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Grant DS, Samuels RJ, Garry RF, Schieffelin JS. Lassa Fever Natural History and Clinical Management. Curr Top Microbiol Immunol 2023. [PMID: 37106159 DOI: 10.1007/82_2023_263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Lassa fever is caused by Lassa virus (LASV), an Old World Mammarenavirus that is carried by Mastomys natalensis and other rodents. It is endemic in Sierra Leone, Nigeria, and other countries in West Africa. The clinical presentation of LASV infection is heterogenous varying from an inapparent or mild illness to a fatal hemorrhagic fever. Exposure to LASV is usually through contact with rodent excreta. After an incubation period of 1-3 weeks, initial symptoms such as fever, headache, and fatigue develop that may progress to sore throat, retrosternal chest pain, conjunctival injection, vomiting, diarrhea, and abdominal pain. Severe illness, including hypotension, shock, and multiorgan failure, develops in a minority of patients. Patient demographics and case fatality rates are distinctly different in Sierra Leone and Nigeria. Laboratory diagnosis relies on the detection of LASV antigens or genomic RNA. LASV-specific immunoglobulin G and M assays can also contribute to clinical management. The mainstay of treatment for Lassa fever is supportive care. The nucleoside analog ribavirin is commonly used to treat acute Lassa fever but is considered useful only if treatment is begun early in the disease course. Drugs in development, including a monoclonal antibody cocktail, have the potential to impact the management of Lassa fever.
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Affiliation(s)
- Donald S Grant
- Lassa Fever Program, Kenema Government Hospital, Ministry of Health, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone
| | - Robert J Samuels
- Lassa Fever Program, Kenema Government Hospital, Ministry of Health, Kenema, Sierra Leone
| | - Robert F Garry
- School of Medicine, Department of Microbiology and Immunology, Tulane University, New Orleans, LA, 70112, USA
- Zalgen Labs, Frederick, MD, 21703, USA
- Global Virus Network (GVN), Baltimore, MD, 21201, USA
| | - John S Schieffelin
- School of Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, 70112, USA.
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Abstract
Lassa virus (LASV) is endemic in the rodent populations of Sierra Leone, Nigeria and other countries in West Africa. Spillover to humans occurs frequently and results in Lassa fever, a viral haemorrhagic fever (VHF) associated with a high case fatality rate. Despite advances, fundamental gaps in knowledge of the immunology, epidemiology, ecology and pathogenesis of Lassa fever persist. More frequent outbreaks, the potential for further geographic expansion of Mastomys natalensis and other rodent reservoirs, the ease of procurement and possible use and weaponization of LASV, the frequent importation of LASV to North America and Europe, and the emergence of novel LASV strains in densely populated West Africa have driven new initiatives to develop countermeasures for LASV. Although promising candidates are being evaluated, as yet there are no approved vaccines or therapeutics for human use. This Review discusses the virology of LASV, the clinical course of Lassa fever and the progress towards developing medical countermeasures.
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Affiliation(s)
- Robert F Garry
- Department of Microbiology and Immunology, Tulane University, New Orleans, LA, USA.
- Zalgen Labs, Frederick, MD, USA.
- Global Viral Network, Baltimore, MD, USA.
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Mencattelli G, Ndione MHD, Rosà R, Marini G, Diagne CT, Diagne MM, Fall G, Faye O, Diallo M, Faye O, Savini G, Rizzoli A. Epidemiology of West Nile virus in Africa: An underestimated threat. PLoS Negl Trop Dis 2022; 16:e0010075. [PMID: 35007285 PMCID: PMC8789169 DOI: 10.1371/journal.pntd.0010075] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/25/2022] [Accepted: 12/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND West Nile virus is a mosquito-borne flavivirus which has been posing continuous challenges to public health worldwide due to the identification of new lineages and clades and its ability to invade and establish in an increasing number of countries. Its current distribution, genetic variability, ecology, and epidemiological pattern in the African continent are only partially known despite the general consensus on the urgency to obtain such information for quantifying the actual disease burden in Africa other than to predict future threats at global scale. METHODOLOGY AND PRINCIPAL FINDINGS References were searched in PubMed and Google Scholar electronic databases on January 21, 2020, using selected keywords, without language and date restriction. Additional manual searches of reference list were carried out. Further references have been later added accordingly to experts' opinion. We included 153 scientific papers published between 1940 and 2021. This review highlights: (i) the co-circulation of WNV-lineages 1, 2, and 8 in the African continent; (ii) the presence of diverse WNV competent vectors in Africa, mainly belonging to the Culex genus; (iii) the lack of vector competence studies for several other mosquito species found naturally infected with WNV in Africa; (iv) the need of more competence studies to be addressed on ticks; (iv) evidence of circulation of WNV among humans, animals and vectors in at least 28 Countries; (v) the lack of knowledge on the epidemiological situation of WNV for 19 Countries and (vii) the importance of carrying out specific serological surveys in order to avoid possible bias on WNV circulation in Africa. CONCLUSIONS This study provides the state of art on WNV investigation carried out in Africa, highlighting several knowledge gaps regarding i) the current WNV distribution and genetic diversity, ii) its ecology and transmission chains including the role of different arthropods and vertebrate species as competent reservoirs, and iii) the real disease burden for humans and animals. This review highlights the needs for further research and coordinated surveillance efforts on WNV in Africa.
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Affiliation(s)
- Giulia Mencattelli
- Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Trento, Italy
- Center Agriculture Food Environment, University of Trento, San Michele all'Adige, Trento, Italy
| | | | - Roberto Rosà
- Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Trento, Italy
- Center Agriculture Food Environment, University of Trento, San Michele all'Adige, Trento, Italy
| | - Giovanni Marini
- Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Trento, Italy
| | | | | | - Gamou Fall
- Department of Virology, Fondation Institut Pasteur de Dakar, Dakar, Senegal
| | - Ousmane Faye
- Department of Virology, Fondation Institut Pasteur de Dakar, Dakar, Senegal
| | - Mawlouth Diallo
- Department of Zoology, Fondation Institut Pasteur de Dakar, Dakar, Senegal
| | - Oumar Faye
- Department of Virology, Fondation Institut Pasteur de Dakar, Dakar, Senegal
| | - Giovanni Savini
- Department of Public Health, OIE Reference Laboratory for WND, Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Teramo, Italy
| | - Annapaola Rizzoli
- Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Trento, Italy
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Koch MR, Kanneh L, Wise PH, Kurina LM, Alhasan F, Garry RF, Schieffelin JS, Shaffer JG, Grant DS. Health seeking behavior after the 2013-16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone. PLoS Negl Trop Dis 2021; 15:e0009576. [PMID: 34260615 PMCID: PMC8312964 DOI: 10.1371/journal.pntd.0009576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/26/2021] [Accepted: 06/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The West African Ebola epidemic of 2013-2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone's Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011-2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare. CONCLUSIONS/SIGNIFICANCE Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.
