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Matson MJ, Bushmaker T, Scott DP, Rosenke R, Saturday G, Chertow DS, Munster VJ. Ebola Virus Tropism in Ex Vivo Cynomolgus Macaque Ocular Tissues. J Infect Dis 2023; 228:S626-S630. [PMID: 37386692 PMCID: PMC10651198 DOI: 10.1093/infdis/jiad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
Ocular complications of Ebola virus disease are well-documented and long-term sequelae in survivors are common and lead to considerable morbidity. However, little is currently known regarding EBOV's tropism and replication kinetics within the eye. To date, limited studies have utilized in vitro infections of ocular cell lines and analyses of archived pathology samples to investigate these issues. Here, we employed ex vivo cultures of cynomolgus macaque eyes to determine the tropism of EBOV in 7 different ocular tissues: cornea, anterior sclera with bulbar conjunctiva, ciliary body, iris, lens, neural retina, and retina pigment epithelium. We report that, except for neural retina, all tissues supported EBOV replication. Retina pigment epithelium produced the fastest growth and highest viral RNA loads, although the differences were not statistically significant. Immunohistochemical staining confirmed and further characterized infection. This study demonstrates that EBOV has a broad tropism within the eye.
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Affiliation(s)
- M Jeremiah Matson
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Trent Bushmaker
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Dana P Scott
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MontanaUSA
| | - Rebecca Rosenke
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MontanaUSA
| | - Greg Saturday
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MontanaUSA
| | - Daniel S Chertow
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Vincent J Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
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2
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Fletcher P, Feldmann F, Takada A, Crossland NA, Hume AJ, Albariño C, Kemenesi G, Feldmann H, Mühlberger E, Marzi A. Pathogenicity of Lloviu and Bombali Viruses in Type I Interferon Receptor Knockout Mice. J Infect Dis 2023; 228:S548-S553. [PMID: 37352146 PMCID: PMC10651197 DOI: 10.1093/infdis/jiad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 06/25/2023] Open
Abstract
Type I interferon receptor knockout (IFNAR-/-) mice are not able to generate a complete innate immune response; therefore, these mice are often considered to assess the pathogenicity of emerging viruses. We infected IFNAR-/- mice with a low or high dose of Lloviu virus (LLOV) or Bombali virus (BOMV) by the intranasal (IN) or intraperitoneal (IP) route and compared virus loads at early and late time points after infection. No signs of disease and no viral RNA were detected after IN infection regardless of LLOV dose. In contrast, IP infections resulted in increased viral loads in the high-dose LLOV and BOMV groups at the early time point. The low-dose LLOV and BOMV groups achieved higher viral loads at the late time point. However, there was 100% survival in all groups and no signs of disease. In conclusion, our results indicate a limited value of the IFNAR-/- mouse model for investigation of the pathogenicity of LLOV and BOMV.
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Affiliation(s)
- Paige Fletcher
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Friederike Feldmann
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Ayato Takada
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Nicholas A Crossland
- National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Adam J Hume
- National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - César Albariño
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gábor Kemenesi
- National Laboratory of Virology, Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Heinz Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Elke Mühlberger
- National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrea Marzi
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
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3
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Scoon WA, Mancio-Silva L, Suder EL, Villacorta-Martin C, Lindstrom-Vautrin J, Bernbaum JG, Mazur S, Johnson RF, Olejnik J, Flores EY, Mithal A, Wang F, Hume AJ, Kaserman JE, March-Riera S, Wilson AA, Bhatia SN, Mühlberger E, Mostoslavsky G. Ebola virus infection induces a delayed type I IFN response in bystander cells and the shutdown of key liver genes in human iPSC-derived hepatocytes. Stem Cell Reports 2022; 17:2286-2302. [PMID: 36084636 PMCID: PMC9561183 DOI: 10.1016/j.stemcr.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
Liver damage and an exacerbated inflammatory response are hallmarks of Ebola virus (EBOV) infection. Little is known about the intrinsic response to infection in human hepatocytes and their contribution to inflammation. Here, we present an induced pluripotent stem cell (iPSC)-derived hepatocyte-like cell (HLC) platform to define the hepato-intrinsic response to EBOV infection. We used this platform to show robust EBOV infection, with characteristic ultrastructural changes and evidence for viral replication. Transcriptomics analysis revealed a delayed response with minimal early transcriptomic changes, followed by a general downregulation of hepatic function and upregulation of interferon signaling, providing a potential mechanism by which hepatocytes participate in disease severity and liver damage. Using RNA-fluorescence in situ hybridization (FISH), we showed that IFNB1 and CXCL10 were mainly expressed in non-infected bystander cells. We did not observe an inflammatory signature during infection. In conclusion, iPSC-HLCs are an immune competent platform to study responses to EBOV infection.
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Affiliation(s)
- Whitney A. Scoon
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA,National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA,Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Liliana Mancio-Silva
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, MA 02139, USA
| | - Ellen L. Suder
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA,Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Carlos Villacorta-Martin
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA
| | - Jonathan Lindstrom-Vautrin
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA
| | - John G. Bernbaum
- Integrated Research Facility, Division of Clinical Research, National Institute for Allergy and Infectious Disease, National Institutes of Health, Frederick, MD 21702, USA
| | - Steve Mazur
- Integrated Research Facility, Division of Clinical Research, National Institute for Allergy and Infectious Disease, National Institutes of Health, Frederick, MD 21702, USA
| | - Reed F. Johnson
- Integrated Research Facility, Division of Clinical Research, National Institute for Allergy and Infectious Disease, National Institutes of Health, Frederick, MD 21702, USA,Emerging Viral Pathogens Section, Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Disease, National Institutes of Health, Frederick, MD 21702, USA
| | - Judith Olejnik
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA,Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Elizabeth Y. Flores
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA,National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA,Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Aditya Mithal
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA,Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Feiya Wang
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA
| | - Adam J. Hume
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA,Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA
| | - Joseph E. Kaserman
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA,The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Sandra March-Riera
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, MA 02139, USA
| | - Andrew A. Wilson
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA,The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Sangeeta N. Bhatia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, MA 02139, USA,Koch Institute for Integrative Cancer Research, Cambridge, MA 02139, USA,Broad Institute, Cambridge, MA 02139, USA,Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Elke Mühlberger
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA; Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA.
| | - Gustavo Mostoslavsky
- Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany Street, Suite 209, Boston, MA 02118, USA; National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street, Boston, MA 02118, USA; Department of Microbiology, Boston University School of Medicine, 620 Albany Street, Boston, MA 02118, USA; Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, 670 Albany Street, Suite 209, Boston, MA 02118, USA.
