer
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emmanuel Lokilo-Lofiko
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Adrienne Amuri-Aziza
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Francisca Muyembe-Mawete
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Claude Makangara-Cigolo
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Amy Whitesell
- Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ruth Kallay
- Emergency Response and Recovery Branch USA, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Choi
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catherine Pratt
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel Mukadi-Bamuleka
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hugo Kavunga-Membo
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo-Kuamfumu
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard Ekila-Ifinji
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Miles Stewart
- Johns Hopkins University Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Julia Eng
- Johns Hopkins University Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Abraham Rajan
- Johns Hopkins University Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Gnakub N Soke
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Peter N Fonjungo
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | | | | | - Elisabeth Pukuta-Simbu
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Emir Talundzic
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Shedroff
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anaïs Legand
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | - Christopher N Mores
- Global Health Department, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Abigail J Porzucek
- Global Health Department, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sarah R Tritsch
- Global Health Department, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - John Kombe
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | - Felix Mulangu
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Eric Delaporte
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Martine Peeters
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Michael R Wiley
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; PraesensBio, Omaha, NE, USA
| | - Joel M Montgomery
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Klena
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean-Jacques Muyembe-Tamfum
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
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4
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Chen Z, Lemey P, Yu H. Approaches and challenges to inferring the geographical source of infectious disease outbreaks using genomic data. THE LANCET. MICROBE 2024; 5:e81-e92. [PMID: 38042165 DOI: 10.1016/s2666-5247(23)00296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 12/04/2023]
Abstract
Genomic data hold increasing potential in the elucidation of transmission dynamics and geographical sources of infectious disease outbreaks. Phylogeographic methods that use epidemiological and genomic data obtained from surveillance enable us to infer the history of spatial transmission that is naturally embedded in the topology of phylogenetic trees as a record of the dispersal of infectious agents between geographical locations. In this Review, we provide an overview of phylogeographic approaches widely used for reconstructing the geographical sources of outbreaks of interest. These approaches can be classified into ancestral trait or state reconstruction and structured population models, with structured population models including popular structured coalescent and birth-death models. We also describe the major challenges associated with sequencing technologies, surveillance strategies, data sharing, and analysis frameworks that became apparent during the generation of large-scale genomic data in recent years, extending beyond inference approaches. Finally, we highlight the role of genomic data in geographical source inference and clarify how this enhances understanding and molecular investigations of outbreak sources.
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Affiliation(s)
- Zhiyuan Chen
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary Virology, KU Leuven, Leuven, Belgium
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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Mukadi-Bamuleka D, Nkuba-Ndaye A, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ. Impact of Ebola epidemics on the daily operation of existing systems in Eastern Democratic Republic of the Congo: a brief review. J Med Econ 2024; 27:184-192. [PMID: 38240249 DOI: 10.1080/13696998.2024.2305009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
AIMS to provide insights into the recent Ebola virus disease (EVD) outbreaks on different aspects of daily life in the Democratic Republic of the Congo and propose possible solutions. METHODS We collected information regarding the effects of EVD outbreaks on existing systems in the eastern part of the Democratic Republic of the Congo (DRC). We searched the PubMed database using the terms "impact effect Ebola outbreak system", "Management Ebola Poor Resources Settings", "Health Economic Challenges Ebola" and "Economic impact Ebola systems." Only studies focusing on epidemiology, diagnostics, sequencing, vaccination, therapeutics, ecology, work force, governance, healthcare provision and health system, and social, political, and economic aspects were considered. The search included the electronic archives of EVD outbreak reports from government and partners. RESULTS EVD outbreaks negatively impacts the functions of countries. The disruption in activities is proportional to the magnitude of the epidemic and slows down the transport of goods, decreases the region's tourist appeal, and increases 'brain drain'. Most low- and medium-income countries, such as the DRC, do not have a long-term holistic emergency plan for unexpected situations or sufficient resources to adequately implement countermeasures against EVD outbreaks. Although the DRC has acquired sufficient expertise in diagnostics, genomic sequencing, administration of vaccines and therapeutics, clinical trials, and research activities, deployment, operation, and maintenance of these expertise and associated tools remains a concern. LIMITATIONS Despite the data search extension, additional reports addressing issues related to social aspects of EVD outbreaks in DRC were not retrieved. CONCLUSION National leadership has not yet taken the lead in strategic, operational, or financial aspects. Therefore, national leaders should double their efforts and awareness to encourage local fundraising, sufficient budget al.location, infrastructure construction, equipment provision, and staff training, to effectively support a holistic approach in response to outbreaks, providing effective results, and all types of research activities.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Rodolphe Mérieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Antoine Nkuba-Ndaye