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Affiliation(s)
- Mikaela R. Koch
- Program in Human Biology, Stanford University, Stanford, California, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Lansana Kanneh
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Paul H. Wise
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Lianne M. Kurina
- Program in Human Biology, Stanford University, Stanford, California, United States of America
| | - Foday Alhasan
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
| | - Robert F. Garry
- Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, Louisiana, United States of America
- Zalgen Labs, LCC, Germantown, MD, United States of America
| | - John S. Schieffelin
- Sections of Infectious Disease, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- * E-mail: (MRK); (JGS); (DSG)
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Rugarabamu S, Mwanyika GO, Rumisha SF, Sindato C, Lim HY, Misinzo G, Mboera LEG. Seroprevalence and associated risk factors of selected zoonotic viral hemorrhagic fevers in Tanzania. Int J Infect Dis 2021; 109:174-181. [PMID: 34242761 DOI: 10.1016/j.ijid.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the seroprevalence of selected zoonotic viral hemorrhagic fevers (VHFs) and their associated risk factors in Tanzania. METHODS Blood samples were collected from consenting outpatients and community members in eight districts selected from five ecological zones of Tanzania. Serum was harvested and tested for the presence of immunoglobulin G (IgG) and M (IgM) antibodies against Crimean-Congo hemorrhagic fever (CCHF), Ebola virus disease (EVD), Marburg virus disease (MVD), Rift Valley fever (RVF), and yellow fever (YF). RESULTS The presence of IgM and IgG antibodies against CCHF, EVD, MVD, RVF, and YF was detected in 64 of 500 samples (12.8%). The prevalences of IgM and IgG antibodies to CCHF, EVD, MVD, RFV, and YF were 2.0%, 3.4%, 1.2%, 4.8%, and 1.4%, respectively. Contact with wild animals (OR = 1.2, CI = 1.3-1.6) and keeping goats (OR = 1.3, CI = 1.5-1.9) were significantly associated with RVF, while contact with bats (OR = 1.2, CI = 1.1-1.5) was associated with MVD. CONCLUSION The findings of this study provide evidence of exposure to CCHF, EVD, MVD, RVF, and YF in Tanzania. Since most of these VHFs occurred without apparent clinical forms of the disease, these findings call for the need to strengthen the surveillance system and management of febrile illnesses in Tanzania.
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Affiliation(s)
- Sima Rugarabamu
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Gaspary O Mwanyika
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania; Mbeya University of Science and Technology, Mbeya, Tanzania.
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania; Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, Perth, Western Australia.
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania.
| | - Hee-Young Lim
- Korea Disease Control and Prevention Agency, National Institute of Health, Osong, Chungchungbukdo, Republic of Korea.
| | - Gerald Misinzo
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.
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6
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Buchwald AG, Hayden MH, Dadzie SK, Paull SH, Carlton EJ. Aedes-borne disease outbreaks in West Africa: A call for enhanced surveillance. Acta Trop 2020; 209:105468. [PMID: 32416077 DOI: 10.1016/j.actatropica.2020.105468] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 01/06/2023]
Abstract
Arboviruses transmitted by Aedes mosquitoes are a growing global concern; however, there remain large gaps in surveillance of both arboviruses and their vectors in West Africa. We reviewed over 50 years of data including outbreak reports, peer-reviewed literature, and prior data compilations describing Zika, dengue, and chikungunya, and their vectors in West Africa. Large outbreaks of dengue, Zika, and chikungunya have recently occurred in the region with over 27,000 cases of Aedes-borne disease documented since 2007. Recent arboviral outbreaks have become more concentrated in urban areas, and Aedes albopictus, recently documented in the region, has emerged as an important vector in several areas. Seroprevalence surveys suggest reported cases are a gross underestimate of the underlying arboviral disease burden. These findings indicate a shifting epidemiology of arboviral disease in West Africa and highlight a need for increased research and implementation of vector and disease control. Rapid urbanization and climate change may further alter disease patterns, underscoring the need for improved diagnostic capacity, and vector and disease surveillance to address this evolving health challenge.
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7
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Boisen ML, Uyigue E, Aiyepada J, Siddle KJ, Oestereich L, Nelson DKS, Bush DJ, Rowland MM, Heinrich ML, Eromon P, Kayode AT, Odia I, Adomeh DI, Muoebonam EB, Akhilomen P, Okonofua G, Osiemi B, Omoregie O, Airende M, Agbukor J, Ehikhametalor S, Aire CO, Duraffour S, Pahlmann M, Böhm W, Barnes KG, Mehta S, Momoh M, Sandi JD, Goba A, Folarin OA, Ogbaini-Emovan E, Asogun DA, Tobin EA, Akpede GO, Okogbenin SA, Okokhere PO, Grant DS, Schieffelin JS, Sabeti PC, Günther S, Happi CT, Branco LM, Garry RF. Field evaluation of a Pan-Lassa rapid diagnostic test during the 2018 Nigerian Lassa fever outbreak. Sci Rep 2020; 10:8724. [PMID: 32457420 PMCID: PMC7250850 DOI: 10.1038/s41598-020-65736-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
Lassa virus (LASV) is the causative agent of Lassa fever (LF), an often-fatal hemorrhagic disease. LF is endemic in Nigeria, Sierra Leone and other West African countries. Diagnosis of LASV infection is challenged by the genetic diversity of the virus, which is greatest in Nigeria. The ReLASV Pan-Lassa Antigen Rapid Test (Pan-Lassa RDT) is a point-of-care, in vitro diagnostic test that utilizes a mixture of polyclonal antibodies raised against recombinant nucleoproteins of representative strains from the three most prevalent LASV lineages (II, III and IV). We compared the performance of the Pan-LASV RDT to available quantitative PCR (qPCR) assays during the 2018 LF outbreak in Nigeria. For patients with acute LF (RDT positive, IgG/IgM negative) during initial screening, RDT performance was 83.3% sensitivity and 92.8% specificity when compared to composite results of two qPCR assays. 100% of samples that gave Ct values below 22 on both qPCR assays were positive on the Pan-Lassa RDT. There were significantly elevated case fatality rates and elevated liver transaminase levels in subjects whose samples were RDT positive compared to RDT negative.
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Affiliation(s)
| | - Eghosa Uyigue
- The African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - John Aiyepada
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Katherine J Siddle
- The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- The Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Lisa Oestereich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
| | | | | | | | | | - Philomena Eromon
- The African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria
| | - Adeyemi T Kayode
- The African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Ikponmwosa Odia
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Donatus I Adomeh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekene B Muoebonam
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Patience Akhilomen
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Grace Okonofua
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Blessing Osiemi
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Omigie Omoregie
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Michael Airende
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Jacqueline Agbukor
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Solomon Ehikhametalor
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chris Okafi Aire
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sophie Duraffour
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
| | - Meike Pahlmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
| | - Wiebke Böhm
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
| | - Kayla G Barnes
- The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samar Mehta
- The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA, USA
| | - Mambu Momoh
- Eastern Polytechnic Institute, Kenema, Sierra Leone
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - John Demby Sandi
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Augustine Goba
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Onikepe A Folarin
- The African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Ephraim Ogbaini-Emovan
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Danny A Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekaete A Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - George O Akpede
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus A Okogbenin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Peter O Okokhere
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
- The Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
- The Department of Medicine, Faculty of Clinical Sciences, Ambrose Alli University, Ekpoma, Edo State, Nigeria
| | - Donald S Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - John S Schieffelin
- Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Pardis C Sabeti
- The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- The Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Harvard-MIT Health Sciences and Technology, MIT, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
| | - Christian T Happi
- The African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria.
- Department of Biological Sciences, College of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria.
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | | | - Robert F Garry
- Zalgen Labs, LLC, Germantown, MD, USA.
- Tulane Health Sciences Center, Tulane University, New Orleans, LA, USA.
- Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, LA, USA.