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Seifert SN, Fischer RJ, Kuisma E, Badzi Nkoua C, Bounga G, Akongo MJ, Schulz JE, Escudero-Pérez B, Akoundzie BJ, Ampiri VRB, Dieudonne A, Indolo GD, Kaba SD, Louzolo I, Macosso LN, Mavoungou Y, Miegakanda VBB, Nina RA, Samabide KT, Ondzie AI, Ntoumi F, Muñoz-Fontela C, Mombouli JV, Olson SH, Walzer C, Niama FR, Munster VJ. Zaire ebolavirus surveillance near the Bikoro region of the Democratic Republic of the Congo during the 2018 outbreak reveals presence of seropositive bats. PLoS Negl Trop Dis 2022; 16:e0010504. [PMID: 35731800 PMCID: PMC9255767 DOI: 10.1371/journal.pntd.0010504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/05/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
On the 8th of May, 2018, an outbreak of Ebola virus disease (EVD) was declared, originating in the Bikoro region of the Democratic Republic of the Congo (DRC) near the border with neighboring Republic of the Congo (ROC). Frequent trade and migration occur between DRC and ROC-based communities residing along the Congo River. In June 2018, a field team was deployed to determine whether Zaire ebolavirus (Ebola virus (EBOV)) was contemporaneously circulating in local bats at the human-animal interface in ROC near the Bikoro EVD outbreak. Samples were collected from bats in the Cuvette and Likouala departments, ROC, bordering the Équateur Province in DRC where the Bikoro EVD outbreak was first detected. EBOV genomic material was not detected in bat-derived samples by targeted quantitative reverse transcription-polymerase chain reaction or by family-level consensus polymerase chain reaction; however, serological data suggests recent exposure to EBOV in bats in the region. We collected serum from 144 bats in the Cuvette department with 6.9% seropositivity against the EBOV glycoprotein and 14.3% seropositivity for serum collected from 27 fruit bats and one Molossinae in the Likouala department. We conclude that proactive investment in longitudinal sampling for filoviruses at the human-animal interface, coupled with ecological investigations are needed to identify EBOV wildlife reservoirs.
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Affiliation(s)
- Stephanie N. Seifert
- Paul G. Allen School for Global Health, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States
- Virus Ecology Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States
- * E-mail:
| | - Robert J. Fischer
- Virus Ecology Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States
| | - Eeva Kuisma
- Wildlife Health Program, Wildlife Conservation Society, Brazzaville, Republic of the Congo
| | - Cynthia Badzi Nkoua
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Gerard Bounga
- Wildlife Health Program, Wildlife Conservation Society, Brazzaville, Republic of the Congo
| | - Marc-Joël Akongo
- Wildlife Health Program, Wildlife Conservation Society, Brazzaville, Republic of the Congo
| | - Jonathan E. Schulz
- Virus Ecology Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States
| | - Beatriz Escudero-Pérez
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, Germany
| | - Beal-Junior Akoundzie
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Vishnou Reize Bani Ampiri
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Ankara Dieudonne
- Direction de la Santé Animale, Ministére de L’Agriculture et de L’Élevage, Brazzaville, Republic of the Congo
| | - Ghislain Dzeret Indolo
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Serge D. Kaba
- Wildlife Health Program, Wildlife Conservation Society, Brazzaville, Republic of the Congo
| | - Igor Louzolo
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Lucette Nathalie Macosso
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Yanne Mavoungou
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Valchy Bel-bebi Miegakanda
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Rock Aimé Nina
- Direction de la Santé Animale, Ministére de L’Agriculture et de L’Élevage, Brazzaville, Republic of the Congo
| | - Kevin Tolovou Samabide
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
- Faculty of Sciences and Techniques, Université Marien N’Gouabi, Brazzaville, Republic of the Congo
| | - Alain I. Ondzie
- Wildlife Health Program, Wildlife Conservation Society, Brazzaville, Republic of the Congo
| | - Francine Ntoumi
- Faculty of Sciences and Techniques, Université Marien N’Gouabi, Brazzaville, Republic of the Congo
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of the Congo
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Jean-Vivien Mombouli
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Sarah H. Olson
- Health Program, Wildlife Conservation Society, New York, New York, United States
| | - Chris Walzer
- Health Program, Wildlife Conservation Society, New York, New York, United States
- Research Institute of Wildlife Ecology, University of Veterinary Medicine, Vienna, Austria
| | - Fabien Roch Niama
- Département de la Recherche et de la Production, Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Vincent J. Munster
- Virus Ecology Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States
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5
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Jeremiah Matson M, Ricotta E, Feldmann F, Massaquoi M, Sprecher A, Giuliani R, Edwards JK, Rosenke K, de Wit E, Feldmann H, Chertow DS, Munster VJ. Evaluation of viral load in patients with Ebola virus disease in Liberia: a retrospective observational study. THE LANCET MICROBE 2022; 3:e533-e542. [PMID: 35617976 PMCID: PMC9254266 DOI: 10.1016/s2666-5247(22)00065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Viral load in patients with Ebola virus disease affects case fatality rate and is an important parameter used for diagnostic cutoffs, stratification in randomised controlled trials, and epidemiological studies. However, viral load in Ebola virus disease is currently estimated using numerous different assays and protocols that were not developed or validated for this purpose. Here, our aim was to conduct a laboratory-based re-evaluation of the viral loads of a large cohort of Liberian patients with Ebola virus disease and analyse these data in the broader context of the west Africa epidemic. Methods In this retrospective observational study, whole blood samples from patients at the Eternal Love Winning Africa Ebola treatment unit (Monrovia, Liberia) were re-extracted with an optimised protocol and analysed by droplet digital PCR (ddPCR) using a novel semi-strand specific assay to measure viral load. To allow for more direct comparisons, the ddPCR viral loads were also back-calculated to cycle threshold (Ct) values. The new viral load data were then compared with the Ct values from the original diagnostic quantitative RT-PCR (qRT-PCR) testing to identify differing trends and discrepancies. Findings Between Aug 28 and Dec 18, 2014, 727 whole blood samples from 528 individuals were collected. 463 (64%) were first-draw samples and 409 (56%) were from patients positive for Ebola virus (EBOV), species Zaire ebolavirus. Of the 307 first-draw EBOV-positive samples, 127 (41%) were from survivors and 180 (59%) were from non-survivors; 155 (50%) were women, 145 (47%) were men, and seven (2%) were not recorded, and the mean age was 29·3 (SD 15·0) years for women and 31·8 (SD 14·8) years for men. Survivors had significantly lower mean viral loads at presentation than non-survivors in both the reanalysed dataset (5·61 [95% CI 5·34–5·87] vs 7·19 [6·99–7·38] log10 EBOV RNA copies per mL; p<0·0001) and diagnostic dataset (Ct value 28·72 [27·97–29·47] vs 26·26 [25·72–26·81]; p<0·0001). However, the prognostic capacity of viral load increased with the reanalysed dataset (odds ratio [OR] of death 8·06 [95% CI 4·81–13·53], p<0·0001 for viral loads above 6·71 log10 EBOV RNA copies per mL vs OR of death 2·02 [1·27–3·20], p=0·0028 for Ct values below 27·37). Diagnostic qRT-PCR significantly (p<0·0001) underestimated viral load in both survivors and non-survivors (difference in diagnostic Ct value minus laboratory Ct value of 1·79 [95% CI 1·16–2·43] for survivors and 5·15 [4·43–5·87] for non-survivors). Six samples that were reported negative by diagnostic testing were found to be positive upon reanalysis and had high viral loads. Interpretation Inaccurate viral load estimation from diagnostic Ct values is probably multifactorial; however, unaddressed PCR inhibition from tissue damage in patients with fulminant Ebola virus disease could largely account for the discrepancies observed in our study. Testing protocols for Ebola virus disease require further standardisation and validation to produce accurate viral load estimates, minimise false negatives, and allow for reliable epidemiological investigation.