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
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Balinandi S, Whitmer S, Mulei S, Nassuna C, Pimundu G, Muyigi T, Kainulainen M, Shedroff E, Krapiunaya I, Scholte F, Nyakarahuka L, Tumusiime A, Kyondo J, Baluku J, Kiconco J, Harris JR, Ario AR, Kagirita A, Bosa HK, Ssewanyana I, Nabadda S, Mwebesa HG, Aceng JR, Atwine D, Lutwama JJ, Shoemaker TR, Montgomery JM, Kaleebu P, Klena JD. Molecular characterization of the 2022 Sudan virus disease outbreak in Uganda. J Virol 2023; 97:e0059023. [PMID: 37750724 PMCID: PMC10617429 DOI: 10.1128/jvi.00590-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023] Open
Abstract
IMPORTANCE Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated. The Mubende variant exhibited 96% amino acid similarity with historic SUDV sequences from the 1970s and a high degree of conservation throughout the outbreak, which was important for ongoing diagnostics and highly promising for future therapy development. Genetic differences between viruses identified during the Mubende SVD outbreak were linked with epidemiological data to better interpret viral spread and contact tracing chains. This methodology should be used to better integrate discrete epidemiological and sequence data for future viral outbreaks.
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Affiliation(s)
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Godfrey Pimundu
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Tonny Muyigi
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Markus Kainulainen
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Shedroff
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inna Krapiunaya
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Florine Scholte
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Luke Nyakarahuka
- Uganda Virus Research Institute, Entebbe, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - Jimmy Baluku
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Alex R. Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Henry K. Bosa
- Ministry of Health, Kampala, Uganda
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Isaac Ssewanyana
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Susan Nabadda
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pontiano Kaleebu
- Uganda Virus Research Institute, Entebbe, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - John D. Klena
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Dupuy LC, Spiropoulou CF, Towner JS, Spengler JR, Sullivan NJ, Montgomery JM. Filoviruses: Scientific Gaps and Prototype Pathogen Recommendation. J Infect Dis 2023; 228:S446-S459. [PMID: 37849404 PMCID: PMC11009505 DOI: 10.1093/infdis/jiad362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Viruses in the family Filoviridae, including the commonly known Ebola (EBOV) and Marburg (MARV) viruses, can cause severe hemorrhagic fever in humans and nonhuman primates. Sporadic outbreaks of filovirus disease occur in sub-Saharan Africa with reported case fatality rates ranging from 25% to 90%. The high mortality and increasing frequency and magnitude of recent outbreaks along with the increased potential for spread from rural to urban areas highlight the importance of pandemic preparedness for these viruses. Despite their designation as high-priority pathogens, numerous scientific gaps exist in critical areas. In this review, these gaps and an assessment of potential prototype pathogen candidates are presented for this important virus family.
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Affiliation(s)
- Lesley C Dupuy
- Virology Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina F Spiropoulou
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan S Towner
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica R Spengler
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nancy J Sullivan
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, Massachusetts, USA
| | - Joel M Montgomery
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Shaw AG, Mampuela TK, Lofiko EL, Pratt C, Troman C, Bujaki E, O'Toole Á, Akello JO, Aziza AA, Lusamaki EK, Makangara JC, Akonga M, Lay Y, Nsunda B, White B, Jorgensen D, Pukuta E, Riziki Y, Rankin KE, Rambaut A, Ahuka-Mundeke S, Muyembe JJ, Martin J, Grassly NC, Mbala-Kingebeni P. Sensitive poliovirus detection using nested PCR and nanopore sequencing: a prospective validation study. Nat Microbiol 2023; 8:1634-1640. [PMID: 37591995 PMCID: PMC10465353 DOI: 10.1038/s41564-023-01453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
Timely detection of outbreaks is needed for poliovirus eradication, but gold standard detection in the Democratic Republic of the Congo takes 30 days (median). Direct molecular detection and nanopore sequencing (DDNS) of poliovirus in stool samples is a promising fast method. Here we report prospective testing of stool samples from suspected polio cases, and their contacts, in the Democratic Republic of the Congo between 10 August 2021 and 4 February 2022. DDNS detected polioviruses in 62/2,339 (2.7%) of samples, while gold standard combination of cell culture, quantitative PCR and Sanger sequencing detected polioviruses in 51/2,339 (2.2%) of the same samples. DDNS provided case confirmation in 7 days (median) in routine surveillance conditions. DDNS enabled confirmation of three serotype 2 circulating vaccine-derived poliovirus outbreaks 23 days (mean) earlier (range 6-30 days) than the gold standard method. The mean sequence similarity between sequences obtained by the two methods was 99.98%. Our data confirm the feasibility of implementing DDNS in a national poliovirus laboratory.