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8
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Immune correlates of postexposure vaccine protection against Marburg virus. Sci Rep 2020; 10:3071. [PMID: 32080323 PMCID: PMC7033120 DOI: 10.1038/s41598-020-59976-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/28/2020] [Indexed: 12/19/2022] Open
Abstract
Postexposure immunization can prevent disease and reduce transmission following pathogen exposure. The rapid immunostimulatory properties of recombinant vesicular stomatitis virus (rVSV)-based vaccines make them suitable postexposure treatments against the filoviruses Ebola virus and Marburg virus (MARV); however, the mechanisms that drive this protection are undefined. Previously, we reported 60–75% survival of rhesus macaques treated with rVSV vectors expressing MARV glycoprotein (GP) 20–30 minutes after a low dose exposure to the most pathogenic variant of MARV, Angola. Survival in this model was linked to production of GP-specific antibodies and lower viral load. To confirm these results and potentially identify novel correlates of postexposure protection, we performed a similar experiment, but analyzed plasma cytokine levels, frequencies of immune cell subsets, and the transcriptional response to infection in peripheral blood. In surviving macaques (80–89%), we observed induction of genes mapping to antiviral and interferon-related pathways early after treatment and a higher percentage of T helper 1 (Th1) and NK cells. In contrast, the response of non-surviving macaques was characterized by hypercytokinemia; a T helper 2 signature; recruitment of low HLA-DR expressing monocytes and regulatory T-cells; and transcription of immune checkpoint (e.g., PD-1, LAG3) genes. These results suggest dysregulated immunoregulation is associated with poor prognosis, whereas early innate signaling and Th1-skewed immunity are important for survival.
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Sebba D, Lastovich AG, Kuroda M, Fallows E, Johnson J, Ahouidi A, Honko AN, Fu H, Nielson R, Carruthers E, Diédhiou C, Ahmadou D, Soropogui B, Ruedas J, Peters K, Bartkowiak M, Magassouba N, Mboup S, Ben Amor Y, Connor JH, Weidemaier K. A point-of-care diagnostic for differentiating Ebola from endemic febrile diseases. Sci Transl Med 2019; 10:10/471/eaat0944. [PMID: 30541788 DOI: 10.1126/scitranslmed.aat0944] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/09/2018] [Indexed: 12/25/2022]
Abstract
Hemorrhagic fever outbreaks such as Ebola are difficult to detect and control because of the lack of low-cost, easily deployable diagnostics and because initial clinical symptoms mimic other endemic diseases such as malaria. Current molecular diagnostic methods such as polymerase chain reaction require trained personnel and laboratory infrastructure, hindering diagnostics at the point of need. Although rapid tests such as lateral flow can be broadly deployed, they are typically not well-suited for differentiating among multiple diseases presenting with similar symptoms. Early detection and control of Ebola outbreaks require simple, easy-to-use assays that can detect and differentiate infection with Ebola virus from other more common febrile diseases. Here, we developed and tested an immunoassay technology that uses surface-enhanced Raman scattering (SERS) tags to simultaneously detect antigens from Ebola, Lassa, and malaria within a single blood sample. Results are provided in <30 min for individual or batched samples. Using 190 clinical samples collected from the 2014 West African Ebola outbreak, along with 163 malaria positives and 233 negative controls, we demonstrated Ebola detection with 90.0% sensitivity and 97.9% specificity and malaria detection with 100.0% sensitivity and 99.6% specificity. These results, along with corresponding live virus and nonhuman primate testing of an Ebola, Lassa, and malaria 3-plex assay, indicate the potential of the SERS technology as an important tool for outbreak detection and clinical triage in low-resource settings.
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Affiliation(s)
- David Sebba
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Alexander G Lastovich
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Melody Kuroda
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Eric Fallows
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Joshua Johnson
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD 21702, USA
| | - Ambroise Ahouidi
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.,Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations (IRESSEF), Diamniadio, BP 7325, Dakar, Senegal
| | - Anna N Honko
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD 21702, USA
| | - Henry Fu
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Rex Nielson
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Erin Carruthers
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Cyrille Diédhiou
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Doré Ahmadou
- Hemorrhagic Fever Laboratory, Université Gamal Abdel Nasser de Conakry, BP 5680, Conakry, Guinea
| | - Barré Soropogui
- Hemorrhagic Fever Laboratory, Université Gamal Abdel Nasser de Conakry, BP 5680, Conakry, Guinea
| | - John Ruedas
- Department of Microbiology and National Infectious Diseases Laboratories, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Kristen Peters
- Department of Microbiology and National Infectious Diseases Laboratories, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Miroslaw Bartkowiak
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA
| | - N'Faly Magassouba
- Hemorrhagic Fever Laboratory, Université Gamal Abdel Nasser de Conakry, BP 5680, Conakry, Guinea
| | - Souleymane Mboup
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.,Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations (IRESSEF), Diamniadio, BP 7325, Dakar, Senegal
| | - Yanis Ben Amor
- Center for Sustainable Development, Earth Institute at Columbia University, 475 Riverside Drive, Suite 1040, New York, NY 10115, USA
| | - John H Connor
- Department of Microbiology and National Infectious Diseases Laboratories, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA.
| | - Kristin Weidemaier
- Becton, Dickinson and Company, 21 Davis Drive, Research Triangle Park, NC 27709, USA.
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10
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Happi AN, Happi CT, Schoepp RJ. Lassa fever diagnostics: past, present, and future. Curr Opin Virol 2019; 37:132-138. [PMID: 31518896 DOI: 10.1016/j.coviro.2019.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022]
Abstract
Lassa fever is a unique viral hemorrhagic fever that is endemic in parts of West Africa, primarily Sierra Leone, Guinea, Liberia, and Nigeria. The disease is caused by the Lassa virus, an Old World arenavirus that has as primary reservoir host the multimammate rodent Mastomys nataliensis, which lives in association with humans. Recent estimates suggest LF causes two million cases and 5000-10000 deaths annually, mainly in West Africa. Clinical diagnosis and laboratory confirmation have always been major challenges for effective management and control of the disease in afflicted areas of West Africa. Recent advancements in molecular biology, recombinant DNA technology, and genomics sequencing has facilitated major advancement in development of better diagnostic and surveillance tools for Lassa fever virus. These include, the multiplex, magnetic bead-based immunodiagnostics for both Lassa virus antigens and antibodies; molecular probe-based quantitative real-time PCR for genomic signatures; rapid diagnostics tests that detects the most prevalent West African lineages; and the successful utilization of next-generation sequencing technology to diagnose and characterize Lassa virus in West Africa. These advances will continue to improve disease treatment, control, and prevention. In this review we will discuss progression of Lassa virus diagnostics from the past and into the future.
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Affiliation(s)
- Anise N Happi
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christian T Happi
- Department of Biological Sciences, College of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria; African center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Randal J Schoepp
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, USA.
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11
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Field validation of recombinant antigen immunoassays for diagnosis of Lassa fever. Sci Rep 2018; 8:5939. [PMID: 29651117 PMCID: PMC5897328 DOI: 10.1038/s41598-018-24246-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022] Open
Abstract
Lassa fever, a hemorrhagic fever caused by Lassa virus (LASV), is endemic in West Africa. It is difficult to distinguish febrile illnesses that are common in West Africa from Lassa fever based solely on a patient’s clinical presentation. The field performance of recombinant antigen-based Lassa fever immunoassays was compared to that of quantitative polymerase chain assays (qPCRs) using samples from subjects meeting the case definition of Lassa fever presenting to Kenema Government Hospital in Sierra Leone. The recombinant Lassa virus (ReLASV) enzyme-linked immunosorbant assay (ELISA) for detection of viral antigen in blood performed with 95% sensitivity and 97% specificity using a diagnostic standard that combined results of the immunoassays and qPCR. The ReLASV rapid diagnostic test (RDT), a lateral flow immunoassay based on paired monoclonal antibodies to the Josiah strain of LASV (lineage IV), performed with 90% sensitivity and 100% specificity. ReLASV immunoassays performed better than the most robust qPCR currently available, which had 82% sensitivity and 95% specificity. The performance characteristics of recombinant antigen-based Lassa virus immunoassays indicate that they can aid in the diagnosis of LASV Infection and inform the clinical management of Lassa fever patients.