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Affiliation(s)
- M Jeremiah Matson
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA; Marshall University Joan C Edwards School of Medicine, Huntington, WV, USA
| | - Emily Ricotta
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Friederike Feldmann
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | | | | | | | | | - Kyle Rosenke
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Emmie de Wit
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Heinz Feldmann
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Vincent J Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
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6
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Gryseels S, Mbala-Kingebeni P, Akonda I, Angoyo R, Ayouba A, Baelo P, Mukadi DB, Bugentho E, Bushmaker T, Butel C, Calvignac-Spencer S, Delaporte E, De Smet B, Düx A, Edidi-Atani F, Fischer R, Kahandi C, Kapetshi J, Sumba SK, Kouadio L, Bendeke AM, Mande C, Sepolo GM, Moudindo J, Ngole EM, Musaba P, Mutombo P, Bass IN, Nebesse C, Ngoy S, Kumogo SPN, Seifert SN, Tanzito J, Akaibe D, Amundala N, Ariën KK, Gembu GC, Leendertz FH, Leirs H, Mukinzi JC, Munster V, Muyembe-Tamfum JJ, Peeters M, Verheyen E, Ahuka-Mundeke S. Role of Wildlife in Emergence of Ebola Virus in Kaigbono (Likati), Democratic Republic of the Congo, 2017. Emerg Infect Dis 2021; 26:2205-2209. [PMID: 32818404 PMCID: PMC7454093 DOI: 10.3201/eid2609.191552] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
After the 2017 Ebola virus (EBOV) outbreak in Likati, a district in northern Democratic Republic of the Congo, we sampled small mammals from the location where the primary case-patient presumably acquired the infection. None tested positive for EBOV RNA or antibodies against EBOV, highlighting the ongoing challenge in detecting animal reservoirs for EBOV.
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7
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Figueroa DM, Kuisma E, Matson MJ, Ondzie AU, Bushmaker T, Seifert SN, Ntoumi F, Escudero-Pérez B, Muñoz-Fontela C, Walzer C, Olson SH, Goma-Nkoua C, Mombouli JV, Fischer RJ, Munster VJ. Development and validation of portable, field-deployable Ebola virus point-of-encounter diagnostic assay for wildlife surveillance. ONE HEALTH OUTLOOK 2021; 3:9. [PMID: 34024280 PMCID: PMC8142476 DOI: 10.1186/s42522-021-00041-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
Early detection of Ebola virus spillover into wildlife is crucial for rapid response. We developed and validated a portable, cold-chain independent Ebola virus RT-qPCR assay. METHODS The field syringe-based RNA extraction method was compared with a conventional laboratory-based spin-column RNA extraction method. Next, the qPCR efficiency and limit of detection of the assay was compared to standard laboratory-based reagents and equipment. The specificity of the assay was confirmed by testing against multiple Zaire Ebolavirus (EBOV) variants and other ebolavirus species. Lastly, swabs from an EBOV-infected non-human primate carcass, stored at environmental conditions mimicking central and west Africa, were analyzed to mimic in field conditions. RESULTS The syringe-based RNA extraction method performed comparably to a standard laboratory spin-column-based method. The developed assay was comparable in sensitivity and specificity to standard laboratory-based diagnostic assays. The assay specifically detected EBOV and not any of the other tested ebolavirus species, including Reston ebolavirus, Sudan ebolavirus, Bundibugyo ebolavirus, and Tai Forrest ebolavirus. Notably, the assays limit of detection for EBOV isolates were all below 4 genome copies/μL. The assay was able to detect EBOV in oral, nasal, thoracic cavity, and conjunctiva swabs obtained from an infected non-human primate. CONCLUSION We developed a field-based Ebolavirus assay which is comparable in sensitivity and specificity to laboratory-based assays. Currently, the assay is being incorporated into wildlife carcass surveillance in the Republic of the Congo and is being adapted for other infectious disease agents.
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Affiliation(s)
- Dania M Figueroa
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA
| | - Eeva Kuisma
- Wildflife Conservation Society, Health Program, Bronx, NY, USA
| | - M Jeremiah Matson
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA
- Marshall University, Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Alain U Ondzie
- Wildflife Conservation Society, Health Program, Bronx, NY, USA
| | - Trent Bushmaker
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA
| | - Stephanie N Seifert
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Republic of Congo
| | - Beatriz Escudero-Pérez
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg, Bernhard Nocht Strasse 74, 20359, Hamburg, Germany
| | - César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg, Bernhard Nocht Strasse 74, 20359, Hamburg, Germany
| | - Chris Walzer
- Wildflife Conservation Society, Health Program, Bronx, NY, USA
- Department of Interdisciplinary Life Sciences, Research Institute of Wildlife Ecology, University of Veterinary Medicine, Vienna, Austria
| | - Sarah H Olson
- Wildflife Conservation Society, Health Program, Bronx, NY, USA
| | - Cynthia Goma-Nkoua
- Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | | | - Robert J Fischer
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA
| | - Vincent J Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA.
- Rocky Mountain Laboratories, NIAID/NIH, 903S 4th Street, Hamilton, MT, 59840, USA.
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8
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Warsame A, Murray J, Gimma A, Checchi F. The practice of evaluating epidemic response in humanitarian and low-income settings: a systematic review. BMC Med 2020; 18:315. [PMID: 33138813 PMCID: PMC7606030 DOI: 10.1186/s12916-020-01767-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. However, relatively little is known about responses to these epidemics. Robust evaluations can generate evidence on response efforts and inform future improvements. This systematic review aimed to (i) identify epidemics reported in low-income and crisis settings, (ii) determine the frequency with which evaluations of responses to these epidemics were conducted, (iii) describe the main typologies of evaluations undertaken and (iv) identify key gaps and strengths of recent evaluation practice. METHODS Reported epidemics were extracted from the following sources: World Health Organization Disease Outbreak News (WHO DON), UNICEF Cholera platform, Reliefweb, PROMED and Global Incidence Map. A systematic review for evaluation reports was conducted using the MEDLINE, EMBASE, Global Health, Web of Science, WPRIM, Reliefweb, PDQ Evidence and CINAHL Plus databases, complemented by grey literature searches using Google and Google Scholar. Evaluation records were quality-scored and linked to epidemics based on time and place. The time period for the review was 2010-2019. RESULTS A total of 429 epidemics were identified, primarily in sub-Saharan Africa, the Middle East and Central Asia. A total of 15,424 potential evaluations records were screened, 699 assessed for eligibility and 132 included for narrative synthesis. Only one tenth of epidemics had a corresponding response evaluation. Overall, there was wide variability in the quality, content as well as in the disease coverage of evaluation reports. CONCLUSION The current state of evaluations of responses to these epidemics reveals large gaps in coverage and quality and bears important implications for health equity and accountability to affected populations. The limited availability of epidemic response evaluations prevents improvements to future public health response. The diversity of emphasis and methods of available evaluations limits comparison across responses and time. In order to improve future response and save lives, there is a pressing need to develop a standardized and practical approach as well as governance arrangements to ensure the systematic conduct of epidemic response evaluations in low-income and crisis settings.
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Affiliation(s)
- Abdihamid Warsame
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK.
| | - Jillian Murray
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK
| | - Amy Gimma
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Checchi
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK
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9
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Bacillus paranthracis Isolate from Blood of Fatal Ebola Virus Disease Case. Pathogens 2020; 9:pathogens9060475. [PMID: 32560095 PMCID: PMC7350349 DOI: 10.3390/pathogens9060475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022] Open
Abstract
A Bacillus paranthracis isolate was cultured from the blood of a fatal Ebola virus disease (EVD) case in Liberia and was identified by whole genome sequencing. Although B. paranthracis has only recently been described and is poorly characterized, this case may represent the bacterial co-infection of an EVD patient.