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Affiliation(s)
- Alexander G Shaw
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Tresor Kabeya Mampuela
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Catherine Pratt
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Catherine Troman
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Erika Bujaki
- Department of Vaccines, National Institute for Biological Standards and Control (NIBSC), Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Áine O'Toole
- Institute of Ecology and Evolution, University of Edinburgh, Ashworth Laboratories, Edinburgh, UK
| | - Joyce Odeke Akello
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Adrienne Amuri Aziza
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Eddy Kinganda Lusamaki
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes), University of Montpellier (UM), French National Research Institute for Sustainable Development (IRD), INSERM, Montpellier, France
| | - Jean Claude Makangara
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Marceline Akonga
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Yvonne Lay
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bibiche Nsunda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bailey White
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Jorgensen
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Elizabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Andrew Rambaut
- Institute of Ecology and Evolution, University of Edinburgh, Ashworth Laboratories, Edinburgh, UK
| | - Steve Ahuka-Mundeke
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Javier Martin
- Department of Vaccines, National Institute for Biological Standards and Control (NIBSC), Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Nicholas C Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Placide Mbala-Kingebeni
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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9
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Kinganda-Lusamaki E, Baketana LK, Ndomba-Mukanya E, Bouillin J, Thaurignac G, Aziza AA, Luakanda-Ndelemo G, Nuñez NF, Kalonji-Mukendi T, Pukuta ES, Nkuba-Ndaye A, Lofiko EL, Kibungu EM, Lushima RS, Ayouba A, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Delaporte E, Peeters M, Ahuka-Mundeke S. Use of Mpox Multiplex Serology in the Identification of Cases and Outbreak Investigations in the Democratic Republic of the Congo (DRC). Pathogens 2023; 12:916. [PMID: 37513764 PMCID: PMC10385798 DOI: 10.3390/pathogens12070916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Human Mpox cases are increasingly reported in Africa, with the highest burden in the Democratic Republic of Congo (DRC). While case reporting on a clinical basis can overestimate infection rates, laboratory confirmation by PCR can underestimate them, especially on suboptimal samples like blood, commonly used in DRC. Here we used a Luminex-based assay to evaluate whether antibody testing can be complementary to confirm cases and to identify human transmission chains during outbreak investigations. We used left-over blood samples from 463 patients, collected during 174 outbreaks between 2013 and 2022, with corresponding Mpox and VZV PCR results. In total, 157 (33.9%) samples were orthopox-PCR positive and classified as Mpox+; 124 (26.8%) had antibodies to at least one of the three Mpox peptides. The proportion of antibody positive samples was significantly higher in Mpox positive samples (36.9%) versus negative (21.6%) (p < 0.001). By combining PCR and serology, 66 additional patients were identified, leading to an Mpox infection rate of 48.2% (223/463) versus 33.9% when only PCR positivity is considered. Mpox infections were as such identified in 14 additional health zones and 23 additional outbreaks (111/174 (63.8%) versus 88/174 (50.6%)). Our findings highlight the urgent need of rapid on-site diagnostics to circumvent Mpox spread.