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12
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Dariano DF, Taitt CR, Jacobsen KH, Bangura U, Bockarie AS, Bockarie MJ, Lahai J, Lamin JM, Leski TA, Yasuda C, Stenger DA, Ansumana R. Surveillance of Vector-Borne Infections (Chikungunya, Dengue, and Malaria) in Bo, Sierra Leone, 2012-2013. Am J Trop Med Hyg 2017; 97:1151-1154. [PMID: 29031286 DOI: 10.4269/ajtmh.16-0798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Malaria remains a significant cause of morbidity and mortality in West Africa, but the contribution of other vector-borne infections (VBIs) to the burden of disease has been understudied. We used rapid diagnostic tests (RDTs) for three VBIs to test blood samples from 1,795 febrile residents of Bo City, Sierra Leone, over a 1-year period in 2012-2013. In total, 24% of the tests were positive for malaria, fewer than 5% were positive for markers of dengue virus infection, and 39% were positive for IgM directed against chikungunya virus (CHIKV) or a related alphavirus. In total, more than half (55%) of these febrile individuals tested positive for at least one of the three VBIs, which highlights the very high burden of vector-borne diseases in this population. The prevalence of positives on the Chikungunya IgM and dengue tests did not vary significantly with age (P > 0.36), but higher rates of malaria were observed in children < 15 years of age (P < 0.001). Positive results on the Chikungunya IgM RDTs were moderately correlated with rainfall (r2 = 0.599). Based on the high prevalence of positive results on the Chikungunya IgM RDTs from individuals Bo and its environs, there is a need to examine whether an ecological shift toward a greater burden from CHIKV or related alphaviruses is occurring in other parts of Sierra Leone or the West African region.
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Affiliation(s)
| | - Chris R Taitt
- Center for Biomolecular Science and Engineering, U.S. Naval Research Laboratory, Washington, District of Columbia
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Umaru Bangura
- Mercy Hospital Research Laboratory, Bo, Sierra Leone
| | - Alfred S Bockarie
- Njala University, Bo Campus, Sierra Leone.,Mercy Hospital Research Laboratory, Bo, Sierra Leone
| | - Moses J Bockarie
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joseph Lahai
- Mercy Hospital Research Laboratory, Bo, Sierra Leone
| | | | - Tomasz A Leski
- Center for Biomolecular Science and Engineering, U.S. Naval Research Laboratory, Washington, District of Columbia
| | - Chadwick Yasuda
- Center for Biomolecular Science and Engineering, U.S. Naval Research Laboratory, Washington, District of Columbia
| | - David A Stenger
- Center for Biomolecular Science and Engineering, U.S. Naval Research Laboratory, Washington, District of Columbia
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Bo, Sierra Leone.,Njala University, Bo Campus, Sierra Leone.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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13
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Gale TV, Horton TM, Grant DS, Garry RF. Metabolomics analyses identify platelet activating factors and heme breakdown products as Lassa fever biomarkers. PLoS Negl Trop Dis 2017; 11:e0005943. [PMID: 28922385 PMCID: PMC5619842 DOI: 10.1371/journal.pntd.0005943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/28/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022] Open
Abstract
Lassa fever afflicts tens of thousands of people in West Africa annually. The rapid progression of patients from febrile illness to fulminant syndrome and death provides incentive for development of clinical prognostic markers that can guide case management. The small molecule profile of serum from febrile patients triaged to the Viral Hemorrhagic Fever Ward at Kenema Government Hospital in Sierra Leone was assessed using untargeted Ultra High Performance Liquid Chromatography Mass Spectrometry. Physiological dysregulation resulting from Lassa virus (LASV) infection occurs at the small molecule level. Effects of LASV infection on pathways mediating blood coagulation, and lipid, amino acid, nucleic acid metabolism are manifest in changes in the levels of numerous metabolites in the circulation. Several compounds, including platelet activating factor (PAF), PAF-like molecules and products of heme breakdown emerged as candidates that may prove useful in diagnostic assays to inform better care of Lassa fever patients. Lassa fever afflicts tens of thousands of people in West Africa each year. The disease progresses rapidly, but there are no tests available to determine which patients are at high risk for dying. We measured the levels of small molecules in the blood of febrile patients with and without infection by LASV that presented to Kenema Government Hospital in Sierra Leone using Ultra High Performance Liquid Chromatography Mass Spectrometry (LCMS), which identifies compounds based on their precise mass. Computational analyses were used to identify compounds that differed in patients with an acute LASV infection, patients with evidence of prior exposure to LASV and patients with fever, but who did not have evidence of exposure to LASV. Several serum metabolites, including factors that are involved in blood clotting and breakdown products of heme, were identified that may prove useful in diagnostic assays that will inform better care of Lassa fever patients or development of therapeutic interventions.
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Affiliation(s)
- Trevor V. Gale
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
| | - Timothy M. Horton
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert F. Garry
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
- Zalgen Labs, LLC, Germantown, Maryland, United States of America
- Tulane Center of Excellence, Global Viral Network, New Orleans, Louisiana, United States of America
- * E-mail:
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14
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15
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Bower H, Glynn JR. A systematic review and meta-analysis of seroprevalence surveys of ebolavirus infection. Sci Data 2017; 4:160133. [PMID: 28140390 PMCID: PMC5283061 DOI: 10.1038/sdata.2016.133] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 12/15/2016] [Indexed: 01/06/2023] Open
Abstract
Asymptomatic ebolavirus infection could greatly influence transmission dynamics, but there is little consensus on how frequently it occurs or even if it exists. This paper summarises the available evidence on seroprevalence of Ebola, Sudan and Bundibugyo virus IgG in people without known ebolavirus disease. Through systematic review, we identified 51 studies with seroprevalence results in sera collected from 1961 to 2016. We tabulated findings by study population, contact, assay, antigen and positivity threshold used, and present seroprevalence point estimates and 95% confidence intervals. We classified sampled populations in three groups: those with household or known case-contact; those living in outbreak or epidemic areas but without reported case-contact; and those living in areas with no recorded cases of ebolavirus disease. We performed meta-analysis only in the known case-contact group since this is the only group with comparable exposures between studies. Eight contact studies fitted our inclusion criteria, giving an overall estimate of seroprevalence in contacts with no reported symptoms of 3.3% (95% CI 2.4-4.4, P<0.001), but with substantial heterogeneity.
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Affiliation(s)
- Hilary Bower
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Judith R. Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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16
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Sogoba N, Rosenke K, Adjemian J, Diawara SI, Maiga O, Keita M, Konaté D, Keita AS, Sissoko I, Boisen M, Nelson D, Oottamasathien D, Millett M, Garry RF, Branco LM, Traoré SF, Doumbia S, Feldmann H, Safronetz D. Lassa Virus Seroprevalence in Sibirilia Commune, Bougouni District, Southern Mali. Emerg Infect Dis 2016; 22:657-63. [PMID: 26981786 PMCID: PMC4806955 DOI: 10.3201/eid2204.151814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The high rate documented in this study highlights the need for increased surveillance. Lassa Virus Seroprevalence, Mali Lassa virus (LASV) is endemic to several nations in West Africa. In Mali, LASV was unknown until an exported case of Lassa fever was reported in 2009. Since that time, rodent surveys have found evidence of LASV-infected Mastomys natalensis rats in several communities in southern Mali, near the border with Côte d’Ivoire. Despite increased awareness, to date only a single case of Lassa fever has been confirmed in Mali. We conducted a survey to determine the prevalence of LASV exposure among persons in 3 villages in southern Mali where the presence of infected rodents has been documented. LASV IgG seroprevalence ranged from 14.5% to 44% per village. No sex bias was noted; however, seropositivity rates increased with participant age. These findings confirm human LASV exposure in Mali and suggest that LASV infection/Lassa fever is a potential public health concern in southern Mali.