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10
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Previremic Identification of Ebola or Marburg Virus Infection Using Integrated Host-Transcriptome and Viral Genome Detection. mBio 2020; 11:mBio.01157-20. [PMID: 32546624 PMCID: PMC7298714 DOI: 10.1128/mbio.01157-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Current molecular tests that identify infection with high-consequence viruses such as Ebola virus and Marburg virus are based on the detection of virus material in the blood. These viruses do not undergo significant early replication in the blood and, instead, replicate in organs such as the liver and spleen. Thus, virus begins to accumulate in the blood only after significant replication has already occurred in those organs, making viremia an indicator of infection only after initial stages have become established. Here, we show that a multianalyte assay can correctly identify the infectious agent in nonhuman primates (NHPs) prior to viremia through tracking host infection response transcripts. This illustrates that a single-tube, sample-to-answer format assay could be used to advance the time at which the type of infection can be determined and thereby improve outcomes. Outbreaks of filoviruses, such as those caused by the Ebola (EBOV) and Marburg (MARV) virus, are difficult to detect and control. The initial clinical symptoms of these diseases are nonspecific and can mimic other endemic pathogens. This makes confident diagnosis based on clinical symptoms alone impossible. Molecular diagnostics for these diseases that rely on the detection of viral RNA in the blood are only effective after significant disease progression. As an approach to identify these infections earlier in the disease course, we tested the effectiveness of viral RNA detection combined with an assessment of sentinel host mRNAs that are upregulated following filovirus infection. RNAseq analysis of EBOV-infected nonhuman primates identified host RNAs that are upregulated at early stages of infection. NanoString probes that recognized these host-response RNAs were combined with probes that recognized viral RNA and were used to classify viral infection both prior to viremia and postviremia. This approach was highly successful at identifying samples from nonhuman primate subjects and correctly distinguished the causative agent in a previremic stage in 10 EBOV and 5 MARV samples. This work suggests that unified host response/viral fingerprint assays can enable diagnosis of disease earlier than testing for viral nucleic acid alone, which could decrease transmission events and increase therapeutic effectiveness.
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11
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Teng TZ, Beavogui AH, Diarra B, Delamou A, Holl J, Maiga AI, Sadio Sarro YD, Kone A, Kone B, Fofana DB, Dembele E, Sow MS, Seydi M, Oumar AA, Diakité M, Diallo S, Doumbia S, Dao S, Murphy RL, Maiga M. Diagnostic Laboratories' Capacities and Preparedness for Emerging Viral Diseases in Guinea and Mali. INFECTIOUS DISEASES DIAGNOSIS & TREATMENT 2020; 4:135. [PMID: 34532653 PMCID: PMC8442766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The 2014-2016 Ebola epidemic in Guinea highlighted the need for more extensive evaluation of laboratories diagnostic capacities and preparedness in anticipation of future emerging viral disease outbreaks. We developed a questionnaire to assess the diagnostic capacities and preparedness of the four major medical laboratories in Guinea and Mali that are responsible for the provision of Ebola, Lassa, and Dengue diagnostics. The questionnaire inquired about the current state and need for equipment and reagents and adequacy of equipment and training received. In Guinea, all three diagnostic laboratories have the capacity and are well-prepared to perform Ebola diagnostics, however, only two have the capacity and trained staff to diagnose Lassa and none are currently prepared to diagnose Dengue infection. In Mali, the University Clinical Research Center (UCRC) laboratory, which was in charge of Ebola diagnostics during the last epidemic, currently has the capacity and is prepared to diagnose Ebola, Lassa, and Dengue infections. Combined, Guinea and Mali appear to have complementary capacity and preparedness to diagnose these Category A Priority Pathogens. While, the equipment, reagents and training efforts should be maintained, the gap in Dengue diagnostic capability in Guinea should be addressed with further equipping and training of additional district laboratories to strengthen the public health response for all viral diseases in these high-risk, yet, low-resource settings.
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Affiliation(s)
- Tiffany Zhang Teng
- Institute for Global Health, Northwestern University, Chicago, Illinois, USA
| | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Center of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bassirou Diarra
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Center of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Jane Holl
- Center for Healthcare Delivery Science and Innovation, The University of Chicago, Chicago, Illinois, USA
| | - Almoustapha Issiaka Maiga
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yeya Dit Sadio Sarro
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Amadou Kone
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Bourahima Kone
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Djeneba Bocar Fofana
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Etienne Dembele
- Institute for Global Health, Northwestern University, Chicago, Illinois, USA
| | - Mamadou Saliou Sow
- Centre de Recherche et de Formation en Infectiologie de Guinée, University of Conakry, Conakry, Guinea
| | | | - Aboubacar Alassane Oumar
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mahamadou Diakité
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Souleymane Diallo
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Seydou Doumbia
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Sounkalo Dao
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Robert L Murphy
- Institute for Global Health, Northwestern University, Chicago, Illinois, USA
| | - Mamoudou Maiga
- Institute for Global Health, Northwestern University, Chicago, Illinois, USA
- University Clinical Research Center (UCRC)-SEREFO, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
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12
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Rosenke K, Mercado-Hernandez R, Cronin J, Conteh S, Duffy P, Feldmann H, de Wit E. The Effect of Plasmodium on the Outcome of Ebola Virus Infection in a Mouse Model. J Infect Dis 2019; 218:S434-S437. [PMID: 29878224 DOI: 10.1093/infdis/jiy236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Following the Ebola virus epidemic in West Africa, several studies investigated whether there was an effect of Plasmodium coinfection on survival in Ebola virus (EBOV) disease patients. Different effects of coinfection were found in different patient cohorts. To determine whether an effect of Plasmodium coinfection on EBOV survival may exist, we modeled coinfection of Plasmodium yoelii and mouse-adapted EBOV (MA-EBOV) in CD1 mice. Subsequent infection with MA-EBOV at different time points after P. yoelii infection did not have any significant effect on survival.
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Affiliation(s)
- Kyle Rosenke
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana
| | - Reinaldo Mercado-Hernandez
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana
| | - Jacqueline Cronin
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana
| | - Solomon Conteh
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH Bethesda, Maryland
| | - Patrick Duffy
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH Bethesda, Maryland
| | - Heinz Feldmann
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana
| | - Emmie de Wit
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana
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13
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Kuisma E, Olson SH, Cameron KN, Reed PE, Karesh WB, Ondzie AI, Akongo MJ, Kaba SD, Fischer RJ, Seifert SN, Muñoz-Fontela C, Becker-Ziaja B, Escudero-Pérez B, Goma-Nkoua C, Munster VJ, Mombouli JV. Long-term wildlife mortality surveillance in northern Congo: a model for the detection of Ebola virus disease epizootics. Philos Trans R Soc Lond B Biol Sci 2019; 374:20180339. [PMID: 31401969 DOI: 10.1098/rstb.2018.0339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Ebolavirus (EBOV) has caused disease outbreaks taking thousands of lives, costing billions of dollars in control efforts and threatening great ape populations. EBOV ecology is not fully understood but infected wildlife and consumption of animal carcasses have been linked to human outbreaks, especially in the Congo Basin. Partnering with the Congolese Ministry of Health, we conducted wildlife mortality surveillance and educational outreach in the northern Republic of Congo (RoC). Designed for EBOV detection and to alert public health authorities, we established a low-cost wildlife mortality reporting network covering 50 000 km2. Simultaneously, we delivered educational outreach promoting behavioural change to over 6600 people in rural northern RoC. We achieved specimen collection by training project staff on a safe sampling protocol and equipping geographically distributed bases with sampling kits. We established in-country diagnostics for EBOV testing, reducing diagnostic turnaround time to 3 days and demonstrated the absence of EBOV in 58 carcasses. Central Africa remains a high-risk EBOV region, but RoC, home to the largest remaining populations of great apes, has not had an epidemic since 2005. This effort continues to function as an untested early warning system in RoC, where people and great apes have died from past Ebola virus disease outbreaks. This article is part of the theme issue 'Dynamic and integrative approaches to understanding pathogen spillover'.