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Affiliation(s)
- Eddy Kinganda-Lusamaki
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Lionel Kinzonzi Baketana
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Etienne Ndomba-Mukanya
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Julie Bouillin
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Guillaume Thaurignac
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Adrienne Amuri Aziza
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Gradi Luakanda-Ndelemo
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Nicolas Fernandez Nuñez
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Thierry Kalonji-Mukendi
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Elisabeth Simbu Pukuta
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Antoine Nkuba-Ndaye
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Emmanuel Lokilo Lofiko
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Emile Malembi Kibungu
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Robert Shongo Lushima
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Eric Delaporte
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Martine Peeters
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
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10
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Rijal P, Donnellan FR. A review of broadly protective monoclonal antibodies to treat Ebola virus disease. Curr Opin Virol 2023; 61:101339. [PMID: 37392670 DOI: 10.1016/j.coviro.2023.101339] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/26/2023] [Accepted: 05/28/2023] [Indexed: 07/03/2023]
Abstract
The filovirus vaccine and the therapeutic monoclonal antibody (mAb) research have made substantial progress. However, existing vaccines and mAbs approved for use in humans are specific to Zaire ebolavirus (EBOV). Since other Ebolavirus species are a continuing threat to public health, the search for broadly protective mAbs has drawn attention. Here, we review viral glycoprotein-targeting mAbs that have proved their broader protective efficacy in animal models. MBP134AF, the most advanced of these new-generation mAb therapies, has recently been deployed in Uganda during the Sudan ebolavirus outbreak. Furthermore, we discuss the measures associated with enhancing antibody therapies and the risks associated with them, including the rise of escape mutations following the mAb treatment and naturally occurring EBOV variants.
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Affiliation(s)
- Pramila Rijal
- Center for Translational Immunology, Chinese Academy of Medical Science Oxford Institute, Nuffield Department of Medicine, University of Oxford, UK; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DS, United Kingdom.
| | - Francesca R Donnellan
- Department of Biochemistry, Dorothy Crowfoot Hodgkin Building, South Parks Road, Oxford, OX1 3QU, United Kingdom; Kavli Institute for Nanoscience Discovery, University of Oxford, UK.
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11
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Hill V, Githinji G, Vogels CBF, Bento AI, Chaguza C, Carrington CVF, Grubaugh ND. Toward a global virus genomic surveillance network. Cell Host Microbe 2023; 31:861-873. [PMID: 36921604 PMCID: PMC9986120 DOI: 10.1016/j.chom.2023.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The COVID-19 pandemic galvanized the field of virus genomic surveillance, demonstrating its utility for public health. Now, we must harness the momentum that led to increased infrastructure, training, and political will to build a sustainable global genomic surveillance network for other epidemic and endemic viruses. We suggest a generalizable modular sequencing framework wherein users can easily switch between virus targets to maximize cost-effectiveness and maintain readiness for new threats. We also highlight challenges associated with genomic surveillance and when global inequalities persist. We propose solutions to mitigate some of these issues, including training and multilateral partnerships. Exploring alternatives to clinical sequencing can also reduce the cost of surveillance programs. Finally, we discuss how establishing genomic surveillance would aid control programs and potentially provide a warning system for outbreaks, using a global respiratory virus (RSV), an arbovirus (dengue virus), and a regional zoonotic virus (Lassa virus) as examples.
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Affiliation(s)
- Verity Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - George Githinji
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Biochemistry and Biotechnology, Pwani University, Kilifi, Kenya
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - Ana I Bento
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA; The Rockefeller Foundation, New York, NY, USA
| | - Chrispin Chaguza
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - Christine V F Carrington
- Department of Preclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale Institute for Global Health, Yale University, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA; Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA.
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12
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Christoffels A, Mboowa G, van Heusden P, Makhubela S, Githinji G, Mwangi S, Onywera H, Nnaemeka N, Amoako DG, Olawoye I, Diallo A, Mbala-Kingebeni P, Oyola SO, Adu B, Mvelase C, Ondoa P, Dratibi FA, Sow A, Gumede N, Tessema SK, Ouma AO, Tebeje YK. A pan-African pathogen genomics data sharing platform to support disease outbreaks. Nat Med 2023; 29:1052-1055. [PMID: 37161068 DOI: 10.1038/s41591-023-02266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Alan Christoffels
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia.
- South African National Bioinformatics Institute, SAMRC Bioinformatics Unit, University of the Western Cape, Cape Town, South Africa.
| | - Gerald Mboowa
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | - Peter van Heusden
- South African National Bioinformatics Institute, SAMRC Bioinformatics Unit, University of the Western Cape, Cape Town, South Africa
| | | | - George Githinji
- KEMRI-Wellcome Trust Research Programme/KEMRI-CGMR-C, Kilifi, Kenya
| | - Sarah Mwangi
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | - Harris Onywera
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | | | - Daniel Gyamfi Amoako
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Idowu Olawoye
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | | | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Samuel O Oyola
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Bright Adu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Pascale Ondoa
- African Society for Laboratory Medicine (ASLM), Addis Ababa, Ethiopia
| | | | | | - Nicksy Gumede
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Sofonias K Tessema
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia.