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17
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Formella M, Gatherer D. The serology of Ebolavirus - a wider geographical range, a wider genus of viruses or a wider range of virulence? J Gen Virol 2016; 97:3120-3130. [PMID: 27902321 DOI: 10.1099/jgv.0.000638] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Viruses of the genus Ebolavirus are the causative agents of Ebola virus disease (EVD), of which there have been only 25 recorded outbreaks since the discovery of Zaire and Sudan ebolaviruses in the late 1970s. Until the west African outbreak commencing in late 2013, EVD was confined to an area of central Africa stretching from the coast of Gabon through the Congo river basin and eastward to the Great Lakes. Nevertheless, population serological studies since 1976, most of which were carried out in the first two decades after that date, have suggested a wider distribution and more frequent occurrence across tropical Africa. We review this body of work, discussing the various methods employed over the years and the degree to which they can currently be regarded as reliable. We conclude that there is adequate evidence for a wider geographical range of exposure to Ebolavirus or related filoviruses and discuss three possibilities that could account for this: (a) EVD outbreaks have been misidentified as other diseases in the past; (b) unidentified, and clinically milder, species of the genus Ebolavirus circulate over a wider range than the most pathogenic species; and (c) EVD may be subclinical with a frequency high enough that smaller outbreaks may be unidentified. We conclude that the second option is the most likely and therefore predict the future discovery of other, less virulent, members of the genus Ebolavirus.
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Affiliation(s)
- Magdalena Formella
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Derek Gatherer
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
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18
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Safronetz D, Sacko M, Sogoba N, Rosenke K, Martellaro C, Traoré S, Cissé I, Maiga O, Boisen M, Nelson D, Oottamasathien D, Millett M, Garry RF, Branco LM, Doumbia S, Feldmann H, Traoré MS. Vectorborne Infections, Mali. Emerg Infect Dis 2016; 22:340-2. [PMID: 26812625 PMCID: PMC4734548 DOI: 10.3201/eid2202.150688] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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O'Hearn AE, Voorhees MA, Fetterer DP, Wauquier N, Coomber MR, Bangura J, Fair JN, Gonzalez JP, Schoepp RJ. Serosurveillance of viral pathogens circulating in West Africa. Virol J 2016; 13:163. [PMID: 27716429 PMCID: PMC5048616 DOI: 10.1186/s12985-016-0621-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/22/2016] [Indexed: 01/02/2023] Open
Abstract
Background Sub-Saharan Africa is home to a variety of pathogens, but disease surveillance and the healthcare infrastructure necessary for proper management and control are severely limited. Lassa virus, the cause of Lassa fever, a severe hemorrhagic fever in humans is endemic in West Africa. In Sierra Leone at the Kenema Government Hospital Lassa Diagnostic Laboratory, up to 70 % of acute patient samples suspected of Lassa fever test negative for Lassa virus infection. This large amount of acute undiagnosed febrile illness can be attributed in part to an array of hemorrhagic fever and arthropod-borne viruses causing disease that goes undetected and untreated. Methods To better define the nature and extent of viral pathogens infecting the Sierra Leonean population, we developed a multiplexed MAGPIX® assay to detect IgG antibodies against Lassa, Ebola, Marburg, Rift Valley fever, and Crimean-Congo hemorrhagic fever viruses as well as pan-assays for flaviviruses and alphaviruses. This assay was used to survey 675 human serum samples submitted to the Lassa Diagnostic Laboratory between 2007 and 2014. Results In the study population, 50.2 % were positive for Lassa virus, 5.2 % for Ebola virus, 10.7 % for Marburg virus, 1.8 % for Rift Valley fever virus, 2.0 % for Crimean-Congo hemorrhagic fever virus, 52.9 % for flaviviruses and 55.8 % for alphaviruses. Conclusions These data exemplify the importance of disease surveillance and differential diagnosis for viral diseases in Sierra Leone. We demonstrate the endemic nature of some of these viral pathogens in the region and suggest that unrecognized outbreaks of viral infection have occurred.
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Affiliation(s)
- Aileen E O'Hearn
- Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD, 21702-5011, USA
| | - Matthew A Voorhees
- Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD, 21702-5011, USA
| | - David P Fetterer
- Statistics Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA
| | | | - Moinya R Coomber
- Kenema Government Hospital, Lassa Diagnostic Laboratory, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | | | | | | | - Randal J Schoepp
- Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD, 21702-5011, USA.
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20
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Shorten RJ, Brown CS, Jacobs M, Rattenbury S, Simpson AJ, Mepham S. Diagnostics in Ebola Virus Disease in Resource-Rich and Resource-Limited Settings. PLoS Negl Trop Dis 2016; 10:e0004948. [PMID: 27788135 PMCID: PMC5082928 DOI: 10.1371/journal.pntd.0004948] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Ebola virus disease (EVD) outbreak in West Africa was unprecedented in scale and location. Limited access to both diagnostic and supportive pathology assays in both resource-rich and resource-limited settings had a detrimental effect on the identification and isolation of cases as well as individual patient management. Limited access to such assays in resource-rich settings resulted in delays in differentiating EVD from other illnesses in returning travellers, in turn utilising valuable resources until a diagnosis could be made. This had a much greater impact in West Africa, where it contributed to the initial failure to contain the outbreak. This review explores diagnostic assays of use in EVD in both resource-rich and resource-limited settings, including their respective limitations, and some novel assays and approaches that may be of use in future outbreaks.
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Affiliation(s)
- Robert J Shorten
- Public Health Laboratory Manchester, Manchester Royal Infirmary, Manchester, United Kingdom
- University College London, Centre for Clinical Microbiology, Department of Infection, London United Kingdom
| | - Colin S Brown
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- King’s Sierra Leone Partnership, King’s Centre for Global Health, King’s College London, and King’s Health Partners, London, United Kingdom
| | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Simon Rattenbury
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Andrew J. Simpson
- University College London, Centre for Clinical Microbiology, Department of Infection, London United Kingdom
- Rare and Imported Pathogens Laboratory, Public Health England, Salisbury, United Kingdom
| | - Stephen Mepham
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
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21
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Cross RW, Boisen ML, Millett MM, Nelson DS, Oottamasathien D, Hartnett JN, Jones AB, Goba A, Momoh M, Fullah M, Bornholdt ZA, Fusco ML, Abelson DM, Oda S, Brown BL, Pham H, Rowland MM, Agans KN, Geisbert JB, Heinrich ML, Kulakosky PC, Shaffer JG, Schieffelin JS, Kargbo B, Gbetuwa M, Gevao SM, Wilson RB, Saphire EO, Pitts KR, Khan SH, Grant DS, Geisbert TW, Branco LM, Garry RF. Analytical Validation of the ReEBOV Antigen Rapid Test for Point-of-Care Diagnosis of Ebola Virus Infection. J Infect Dis 2016; 214:S210-S217. [PMID: 27587634 DOI: 10.1093/infdis/jiw293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ebola virus disease (EVD) is a severe viral illness caused by Ebola virus (EBOV). The 2013-2016 EVD outbreak in West Africa is the largest recorded, with >11 000 deaths. Development of the ReEBOV Antigen Rapid Test (ReEBOV RDT) was expedited to provide a point-of-care test for suspected EVD cases. METHODS Recombinant EBOV viral protein 40 antigen was used to derive polyclonal antibodies for RDT and enzyme-linked immunosorbent assay development. ReEBOV RDT limits of detection (LOD), specificity, and interference were analytically validated on the basis of Food and Drug Administration (FDA) guidance. RESULTS The ReEBOV RDT specificity estimate was 95% for donor serum panels and 97% for donor whole-blood specimens. The RDT demonstrated sensitivity to 3 species of Ebolavirus (Zaire ebolavirus, Sudan ebolavirus, and Bundibugyo ebolavirus) associated with human disease, with no cross-reactivity by pathogens associated with non-EBOV febrile illness, including malaria parasites. Interference testing exhibited no reactivity by medications in common use. The LOD for antigen was 4.7 ng/test in serum and 9.4 ng/test in whole blood. Quantitative reverse transcription-polymerase chain reaction testing of nonhuman primate samples determined the range to be equivalent to 3.0 × 105-9.0 × 108 genomes/mL. CONCLUSIONS The analytical validation presented here contributed to the ReEBOV RDT being the first antigen-based assay to receive FDA and World Health Organization emergency use authorization for this EVD outbreak, in February 2015.