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Affiliation(s)
- Eeva Kuisma
- Wildlife Conservation Society, Wildlife Health Program, 151 Avenue du General de Gaulle, BP14537 Brazzaville, Republic of Congo
| | - Sarah H Olson
- Wildlife Conservation Society, Wildlife Health Program, 2300 Southern Boulevard, Bronx, New York, NY 10460, USA
| | - Kenneth N Cameron
- Wildlife Conservation Society, Wildlife Health Program, 2300 Southern Boulevard, Bronx, New York, NY 10460, USA
| | - Patricia E Reed
- Wildlife Conservation Society, Wildlife Health Program, 2300 Southern Boulevard, Bronx, New York, NY 10460, USA
| | - William B Karesh
- Health and Policy, EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA
| | - Alain I Ondzie
- Wildlife Conservation Society, Wildlife Health Program, 151 Avenue du General de Gaulle, BP14537 Brazzaville, Republic of Congo
| | - Marc-Joël Akongo
- Wildlife Conservation Society, Wildlife Health Program, 151 Avenue du General de Gaulle, BP14537 Brazzaville, Republic of Congo
| | - Serge D Kaba
- Wildlife Conservation Society, Wildlife Health Program, 151 Avenue du General de Gaulle, BP14537 Brazzaville, Republic of Congo
| | - Robert J Fischer
- Laboratory of Virology, Virus Ecology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903s 4th street, Hamilton, MT, USA
| | - Stephanie N Seifert
- Laboratory of Virology, Virus Ecology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903s 4th street, Hamilton, MT, USA
| | - César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine and German Center for Infection Research DZIF, Bernhard Nocht Strasse 74, 20359 Hamburg, Germany
| | | | - Beatriz Escudero-Pérez
- Bernhard Nocht Institute for Tropical Medicine and German Center for Infection Research DZIF, Bernhard Nocht Strasse 74, 20359 Hamburg, Germany
| | - Cynthia Goma-Nkoua
- Service d'Epidémiologie Moléculaire, Laboratoire National de Santé Publique, Avenue du General de Gaulle, BP120 Brazzaville, Republic of Congo
| | - Vincent J Munster
- Laboratory of Virology, Virus Ecology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903s 4th street, Hamilton, MT, USA
| | - Jean-Vivien Mombouli
- Service d'Epidémiologie Moléculaire, Laboratoire National de Santé Publique, Avenue du General de Gaulle, BP120 Brazzaville, Republic of Congo
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14
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Hunsperger E, Juma B, Onyango C, Ochieng JB, Omballa V, Fields BS, Njenga MK, Mwangi J, Bigogo G, Omore R, Otieno N, Chaves SS, Munyua P, Njau DM, Verani J, Lowther S, Breiman RF, Montgomery JM, De Cock KM, Widdowson MA. Building laboratory capacity to detect and characterize pathogens of public and global health security concern in Kenya. BMC Public Health 2019; 19:477. [PMID: 32326916 PMCID: PMC6696698 DOI: 10.1186/s12889-019-6770-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Since 1979, multiple CDC Kenya programs have supported the development of diagnostic expertise and laboratory capacity in Kenya. In 2004, CDC’s Global Disease Detection (GDD) program within the Division of Global Health Protection in Kenya (DGHP-Kenya) initiated close collaboration with Kenya Medical Research Institute (KEMRI) and developed a laboratory partnership called the Diagnostic and Laboratory Systems Program (DLSP). DLSP built onto previous efforts by malaria, human immunodeficiency virus (HIV) and tuberculosis (TB) programs and supported the expansion of the diagnostic expertise and capacity in KEMRI and the Ministry of Health. First, DLSP developed laboratory capacity for surveillance of diarrheal, respiratory, zoonotic and febrile illnesses to understand the etiology burden of these common illnesses and support evidenced-based decisions on vaccine introductions and recommendations in Kenya. Second, we have evaluated and implemented new diagnostic technologies such as TaqMan Array Cards (TAC) to detect emerging or reemerging pathogens and have recently added a next generation sequencer (NGS). Third, DLSP provided rapid laboratory diagnostic support for outbreak investigation to Kenya and regional countries. Fourth, DLSP has been assisting the Kenya National Public Health laboratory-National Influenza Center and microbiology reference laboratory to obtain World Health Organization (WHO) certification and ISO15189 accreditation respectively. Fifth, we have supported biosafety and biosecurity curriculum development to help Kenyan laboratories safely and appropriately manage infectious pathogens. These achievements, highlight how in collaboration with existing CDC programs working on HIV, tuberculosis and malaria, the Global Health Security Agenda can have significantly improve public health in Kenya and the region. Moreover, Kenya provides an example as to how laboratory science can help countries detect and control of infectious disease outbreaks and other public health threats more rapidly, thus enhancing global health security.
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Affiliation(s)
- Elizabeth Hunsperger
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya. .,CDC, CGH, DGHP, Epidemiology, Informatics, Surveillance and Laboratory Branch, Atlanta, GA, USA.