| | - Ahmed Ogwell Ouma
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | - Yenew Kebede Tebeje
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
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13
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Mukadi-Bamuleka D, Mambu-Mbika F, De Weggheleire A, Edidi-Atani F, Bulabula-Penge J, Mfumu MMK, Legand A, Nkuba-Ndaye A, N’kasar YTT, Mbala-Kingebeni P, Klena JD, Montgomery JM, Muyembe-Tamfum JJ, Formenty P, van Griensven J, Ariën KK, Ahuka-Mundeke S. Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018–2020. Emerg Infect Dis 2023. [DOI: 10.3201/2901.221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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14
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Mukadi-Bamuleka D, Mambu-Mbika F, De Weggheleire A, Edidi-Atani F, Bulabula-Penge J, Mfumu MMK, Legand A, Nkuba-Ndaye A, N'kasar YTT, Mbala-Kingebeni P, Klena JD, Montgomery JM, Muyembe-Tamfum JJ, Formenty P, van Griensven J, Ariën KK, Ahuka-Mundeke S. Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018-2020. Emerg Infect Dis 2023; 29:1-9. [PMID: 36573642 PMCID: PMC9796222 DOI: 10.3201/eid2901.221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo, the Institut National de Recherche Biomédicale strategically positioned 13 decentralized field laboratories with dedicated equipment to quickly detect cases as the outbreak evolved. The laboratories were operated by national staff, who quickly handed over competencies and skills to local persons to successfully manage future outbreaks. Laboratories analyzed ≈230,000 Ebola diagnostic samples under stringent biosafety measures, documentation, and database management. Field laboratories diversified their activities (diagnosis, chemistry and hematology, survivor follow-up, and genomic sequencing) and shipped 127,993 samples from the field to a biorepository in Kinshasa under good conditions. Deploying decentralized and well-equipped laboratories run by local personnel in at-risk countries for Ebola virus disease outbreaks is an efficient response; all activities are quickly conducted in the field.
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15
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Mehta P, Ravi V, Devi P, Maurya R, Parveen S, Mishra P, Yadav A, Swaminathan A, Saifi S, Khare K, Chattopadhyay P, Yadav M, Chauhan NS, Tarai B, Budhiraja S, Shamim U, Pandey R. Mutational dynamics across VOCs in International travellers and Community transmission underscores importance of Spike-ACE2 interaction. Microbiol Res 2022; 262:127099. [PMID: 35779308 PMCID: PMC9232397 DOI: 10.1016/j.micres.2022.127099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Abstract
Background Emergence of SARS-CoV-2 VOCs at different time points through COVID-19 pandemic raised concern for increased transmissibility, infectivity and vaccination breakthroughs. Methods 1567 international travellers plus community transmission COVID-19 cases were analysed for mutational profile of VOCS, that led to notable waves in India, namely Alpha, Delta, and Omicron. Spike mutations in Linkage Disequilibrium were investigated for potential impact on structural and functional changes of Spike-ACE2. Results ORF1ab and spike harboured diverse mutational signatures for each lineage. B.1.617.2 and AY. * demonstrated comparable profile, yet non-clade defining mutations were majorly unique between international vs community samples. Contrarily, Omicron lineages showed substantial overlap in non-clade defining mutations, signifying early phase of transmission and evolution within Indian community. Mutations in LD for Alpha [N501Y, A570D, D1118H, S982A], Delta [P681R, L452R, EFR:156–158 G, D950N, G142D] and Omicron [P681H, D796Y, N764K, N969K, N501Y, S375F] resulted in decreased binding affinity of Spike-ACE2 for Alpha and BA.1 whereas Delta, Omicron and BA.2 demonstrated strong binding. Conclusion Genomic surveillance tracked spread of VOCs in international travellers’ vs community transmission. Behavioural transmission patterns of variants, based on selective advantage incurred by spike mutations, led us to predict sudden takeover of Delta over Alpha and BA.2 over BA.1 in India. The mutational landscape of 1567 international travellers and community transmission were characterized across VOCs in India Mutations in LD for VOCs demonstrated differentially altered binding affinity and electrostatic interactions of Spike-ACE2. Altered Spike-ACE2 affinity among VOCs predicted sudden takeover of Delta over Alpha and BA.2 over BA.1 in India.