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Affiliation(s)
- Robert W Cross
- Galveston National Laboratory, University of Texas Medical Branch
| | - Matthew L Boisen
- Corgenix, Broomfield, Colorado Department of Microbiology and Immunology Zalgen Labs, Germantown, Maryland
| | | | - Diana S Nelson
- Corgenix, Broomfield, Colorado Zalgen Labs, Germantown, Maryland
| | | | | | | | - Augustine Goba
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation
| | - Mambu Momoh
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation Eastern Polytechnic Institute, Kenema, Sierra Leone
| | - Mohamed Fullah
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation Eastern Polytechnic Institute, Kenema, Sierra Leone
| | | | | | | | | | | | - Ha Pham
- Corgenix, Broomfield, Colorado
| | | | - Krystle N Agans
- Galveston National Laboratory, University of Texas Medical Branch
| | - Joan B Geisbert
- Galveston National Laboratory, University of Texas Medical Branch
| | | | | | | | - John S Schieffelin
- Section of Infectious Diseases, Department of Pediatrics, School of Medicine
| | | | - Momoh Gbetuwa
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation
| | - Sahr M Gevao
- Lassa Fever Program, Kenema Government Hospital University of Sierra Leone, Freetown
| | | | | | | | - Sheik Humarr Khan
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation
| | - Donald S Grant
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation
| | | | | | - Robert F Garry
- Department of Microbiology and Immunology Zalgen Labs, Germantown, Maryland
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22
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Boisen ML, Hartnett JN, Goba A, Vandi MA, Grant DS, Schieffelin JS, Garry RF, Branco LM. Epidemiology and Management of the 2013-16 West African Ebola Outbreak. Annu Rev Virol 2016; 3:147-171. [PMID: 27578439 DOI: 10.1146/annurev-virology-110615-040056] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The 2013-16 West African Ebola outbreak is the largest, most geographically dispersed, and deadliest on record, with 28,616 suspected cases and 11,310 deaths recorded to date in Guinea, Liberia, and Sierra Leone. We provide a review of the epidemiology and management of the 2013-16 Ebola outbreak in West Africa aimed at stimulating reflection on lessons learned that may improve the response to the next international health crisis caused by a pathogen that emerges in a region of the world with a severely limited health care infrastructure. Surveillance efforts employing rapid and effective point-of-care diagnostics designed for environments that lack advanced laboratory infrastructure will greatly aid in early detection and containment efforts during future outbreaks. Introduction of effective therapeutics and vaccines against Ebola into the public health system and the biodefense armamentarium is of the highest priority if future outbreaks are to be adequately managed and contained in a timely manner.
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Affiliation(s)
- M L Boisen
- Corgenix Inc., Broomfield, Colorado 80020.,Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, Louisiana 70112; .,Zalgen Labs, LLC, Germantown, Maryland 20876;
| | - J N Hartnett
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, Louisiana 70112;
| | - A Goba
- Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - M A Vandi
- Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - D S Grant
- Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - J S Schieffelin
- Section of Infectious Diseases, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana 70112
| | - R F Garry
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, Louisiana 70112; .,Zalgen Labs, LLC, Germantown, Maryland 20876;
| | - L M Branco
- Zalgen Labs, LLC, Germantown, Maryland 20876;
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23
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Goba A, Khan SH, Fonnie M, Fullah M, Moigboi A, Kovoma A, Sinnah V, Yoko N, Rogers H, Safai S, Momoh M, Koroma V, Kamara FK, Konowu E, Yillah M, French I, Mustapha I, Kanneh F, Foday M, McCarthy H, Kallon T, Kallon M, Naiebu J, Sellu J, Jalloh AA, Gbakie M, Kanneh L, Massaly JLB, Kargbo D, Kargbo B, Vandi M, Gbetuwa M, Gevao SM, Sandi JD, Jalloh SC, Grant DS, Blyden SO, Crozier I, Schieffelin JS, McLellan SL, Jacob ST, Boisen ML, Hartnett JN, Cross RW, Branco LM, Andersen KG, Yozwiak NL, Gire SK, Tariyal R, Park DJ, Haislip AM, Bishop CM, Melnik LI, Gallaher WR, Wimley WC, He J, Shaffer JG, Sullivan BM, Grillo S, Oman S, Garry CE, Edwards DR, McCormick SJ, Elliott DH, Rouelle JA, Kannadka CB, Reyna AA, Bradley BT, Yu H, Yenni RE, Hastie KM, Geisbert JB, Kulakosky PC, Wilson RB, Oldstone MBA, Pitts KR, Henderson LA, Robinson JE, Geisbert TW, Saphire EO, Happi CT, Asogun DA, Sabeti PC, Garry RF. An Outbreak of Ebola Virus Disease in the Lassa Fever Zone. J Infect Dis 2016; 214:S110-S121. [PMID: 27402779 DOI: 10.1093/infdis/jiw239] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Kenema Government Hospital (KGH) has developed an advanced clinical and laboratory research capacity to manage the threat of Lassa fever, a viral hemorrhagic fever (VHF). The 2013-2016 Ebola virus (EBOV) disease (EVD) outbreak is the first to have occurred in an area close to a facility with established clinical and laboratory capacity for study of VHFs. METHODS Because of its proximity to the epicenter of the EVD outbreak, which began in Guinea in March 2014, the KGH Lassa fever Team mobilized to establish EBOV surveillance and diagnostic capabilities. RESULTS Augustine Goba, director of the KGH Lassa laboratory, diagnosed the first documented case of EVD in Sierra Leone, on 25 May 2014. Thereafter, KGH received and cared for numbers of patients with EVD that quickly overwhelmed the capacity for safe management. Numerous healthcare workers contracted and lost their lives to EVD. The vast majority of subsequent EVD cases in West Africa can be traced back to a single transmission chain that includes this first diagnosed case. CONCLUSIONS Responding to the challenges of confronting 2 hemorrhagic fever viruses will require continued investments in the development of countermeasures (vaccines, therapeutic agents, and diagnostic assays), infrastructure, and human resources.