| | - Bonventure Juma
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya
| | - Clayton Onyango
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya
| | - John B Ochieng
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | | | - Barry S Fields
- CDC, CGH, DGHP, Epidemiology, Informatics, Surveillance and Laboratory Branch, Atlanta, GA, USA
| | | | - Jane Mwangi
- CDC, CGH, Division of Global HIV and TB (DGHT), Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Nancy Otieno
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Sandra S Chaves
- CDC, National Center for Immunization and Respiratory Diseases, Influenza Division, Nairobi, Kenya
| | - Peninah Munyua
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya
| | - Daniel Macharia Njau
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya
| | - Jennifer Verani
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya.,CDC, CGH, DGHP, Epidemiology, Informatics, Surveillance and Laboratory Branch, Atlanta, GA, USA
| | - Sara Lowther
- CDC, DGHP, Workforce Institute Development Branch, Nairobi, Kenya
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Joel M Montgomery
- CDC, CGH, DGHP, Epidemiology, Informatics, Surveillance and Laboratory Branch, Atlanta, GA, USA
| | - Kevin M De Cock
- CDC, CGH, Division of Global HIV and TB (DGHT), Nairobi, Kenya
| | - Marc-Alain Widdowson
- Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global Health Protection (DGHP), Nairobi, Kenya.,CDC, CGH, DGHP, Epidemiology, Informatics, Surveillance and Laboratory Branch, Atlanta, GA, USA
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15
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Mbala-Kingebeni P, Pratt CB, Wiley MR, Diagne MM, Makiala-Mandanda S, Aziza A, Di Paola N, Chitty JA, Diop M, Ayouba A, Vidal N, Faye O, Faye O, Karhemere S, Aruna A, Nsio J, Mulangu F, Mukadi D, Mukadi P, Kombe J, Mulumba A, Duraffour S, Likofata J, Pukuta E, Caviness K, Bartlett ML, Gonzalez J, Minogue T, Sozhamannan S, Gross SM, Schroth GP, Kuhn JH, Donaldson EF, Delaporte E, Sanchez-Lockhart M, Peeters M, Muyembe-Tamfum JJ, Alpha Sall A, Palacios G, Ahuka-Mundeke S. 2018 Ebola virus disease outbreak in Équateur Province, Democratic Republic of the Congo: a retrospective genomic characterisation. THE LANCET. INFECTIOUS DISEASES 2019; 19:641-647. [PMID: 31000465 DOI: 10.1016/s1473-3099(19)30124-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The 2018 Ebola virus disease (EVD) outbreak in Équateur Province, Democratic Republic of the Congo, began on May 8, and was declared over on July 24; it resulted in 54 documented cases and 33 deaths. We did a retrospective genomic characterisation of the outbreak and assessed potential therapeutic agents and vaccine (medical countermeasures). METHODS We used target-enrichment sequencing to produce Ebola virus genomes from samples obtained in the 2018 Équateur Province outbreak. Combining these genomes with genomes associated with known outbreaks from GenBank, we constructed a maximum-likelihood phylogenetic tree. In-silico analyses were used to assess potential mismatches between the outbreak strain and the probes and primers of diagnostic assays and the antigenic sites of the experimental rVSVΔG-ZEBOV-GP vaccine and therapeutics. An in-vitro flow cytometry assay was used to assess the binding capability of the individual components of the monoclonal antibody cocktail ZMapp. FINDINGS A targeted sequencing approach produced 16 near-complete genomes. Phylogenetic analysis of these genomes and 1011 genomes from GenBank revealed a distinct cluster, confirming a new Ebola virus variant, for which we propose the name "Tumba". This new variant appears to have evolved at a slower rate than other Ebola virus variants (0·69 × 10-3 substitutions per site per year with "Tumba" vs 1·06 × 10-3 substitutions per site per year without "Tumba"). We found few sequence mismatches in the assessed assay target regions and antigenic sites. We identified nine amino acid changes in the Ebola virus surface glycoprotein, of which one resulted in reduced binding of the 13C6 antibody within the ZMapp cocktail. INTERPRETATION Retrospectively, we show the feasibility of using genomics to rapidly characterise a new Ebola virus variant within the timeframe of an outbreak. Phylogenetic analysis provides further indications that these variants are evolving at differing rates. Rapid in-silico analyses can direct in-vitro experiments to quickly assess medical countermeasures. FUNDING Defense Biological Product Assurance Office.
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Affiliation(s)
- Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Catherine B Pratt
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael R Wiley
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Sheila Makiala-Mandanda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Amuri Aziza
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Nicholas Di Paola
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Joseph A Chitty
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | | | - Ahidjo Ayouba
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Nicole Vidal
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | | | - Oumar Faye
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Stormy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Aaron Aruna
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Justus Nsio
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Felix Mulangu
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Daniel Mukadi
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - John Kombe
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Anastasie Mulumba
- Monsieur le Représentant de l'Organisation Mondiale de la Santé, Democratic Republic of the Congo
| | - Sophie Duraffour
- Monsieur le Représentant de l'Organisation Mondiale de la Santé, Democratic Republic of the Congo; Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany
| | - Jacques Likofata
- Laboratoire Provinciale, Mbandaka, Democratic Republic of the Congo
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Katie Caviness
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Maggie L Bartlett
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jeanette Gonzalez
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Timothy Minogue
- Diagnostics Services Division, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Shanmuga Sozhamannan
- Defense Biological Product Assurance Office, Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense-Joint Project Management Office for Guardian, Frederick, MD, USA; Logistics Management Institute, Tysons, VA, USA
| | | | | | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Eric F Donaldson
- Division of Antiviral Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Eric Delaporte
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Mariano Sanchez-Lockhart
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Martine Peeters
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Gustavo Palacios
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA.
| | - Steve Ahuka-Mundeke
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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16
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Mbala-Kingebeni P, Aziza A, Di Paola N, Wiley MR, Makiala-Mandanda S, Caviness K, Pratt CB, Ladner JT, Kugelman JR, Prieto K, Chitty JA, Larson PA, Beitzel B, Ayouba A, Vidal N, Karhemere S, Diop M, Diagne MM, Faye M, Faye O, Aruna A, Nsio J, Mulangu F, Mukadi D, Mukadi P, Kombe J, Mulumba A, Villabona-Arenas CJ, Pukuta E, Gonzalez J, Bartlett ML, Sozhamannan S, Gross SM, Schroth GP, Tim R, Zhao JJ, Kuhn JH, Diallo B, Yao M, Fall IS, Ndjoloko B, Mossoko M, Lacroix A, Delaporte E, Sanchez-Lockhart M, Sall AA, Muyembe-Tamfum JJ, Peeters M, Palacios G, Ahuka-Mundeke S. Medical countermeasures during the 2018 Ebola virus disease outbreak in the North Kivu and Ituri Provinces of the Democratic Republic of the Congo: a rapid genomic assessment. THE LANCET. INFECTIOUS DISEASES 2019; 19:648-657. [PMID: 31000464 DOI: 10.1016/s1473-3099(19)30118-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The real-time generation of information about pathogen genomes has become a vital goal for transmission analysis and characterisation in rapid outbreak responses. In response to the recently established genomic capacity in the Democratic Republic of the Congo, we explored the real-time generation of genomic information at the start of the 2018 Ebola virus disease (EVD) outbreak in North Kivu Province. METHODS We used targeted-enrichment sequencing to produce two coding-complete Ebola virus genomes 5 days after declaration of the EVD outbreak in North Kivu. Subsequent sequencing efforts yielded an additional 46 genomes. Genomic information was used to assess early transmission, medical countermeasures, and evolution of Ebola virus. FINDINGS The genomic information demonstrated that the EVD outbreak in the North Kivu and Ituri Provinces was distinct from the 2018 EVD outbreak in Équateur Province of the Democratic Republic of the Congo. Primer and probe mismatches to Ebola virus were identified in silico for all deployed diagnostic PCR assays, with the exception of the Cepheid GeneXpert GP assay. INTERPRETATION The first two coding-complete genomes provided actionable information in real-time for the deployment of the rVSVΔG-ZEBOV-GP Ebola virus envelope glycoprotein vaccine, available therapeutics, and sequence-based diagnostic assays. Based on the mutations identified in the Ebola virus surface glycoprotein (GP12) observed in all 48 genomes, deployed monoclonal antibody therapeutics (mAb114 and ZMapp) should be efficacious against the circulating Ebola virus variant. Rapid Ebola virus genomic characterisation should be included in routine EVD outbreak response procedures to ascertain efficacy of medical countermeasures. FUNDING Defense Biological Product Assurance Office.