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16
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Ibe C. The impact of COVID-19 pandemic on invasive fungal infections in Africa: What have we learned? PLoS Negl Trop Dis 2022; 16:e0010720. [PMID: 36040906 PMCID: PMC9426908 DOI: 10.1371/journal.pntd.0010720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Invasive fungal infections (IFIs) have been described as diseases of the poor. The mortality rate of the infections is comparable to that of malaria, HIV, and TB, yet the infections remain poorly funded, neglected in research, and policy at all levels of human resources. The Coronavirus Disease 2019 (COVID-19) pandemic has further worsened the current state of management for IFIs. At the same time, response to COVID-19 has stirred and boosted vaccine production, vaccine substance manufacturing, and building of next-generation sequencing capacity and genomics data sharing network in the continent. Through collaboration and transdisciplinary research effort, these network and technology can be extended to encourage fungal research to address health issues of existing and emerging fungal pathogens.
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Affiliation(s)
- Chibuike Ibe
- Departments of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
- * E-mail:
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17
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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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Nyakarahuka L, Mulei S, Whitmer S, Jackson K, Tumusiime A, Schuh A, Baluku J, Joyce A, Ocom F, Tusiime JB, Montgomery JM, Balinandi S, Lutwama JJ, Klena JD, Shoemaker TR. First laboratory confirmation and sequencing of Zaire ebolavirus in Uganda following two independent introductions of cases from the 10th Ebola Outbreak in the Democratic Republic of the Congo, June 2019. PLoS Negl Trop Dis 2022; 16:e0010205. [PMID: 35192613 PMCID: PMC8896669 DOI: 10.1371/journal.pntd.0010205] [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: 07/22/2021] [Revised: 03/04/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
Uganda established a domestic Viral Hemorrhagic Fever (VHF) testing capacity in 2010 in response to the increasing occurrence of filovirus outbreaks. In July 2018, the neighboring Democratic Republic of Congo (DRC) experienced its 10th Ebola Virus Disease (EVD) outbreak and for the duration of the outbreak, the Ugandan Ministry of Health (MOH) initiated a national EVD preparedness stance. Almost one year later, on 10th June 2019, three family members who had contracted EVD in the DRC crossed into Uganda to seek medical treatment.
Samples were collected from all the suspected cases using internationally established biosafety protocols and submitted for VHF diagnostic testing at Uganda Virus Research Institute. All samples were initially tested by RT-PCR for ebolaviruses, marburgviruses, Rift Valley fever (RVF) virus and Crimean-Congo hemorrhagic fever (CCHF) virus. Four people were identified as being positive for Zaire ebolavirus, marking the first report of Zaire ebolavirus in Uganda. In-country Next Generation Sequencing (NGS) and phylogenetic analysis was performed for the first time in Uganda, confirming the outbreak as imported from DRC at two different time point from different clades. This rapid response by the MoH, UVRI and partners led to the control of the outbreak and prevention of secondary virus transmission.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University, Kampala, Uganda
- * E-mail:
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kyondo Jackson
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Amy Schuh
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Allison Joyce
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Felix Ocom
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | | | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen Balinandi
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Sherwood LJ, Hayhurst A. Generating Uniformly Cross-Reactive Ebolavirus spp. Anti-nucleoprotein Nanobodies to Facilitate Forward Capable Detection Strategies. ACS Infect Dis 2022; 8:343-359. [PMID: 34994194 DOI: 10.1021/acsinfecdis.1c00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It is often challenging for a single monoclonal antibody to cross-react equally with all species of a particular viral genus that are separated by time and geographies to ensure broad long-term global immunodiagnostic use. Here, we set out to isolate nanobodies or single-domain antibodies (sdAbs) with uniform cross-reactivity to the genus Ebolavirus by immunizing a llama with recombinant nucleoprotein (NP) representing the 5 cultivated species to assemble a phage display repertoire for mining. Screening sdAbs for reactivity against the C-terminal domain of NP guided the isolation of clones that could perform as both captor and tracer for polyvalent antigen in sandwich assays. Two promising sdAbs had equivalent reactivities across all 5 species and greatly enhanced the equilibrium concentration at 50% (EC50) for recombinant NP when compared with a differentially cross-reactive nonimmune sdAb isolated previously. Uniform reactivity and enhanced sensitivity were relayed to live virus titrations, resulting in lower limits of detection of 2-5 pfu for the best sdAbs, representing 10-, 20-, and 100-fold improvements for Zaire, Sudan/Reston, and Taï Forest viruses, respectively. Fusions of the sdAbs with ascorbate peroxidase (APEX2) and mNeonGreen generated one-step immunoreagents useful for colorimetric and fluorescent visualization of cellular NP. Both sdAbs were also able to recognize recombinant NPs from the recently discovered Bombali virus, a putative sixth Ebolavirus species unknown at the start of these experiments, validating the forward capabilities of the sdAbs. The simplicity and modularity of these sdAbs should enable advances in antigen-based diagnostic technologies to be retuned toward filoviral detection relatively easily, thereby proactively safeguarding human health.