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Affiliation(s)
- Augustine Goba
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - S Humarr Khan
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Mbalu Fonnie
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Mohamed Fullah
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Alex Moigboi
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Alice Kovoma
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Vandi Sinnah
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Nancy Yoko
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Hawa Rogers
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Siddiki Safai
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Mambu Momoh
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | | | - Edwin Konowu
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Mohamed Yillah
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Issa French
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | | | - Momoh Foday
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | - Tiangay Kallon
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | - Jenneh Naiebu
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | - Abdul A Jalloh
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Michael Gbakie
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | - Lansana Kanneh
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | | | | | | | | | | | - John D Sandi
- Viral Hemorrhagic Fever Program, Kenema Government Hospital
| | | | - Donald S Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital Ministry of Health and Sanitation
| | | | - Ian Crozier
- World Health Organization Sierra Leone Ebola Response Team, Freetown, Sierra Leone Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda
| | - John S Schieffelin
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Susan L McLellan
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine Department of Tropical Medicine
| | - Shevin T Jacob
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Matt L Boisen
- Corgenix, Broomfield, Colorado Zalgen Labs, Germantown, Maryland
| | | | - Robert W Cross
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston
| | | | | | | | | | | | | | | | | | | | - William R Gallaher
- Department of Microbiology, Immunology, and Parasitology, LSU Health Mockingbird Nature Research Group, Pearl River, Louisiana
| | | | - Jing He
- Department of Biochemistry, Tulane University
| | - Jeffrey G Shaffer
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine
| | | | - Sonia Grillo
- Naval Engineering Facilities Command, Naples, Italy
| | | | - Courtney E Garry
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine Autoimmune Technologies, New Orleans
| | | | | | - Deborah H Elliott
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Julie A Rouelle
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Chandrika B Kannadka
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Ashley A Reyna
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Benjamin T Bradley
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Haini Yu
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | | | | | - Joan B Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston
| | | | | | | | | | | | - James E Robinson
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston
| | - Erica Ollmann Saphire
- Department of Immunology and Microbial Science The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla
| | - Christian T Happi
- Redeemer's University, Ede Irrua Specialist Teaching Hospital, Nigeria
| | | | - Pardis C Sabeti
- Broad Institute of MIT and Harvard Department of Organismic and Evolutionary Biology, Center for Systems Biology, Harvard University, Cambridge, Massachusetts
| | - Robert F Garry
- Department of Microbiology and Immunology Zalgen Labs, Germantown, Maryland
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24
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Duy J, Koehler JW, Honko AN, Schoepp RJ, Wauquier N, Gonzalez JP, Pitt ML, Mucker EM, Johnson JC, O’Hearn A, Bangura J, Coomber M, Minogue TD. Circulating microRNA profiles of Ebola virus infection. Sci Rep 2016; 6:24496. [PMID: 27098369 PMCID: PMC4838880 DOI: 10.1038/srep24496] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/30/2016] [Indexed: 01/08/2023] Open
Abstract
Early detection of Ebola virus (EBOV) infection is essential to halting transmission and adjudicating appropriate treatment. However, current methods rely on viral identification, and this approach can misdiagnose presymptomatic and asymptomatic individuals. In contrast, disease-driven alterations in the host transcriptome can be exploited for pathogen-specific diagnostic biomarkers. Here, we present for the first time EBOV-induced changes in circulating miRNA populations of nonhuman primates (NHPs) and humans. We retrospectively profiled longitudinally-collected plasma samples from rhesus macaques challenged via intramuscular and aerosol routes and found 36 miRNAs differentially present in both groups. Comparison of miRNA abundances to viral loads uncovered 15 highly correlated miRNAs common to EBOV-infected NHPs and humans. As proof of principle, we developed an eight-miRNA classifier that correctly categorized infection status in 64/74 (86%) human and NHP samples. The classifier identified acute infections in 27/29 (93.1%) samples and in 6/12 (50%) presymptomatic NHPs. These findings showed applicability of NHP-derived miRNAs to a human cohort, and with additional research the resulting classifiers could impact the current capability to diagnose presymptomatic and asymptomatic EBOV infections.
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Affiliation(s)
- Janice Duy
- Diagnostic Systems Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Jeffrey W. Koehler
- Diagnostic Systems Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Anna N. Honko
- Virology Division, U.S. Army Medical Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Randal J. Schoepp
- Diagnostic Systems Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | | | | | - M. Louise Pitt
- Virology Division, U.S. Army Medical Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Eric M. Mucker
- Virology Division, U.S. Army Medical Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Joshua C. Johnson
- Virology Division, U.S. Army Medical Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Aileen O’Hearn
- Diagnostic Systems Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | | | | | - Timothy D. Minogue
- Diagnostic Systems Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
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25
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Wölfel R, Stoecker K, Fleischmann E, Gramsamer B, Wagner M, Molkenthin P, Di Caro A, Günther S, Ibrahim S, Genzel GH, Ozin-Hofsäss AJ, Formenty P, Zöller L. Mobile diagnostics in outbreak response, not only for Ebola: a blueprint for a modular and robust field laboratory. ACTA ACUST UNITED AC 2016; 20:30055. [PMID: 26559006 DOI: 10.2807/1560-7917.es.2015.20.44.30055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/23/2015] [Indexed: 11/20/2022]
Abstract
We established a modular, rapidly deployable laboratory system that provides diagnostic support in resource-limited, remote areas. Developed as a quick response asset to unusual outbreaks of infectious diseases worldwide, several of these laboratories have been used as part of the World Health Organization response to the Ebola virus outbreaks by teams of the 'European Mobile Lab' project in West Africa since March 2014. Within three days from deployment, the first European mobile laboratory became operational at the Ebola Treatment Unit (ETU) in Guéckédou, southern Guinea. Deployment in close proximity to the ETU decreased the turnaround time to an average of 4 h instead of several days in many cases. Between March 2014 and May 2015, more than 5,800 samples were tested in this field laboratory. Further EMLab units were deployed to Nigeria, Liberia and Sierra Leone in the following months of the Ebola outbreak. The technical concept of the EMLab units served as a blueprint for other mobile Ebola laboratories which have been set up in Mali, Côte d'Ivoire, Sierra Leone and other countries in West Africa. Here, we describe design, capabilities and utility of this deployable laboratory system for use in response to disease outbreaks, epidemiological surveillance and patient management.
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Affiliation(s)
- Roman Wölfel
- Bundeswehr Institute of Microbiology, Munich, Germany
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26
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de La Vega MA, Caleo G, Audet J, Qiu X, Kozak RA, Brooks JI, Kern S, Wolz A, Sprecher A, Greig J, Lokuge K, Kargbo DK, Kargbo B, Di Caro A, Grolla A, Kobasa D, Strong JE, Ippolito G, Van Herp M, Kobinger GP. Ebola viral load at diagnosis associates with patient outcome and outbreak evolution. J Clin Invest 2015; 125:4421-8. [PMID: 26551677 DOI: 10.1172/jci83162] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ebola virus (EBOV) causes periodic outbreaks of life-threatening EBOV disease in Africa. Historically, these outbreaks have been relatively small and geographically contained; however, the magnitude of the EBOV outbreak that began in 2014 in West Africa has been unprecedented. The aim of this study was to describe the viral kinetics of EBOV during this outbreak and identify factors that contribute to outbreak progression. METHODS From July to December 2014, one laboratory in Sierra Leone processed over 2,700 patient samples for EBOV detection by quantitative PCR (qPCR). Viremia was measured following patient admission. Age, sex, and approximate time of symptom onset were also recorded for each patient. The data was analyzed using various mathematical models to find trends of potential interest. RESULTS The analysis revealed a significant difference (P = 2.7 × 10(-77)) between the initial viremia of survivors (4.02 log10 genome equivalents [GEQ]/ml) and nonsurvivors (6.18 log10 GEQ/ml). At the population level, patient viral loads were higher on average in July than in November, even when accounting for outcome and time since onset of symptoms. This decrease in viral loads temporally correlated with an increase in circulating EBOV-specific IgG antibodies among individuals who were suspected of being infected but shown to be negative for the virus by PCR. CONCLUSIONS Our results indicate that initial viremia is associated with outcome of the individual and outbreak duration; therefore, care must be taken in planning clinical trials and interventions. Additional research in virus adaptation and the impacts of host factors on EBOV transmission and pathogenesis is needed.