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Affiliation(s)
- Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Amuri Aziza
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Nicholas Di Paola
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Michael R Wiley
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; College of Public Health, Northern Arizona University, Flagstaff, AZ, USA
| | - Sheila Makiala-Mandanda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Katie Caviness
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Catherine B Pratt
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; College of Public Health, Northern Arizona University, Flagstaff, AZ, USA
| | - Jason T Ladner
- University of Nebraska Medical Center, Omaha, NE, USA; The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | | | - Karla Prieto
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; College of Public Health, Northern Arizona University, Flagstaff, AZ, USA
| | - Joseph A Chitty
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Peter A Larson
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Brett Beitzel
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Ahidjo Ayouba
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Nicole Vidal
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | - Aaron Aruna
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Justus Nsio
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Felix Mulangu
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Daniel Mukadi
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - John Kombe
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Anastasie Mulumba
- l'Organisation Mondiale de la Santé, Kinshasa, Democratic Republic of the Congo
| | | | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Jeanette Gonzalez
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Maggie L Bartlett
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; Department of Pathology and Microbiology, Northern Arizona University, Flagstaff, AZ, USA
| | - Shanmuga Sozhamannan
- Defense Biological Product Assurance Office, Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense-Joint Project Management Office for Guardian, Frederick, MA, USA; The Tauri Group, Alexandria, VA, USA
| | | | | | | | | | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | | | - Michel Yao
- World Health Organization, Geneva, Switzerland
| | | | - Bathe Ndjoloko
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Mathias Mossoko
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Audrey Lacroix
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Eric Delaporte
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Mariano Sanchez-Lockhart
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; Department of Pathology and Microbiology, Northern Arizona University, Flagstaff, AZ, USA
| | | | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martine Peeters
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Gustavo Palacios
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA.
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
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Tembo J, Simulundu E, Changula K, Handley D, Gilbert M, Chilufya M, Asogun D, Ansumana R, Kapata N, Ntoumi F, Ippolito G, Zumla A, Bates M. Recent advances in the development and evaluation of molecular diagnostics for Ebola virus disease. Expert Rev Mol Diagn 2019; 19:325-340. [PMID: 30916590 DOI: 10.1080/14737159.2019.1595592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The 2014-16 outbreak of ebola virus disease (EVD) in West Africa resulted in 11,308 deaths. During the outbreak only 60% of patients were laboratory confirmed and global health authorities have identified the need for accurate and readily deployable molecular diagnostics as an important component of the ideal response to future outbreaks, to quickly identify and isolate patients. Areas covered: Currently PCR-based techniques and rapid diagnostic tests (RDTs) that detect antigens specific to EVD infections dominate the diagnostic landscape, but recent advances in biosensor technologies have led to novel approaches for the development of EVD diagnostics. This review summarises the literature and available performance data of currently available molecular diagnostics for ebolavirus, identifies knowledge gaps and maps out future priorities for research in this field. Expert opinion: While there are now a plethora of diagnostic tests for EVD at various stages of development, there is an acute need for studies to compare their clinical performance, but the sporadic nature of EVD outbreaks makes this extremely challenging, demanding pragmatic new modalities of research funding and ethical/institutional approval, to enable responsive research in outbreak settings. Retrospective head-to-head diagnostic comparisons could also be implemented using biobanked specimens, providing this can be done safely.
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Affiliation(s)
- John Tembo
- a HerpeZ , University Teaching hospital , Lusaka , Zambia
| | - Edgar Simulundu
- b Department of Disease Control , University of Zambia School of Veterinary Medicine , Lusaka , Zambia
| | - Katendi Changula
- b Department of Disease Control , University of Zambia School of Veterinary Medicine , Lusaka , Zambia
| | - Dale Handley
- c School of Life Sciences , University of Lincoln , Lincoln , UK
| | - Matthew Gilbert
- c School of Life Sciences , University of Lincoln , Lincoln , UK
| | - Moses Chilufya
- a HerpeZ , University Teaching hospital , Lusaka , Zambia
| | - Danny Asogun
- d Lassa fever research institute , Irrua University Teaching Hospital , Irrua , Nigeria
| | | | - Nathan Kapata
- f Zambia National Public Health Institute , Lusaka , Zambia
| | - Francine Ntoumi
- g Fondation Congolaise pour la Recherche Médicale , Brazzaville , Republic of Congo
| | - Giuseppe Ippolito
- h National Institute for Infectious Diseases , Lazzaro Spallanzani, IRCCS , Rome , Italy
| | - Alimuddin Zumla
- i Centre for Clinical Microbiology, Division of Infection and Immunity , University College London (UCL) , London , UK.,j National Institute of Health and Research Biomedical Research Centre , UCL Hospitals National Health Service Foundation Trust , London , UK
| | - Matthew Bates
- a HerpeZ , University Teaching hospital , Lusaka , Zambia.,c School of Life Sciences , University of Lincoln , Lincoln , UK.,i Centre for Clinical Microbiology, Division of Infection and Immunity , University College London (UCL) , London , UK
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18
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Spengler JR, Welch SR, Genzer SC, Coleman-McCray J, Harmon JR, Nichol ST, Spiropoulou CF. Suboptimal Handling of Piccolo Samples or Reagent Discs for Consideration in Ebola Response. Emerg Infect Dis 2019; 25:1238-1240. [PMID: 30900978 PMCID: PMC6537746 DOI: 10.3201/eid2506.181928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Operating clinical analyzers within recommended parameters can be challenging during outbreak response. Using the Piccolo Xpress point-of-care blood chemistry analyzer on guinea pig blood, we found that values of many analytes are still readily comparable when samples and reagent discs are handled at various conditions outside of manufacturer recommendations.
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19
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Strong JE, Feldmann H. The Crux of Ebola Diagnostics. J Infect Dis 2019; 216:1340-1342. [PMID: 29029148 DOI: 10.1093/infdis/jix490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/20/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- James E Strong
- Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Heinz Feldmann
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
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Mobile High-Containment Biological Laboratories Deployment: Opportunities and Challenges in Expeditionary Deployments to Outbreak Response. APPLIED BIOSAFETY 2018; 24:20-29. [DOI: 10.1177/1535676018818563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening. PLoS Negl Trop Dis 2018; 12:e0006135. [PMID: 29304039 PMCID: PMC5755746 DOI: 10.1371/journal.pntd.0006135] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/24/2017] [Indexed: 11/19/2022] Open
Abstract
The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64-100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.
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22
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Diarra B, Safronetz D, Sarro YDS, Kone A, Sanogo M, Tounkara S, Togo ACG, Daou F, Maiga AI, Dao S, Rosenke K, Falzarano D, Doumbia S, Zoon KC, Polis M, Siddiqui S, Sow S, Schwan TG, Feldmann H, Diallo S, Koita OA. Laboratory Response to 2014 Ebola Virus Outbreak in Mali. J Infect Dis 2017; 214:S164-S168. [PMID: 27707892 DOI: 10.1093/infdis/jiw200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aware of the rapid spread of Ebola virus (EBOV) during the current West African epidemic, Mali took several proactive steps to rapidly identify cases within its borders. Under the Mali International Center for Excellence in Research program, a collaboration between the National Institute of Allergy and Infectious Diseases and the Malian Ministry of Higher Education and Scientific Research established a national EBOV diagnostic site at the University of Sciences, Techniques and Technologies of Bamako in the SEREFO Laboratory. Two separate introductions of EBOV occurred in Mali from neighboring Guinea, but both chains of transmission were quickly halted, and Mali was declared "Ebola free" on 18 January 2015 and has remained so since. The SEREFO Laboratory was instrumental in the success of Mali's Ebola response by providing timely and accurate diagnostics. As of today, the SEREFO Laboratory has tested 103 samples from 88 suspected cases, 10 of which were EBOV positive, since the Ebola diagnostics unit started in April 2014. The establishment of Ebola diagnostics in the SEREFO Laboratory, safety precautions, and diagnostics are described.