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Affiliation(s)
- Laura Jo Sherwood
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, Texas 78227, United States
| | - Andrew Hayhurst
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, Texas 78227, United States
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Liu P, Song Y, Colijn C, MacPherson A. The impact of sampling bias on viral phylogeographic reconstruction. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000577. [PMID: 36962555 PMCID: PMC10021582 DOI: 10.1371/journal.pgph.0000577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022]
Abstract
Genomic epidemiology plays an ever-increasing role in our understanding of and response to the spread of infectious pathogens. Phylogeography, the reconstruction of the historical location and movement of pathogens from the evolutionary relationships among sampled pathogen sequences, can inform policy decisions related to viral movement among jurisdictions. However, phylogeographic reconstruction is impacted by the fact that the sampling and virus sequencing policies differ among jurisdictions, and these differences can cause bias in phylogeographic reconstructions. Here we assess the potential impacts of geographic-based sampling bias on estimated viral locations in the past, and on whether key viral movements can be detected. We quantify the effect of bias using simulated phylogenies with known geographic histories, and determine the impact of the biased sampling and of the underlying migration rate on the accuracy of estimated past viral locations. We find that overall, the accuracy of phylogeographic reconstruction is high, particularly when the migration rate is low. However, results depend on sampling, and sampling bias can have a large impact on the numbers and nature of estimated migration events. We apply these insights to the geographic spread of Ebolavirus in the 2014-2016 West Africa epidemic. This work highlights how sampling policy can both impact geographic inference and be optimized to best ensure the accuracy of specific features of geographic spread.
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Affiliation(s)
- Pengyu Liu
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Yexuan Song
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ailene MacPherson
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
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21
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Progress and challenges in virus genomic epidemiology. Trends Parasitol 2021; 37:1038-1049. [PMID: 34620561 DOI: 10.1016/j.pt.2021.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Genomic epidemiology, which links pathogen genomes with associated metadata to understand disease transmission, has become a key component of outbreak response. Decreasing costs of genome sequencing and increasing computational power provide opportunities to generate and analyse large viral genomic datasets that aim to uncover the spatial scales of transmission, the demographics contributing to transmission patterns, and to forecast epidemic trends. Emerging sources of genomic data and associated metadata provide new opportunities to further unravel transmission patterns. Key challenges include how to integrate genomic data with metadata from multiple sources, how to generate efficient computational algorithms to cope with large datasets, and how to establish sampling frameworks to enable robust conclusions.
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22
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Abstract
PURPOSE OF REVIEW Due to the impact of the COVID-19 pandemic this past year, we have witnessed a significant acceleration in the science, technology, and policy of global health security. This review highlights important progress made toward the mitigation of Zika, Ebola, and COVID-19 outbreaks. These epidemics and their shared features suggest a unified policy and technology agenda that could broadly improve global health security. RECENT FINDINGS Molecular epidemiology is not yet in widespread use, but shows promise toward informing on-the-ground decision-making during outbreaks. Point-of-care (POC) diagnostics have been achieved for each of these threats; however, deployment of Zika and Ebola diagnostics lags behind those for COVID-19. POC metagenomics offers the possibility of identifying novel viruses. Vaccines have been successfully approved for Ebola and COVID-19, due in large part to public-private partnerships and advance purchase commitments. Therapeutics trials conducted during ongoing epidemics have identified effective antibody therapeutics for Ebola, as well as steroids (both inhaled and oral) and a broad-spectrum antiviral for COVID-19. SUMMARY Achieving global health security remains a challenge, though headway has been made over the past years. Promising policy and technology strategies that would increase resilience across emerging viral pathogens should be pursued.
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Affiliation(s)
| | - Michele Barry
- School of Medicine
- Center for Innovation in Global Health, Stanford University, Stanford, California, USA
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