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27
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Development of an antibody capture ELISA using inactivated Ebola Zaire Makona virus. Med Microbiol Immunol 2015; 205:173-83. [DOI: 10.1007/s00430-015-0438-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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28
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Moschos SA. Introducing EbolaCheck: potential for point-of-need infectious disease diagnosis. Expert Rev Mol Diagn 2015; 15:1237-40. [DOI: 10.1586/14737159.2015.1084228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Boisen ML, Oottamasathien D, Jones AB, Millett MM, Nelson DS, Bornholdt ZA, Fusco ML, Abelson DM, Oda SI, Hartnett JN, Rowland MM, Heinrich ML, Akdag M, Goba A, Momoh M, Fullah M, Baimba F, Gbakie M, Safa S, Fonnie R, Kanneh L, Cross RW, Geisbert JB, Geisbert TW, Kulakosky PC, Grant DS, Shaffer JG, Schieffelin JS, Wilson RB, Saphire EO, Branco LM, Garry RF, Khan SH, Pitts KR. Development of Prototype Filovirus Recombinant Antigen Immunoassays. J Infect Dis 2015; 212 Suppl 2:S359-67. [PMID: 26232440 DOI: 10.1093/infdis/jiv353] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Throughout the 2014-2015 Ebola outbreak in West Africa, major gaps were exposed in the availability of validated rapid diagnostic platforms, protective vaccines, and effective therapeutic agents. These gaps potentiated the development of prototype rapid lateral flow immunodiagnostic (LFI) assays that are true point-of-contact platforms, for the detection of active Ebola infections in small blood samples. METHODS Recombinant Ebola and Marburg virus matrix VP40 and glycoprotein (GP) antigens were used to derive a panel of monoclonal and polyclonal antibodies. Antibodies were tested using a multivariate approach to identify antibody-antigen combinations suitable for enzyme-linked immunosorbent assay (ELISA) and LFI assay development. RESULTS Polyclonal antibodies generated in goats were superior reagents for capture and detection of recombinant VP40 in test sample matrices. These antibodies were optimized for use in antigen-capture ELISA and LFI assay platforms. Prototype immunoglobulin M (IgM)/immunoglobulin G (IgG) ELISAs were similarly developed that specifically detect Ebola virus-specific antibodies in the serum of experimentally infected nonhuman primates and in blood samples obtained from patients with Ebola from Sierra Leone. CONCLUSIONS The prototype recombinant Ebola LFI assays developed in these studies have sensitivities that are useful for clinical diagnosis of acute ebolavirus infections. The antigen-capture and IgM/IgG ELISAs provide additional confirmatory assay platforms for detecting VP40 and other ebolavirus-specific immunoglobulins.
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Affiliation(s)
- Matt L Boisen
- Corgenix, Broomfield, Colorado Department of Microbiology and Immunology, School of Medicine
| | | | | | | | | | - Zachary A Bornholdt
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California
| | - Marnie L Fusco
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California
| | - Dafna M Abelson
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California
| | - Shun-Ichiro Oda
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California
| | | | | | | | | | | | - Mambu Momoh
- Lassa Fever Program, Kenema Government Hospital Eastern Polytechnic College, Kenema
| | | | | | - Michael Gbakie
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Tulane University
| | - Sadiki Safa
- Lassa Fever Program, Kenema Government Hospital
| | | | | | - Robert W Cross
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston
| | - Joan B Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston
| | | | - Donald S Grant
- Zalgen Labs, Germantown, Maryland Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Jeffery G Shaffer
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine
| | - John S Schieffelin
- Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Tulane University
| | | | - Erica Ollmann Saphire
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California
| | | | - Robert F Garry
- Department of Microbiology and Immunology, School of Medicine Zalgen Labs, Germantown, Maryland
| | - S Humarr Khan
- Lassa Fever Program, Kenema Government Hospital Ministry of Health and Sanitation, Freetown, Sierra Leone
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30
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Stamm LV. Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control. Am J Trop Med Hyg 2015; 93:438-40. [PMID: 26175026 DOI: 10.4269/ajtmh.15-0229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/23/2015] [Indexed: 11/07/2022] Open
Abstract
Ebola virus disease (EVD) is a life-threatening zoonosis caused by infection with the Ebola virus. Since the first reported EVD outbreak in the Democratic Republic of the Congo, several small outbreaks have been reported in central Africa with about 2,400 cases occurring between 1976 and 2013. The 2013-2015 EVD outbreak in west Africa is the first documented outbreak in this region and the largest ever with over 27,000 cases and more than 11,000 deaths. Although EVD transmission rates have recently decreased in west Africa, this crisis continues to threaten global health and security, particularly since infected travelers could spread EVD to other resource-limited areas of the world. Because vaccines and drugs are not yet licensed for EVD, outbreak control is dependent on the use of non-pharmaceutical interventions (e.g., infection control practices, isolation of EVD cases, contact tracing with follow-up and quarantine, sanitary burial, health education). However, delays in diagnosing and reporting EVD cases in less accessible rural areas continue to hamper control efforts. New advances in rapid diagnostics for identifying presumptive EVD cases and in mobile-based technologies for communicating critical health-related information should facilitate deployment of an early response to prevent the amplification of sporadic EVD cases into large-scale outbreaks.
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Affiliation(s)
- Lola V Stamm
- Program in Infectious Diseases, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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31
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Hartnett JN, Boisen ML, Oottamasathien D, Jones AB, Millett MM, Nelson DS, Muncy IJ, Goba A, Momoh M, Fullah M, Mire CE, Geisbert JB, Geisbert TW, Holton DL, Rouelle JA, Kannadka CB, Reyna AA, Moses LM, Khan SH, Gevao SM, Grant DS, Robinson JE, Happi C, Pitts KR, Garry RF, Branco LM. Current and emerging strategies for the diagnosis, prevention and treatment of Lassa fever. Future Virol 2015. [DOI: 10.2217/fvl.15.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ABSTRACT Lassa fever (LF) is a potentially fatal disease that affects an estimated 300,000–500,000 people in endemic areas of west Africa each year. Though past studies have identified fatality rates of 5–20% in patients suspected to have contracted Lassa virus (LASV), new studies using more precise clinical diagnoses and modern diagnostic assays show fatalities rates above 60% in acutely ill patients from endemic regions. Currently, there are no approved vaccines or therapeutics, and only one Comformité Européenne (CE) marked rapid immunodiagnostic for acute LASV infection. Therefore, preventing LASV transmission is the primary goal in endemic regions. Development of rapid immunodiagnostics and research into the efficacy of current treatment options continues toward saving lives in west Africa as well as creating a line of defense against the nefarious use of LASV in bioterrorism settings.
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Affiliation(s)
- Jessica N Hartnett
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
| | - Matthew L Boisen
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
- Corgenix Medical Corporation, Broomfield, CO 80020, USA
| | | | | | | | | | - Ivana J Muncy
- Corgenix Medical Corporation, Broomfield, CO 80020, USA
| | | | - Mambu Momoh
- Kenema Government Hospital, Kenema, Sierra Leone
- Eastern Polytechnic College, Kenema, Sierra Leone
| | | | - Chad E Mire
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Joan B Geisbert
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Thomas W Geisbert
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Debra L Holton
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
| | - Julie A Rouelle
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
| | - Chandrika B Kannadka
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
| | - Ashley A Reyna
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
| | - Lina M Moses
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
| | | | - Sahr M Gevao
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- University of Sierra Leone, Freetown, Sierra Leone
| | - Donald S Grant
- Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James E Robinson
- Department of Pediatric Infectious Diseases, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | | | - Kelly R Pitts
- Corgenix Medical Corporation, Broomfield, CO 80020, USA
| | - Robert F Garry
- Department of Microbiology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-38, New Orleans, LA 70112, USA
- Zalgen Labs, LLC, Germantown, MD 20876, USA
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