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Affiliation(s)
- Bassirou Diarra
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | | | - Yeya Dit Sadio Sarro
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Amadou Kone
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Moumine Sanogo
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sady Tounkara
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Antieme C G Togo
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Fatoumata Daou
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Almoustapha I Maiga
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sounkalo Dao
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | | | | | - Seydou Doumbia
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Kathryn C Zoon
- Cytokine Biology Section, Division of Intramural Research
| | - Michael Polis
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sophia Siddiqui
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Samba Sow
- Centre des Operations d'Urgence (Malian Center for Emergency Operations), Centre National d'Appui a la lutte contre la Maladie (Malian Center for Disease Control), Ministry of Health, Bamako, Mali
| | - Tom G Schwan
- Laboratory of Zoonotic Pathogens, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | | | - Souleyman Diallo
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Ousmane A Koita
- SEREFO Laboratory, University Clinical Research Center, Faculty of Sciences and Technology, University of Sciences, Techniques and Technologies of Bamako, Mali
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Rosenke K, Adjemian J, Munster VJ, Marzi A, Falzarano D, Onyango CO, Ochieng M, Juma B, Fischer RJ, Prescott JB, Safronetz D, Omballa V, Owuor C, Hoenen T, Groseth A, Martellaro C, van Doremalen N, Zemtsova G, Self J, Bushmaker T, McNally K, Rowe T, Emery SL, Feldmann F, Williamson BN, Best SM, Nyenswah TG, Grolla A, Strong JE, Kobinger G, Bolay FK, Zoon KC, Stassijns J, Giuliani R, de Smet M, Nichol ST, Fields B, Sprecher A, Massaquoi M, Feldmann H, de Wit E. Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus-Infected Patients. Clin Infect Dis 2016; 63:1026-33. [PMID: 27531847 DOI: 10.1093/cid/ciw452] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus. METHODS All blood samples from suspected Ebola virus-infected patients admitted to the Médecins Sans Frontières ELWA3 Ebola treatment unit in Monrovia were tested by quantitative real-time polymerase chain reaction for the presence of Ebola virus and Plasmodium species RNA. Clinical outcome in laboratory-confirmed Ebola virus-infected patients was analyzed as a function of age, sex, Ebola viremia, and Plasmodium species parasitemia. RESULTS The case fatality rate of 1182 patients with laboratory-confirmed Ebola virus infections was 52%. The probability of surviving decreased with increasing age and decreased with increasing Ebola viral load. Ebola virus-infected patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age; those with the highest levels of parasitemia had a survival rate of 83%. This effect was independent of treatment with antimalarials, as this was provided to all patients. Moreover, treatment with antimalarials did not affect survival in the Ebola virus mouse model. CONCLUSIONS Plasmodium species parasitemia is associated with an increase in the probability of surviving Ebola virus infection. More research is needed to understand the molecular mechanism underlying this remarkable phenomenon and translate it into treatment options for Ebola virus infection.
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Affiliation(s)
- Kyle Rosenke
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Jennifer Adjemian
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Commissioned Corps, US Public Health Service, Rockville, Maryland
| | - Vincent J Munster
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Andrea Marzi
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Darryl Falzarano
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Clayton O Onyango
- Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention
| | - Melvin Ochieng
- Kenya Medical Research Institute, Center for Global Health Research, Nairobi
| | - Bonventure Juma
- Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention
| | - Robert J Fischer
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Joseph B Prescott
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - David Safronetz
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Victor Omballa
- Kenya Medical Research Institute, Center for Global Health Research, Nairobi
| | - Collins Owuor
- Kenya Medical Research Institute, Center for Global Health Research, Nairobi
| | - Thomas Hoenen
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Allison Groseth
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Cynthia Martellaro
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Neeltje van Doremalen
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Galina Zemtsova
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joshua Self
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trenton Bushmaker
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Kristin McNally
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Thomas Rowe
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon L Emery
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Friederike Feldmann
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Rocky Mountain Laboratories, National Institutes of Health, Hamilton, Montana
| | - Brandi N Williamson
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Sonja M Best
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Tolbert G Nyenswah
- Ministry of Health and Social Welfare/Incident Management System, Monrovia, Liberia
| | - Allen Grolla
- Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba
| | - James E Strong
- Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Gary Kobinger
- Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba
| | | | - Kathryn C Zoon
- Cytokine Biology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Martin de Smet
- Médecins Sans Frontières, Operational Center, Brussels, Belgium
| | - Stuart T Nichol
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barry Fields
- Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention
| | - Armand Sprecher
- Médecins Sans Frontières, Operational Center, Brussels, Belgium
| | - Moses Massaquoi
- Ministry of Health and Social Welfare/Incident Management System, Monrovia, Liberia
| | - Heinz Feldmann
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Emmie de Wit
- Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
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24
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de Wit E, Kramer S, Prescott J, Rosenke K, Falzarano D, Marzi A, Fischer RJ, Safronetz D, Hoenen T, Groseth A, van Doremalen N, Bushmaker T, McNally KL, Feldmann F, Williamson BN, Best SM, Ebihara H, Damiani IAC, Adamson B, Zoon KC, Nyenswah TG, Bolay FK, Massaquoi M, Sprecher A, Feldmann H, Munster VJ. Clinical Chemistry of Patients With Ebola in Monrovia, Liberia. J Infect Dis 2016; 214:S303-S307. [PMID: 27471319 DOI: 10.1093/infdis/jiw187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of point-of-care clinical chemistry analyzers has enabled the implementation of these ancillary tests in field laboratories in resource-limited outbreak areas. The Eternal Love Winning Africa (ELWA) outbreak diagnostic laboratory, established in Monrovia, Liberia, to provide Ebola virus and Plasmodium spp. diagnostics during the Ebola epidemic, implemented clinical chemistry analyzers in December 2014. Clinical chemistry testing was performed for 68 patients in triage, including 12 patients infected with Ebola virus and 18 infected with Plasmodium spp. The main distinguishing feature in clinical chemistry of Ebola virus-infected patients was the elevation in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyltransferase levels and the decrease in calcium. The implementation of clinical chemistry is probably most helpful when the medical supportive care implemented at the Ebola treatment unit allows for correction of biochemistry derangements and on-site clinical chemistry analyzers can be used to monitor electrolyte balance.
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Affiliation(s)
- Emmie de Wit
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Shelby Kramer
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Joseph Prescott
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Kyle Rosenke
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Darryl Falzarano
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Andrea Marzi
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Robert J Fischer
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - David Safronetz
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Thomas Hoenen
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Allison Groseth
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Neeltje van Doremalen
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Trenton Bushmaker
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Kristin L McNally
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Friederike Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Brandi N Williamson
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Sonja M Best
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Hideki Ebihara
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Igor A C Damiani
- Médecins Sans Frontières, Operational Center of Brussels, Ixelles, Belgium
| | - Brett Adamson
- Médecins Sans Frontières, Operational Center of Brussels, Ixelles, Belgium
| | - Kathryn C Zoon
- Cytokine Biology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Armand Sprecher
- Médecins Sans Frontières, Operational Center of Brussels, Ixelles, Belgium
| | - Heinz Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Vincent J Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
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