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Masumbuko Claude K, Mukadi-Bamuleka D, Kitenge-Omasumbu R, Edidi-Atani F, Kuamfumu MM, Mulangu S, Tshiani-Mbaya O, Malengera Vicky K, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Lee BE, Houston S, Mumtaz Z, Hawkes MT. Rhabdomyolysis, acute kidney injury, and mortality in Ebola virus disease: retrospective analysis of cases from Eastern Democratic Republic of the Congo, 2019. J Infect Dis 2024:jiae224. [PMID: 38696335 DOI: 10.1093/infdis/jiae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/13/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Skeletal muscle injury in Ebola virus disease (EVD) has been reported, but its association with morbidity and mortality remains poorly defined. METHODS Retrospective study of patients admitted to two EVD Treatment Units, over an eight-month period in 2019, during a large EVD epidemic in the Democratic Republic of the Congo. RESULTS 333 patients (median age 30 years, 58% female) had at least one creatine kinase (CK) measurement (total 2,229 CK measurements, median 5 (IQR 1-11) per patient). 271 patients (81%) had an elevated CK (>380U/L), 202 (61%) had rhabdomyolysis (CK>1,000 IU/L), and 45 (14%) had severe rhabdomyolysis (≥5,000U/L). Among survivors, the maximum CK level was median 1,600 (IQR 550 to 3,400), peaking 3.4 days after admission (IQR 2.3 to 5.5) and decreasing thereafter. Among fatal cases, the CK rose monotonically until death, with maximum CK level of median 2,900 U/L (IQR 1,500 to 4,900). Rhabdomyolysis at admission was an independent predictor of AKI (aOR 2.2 [95%CI 1.2-3.8], p=0.0065) and mortality (aHR 1.7 [95%CI 1.03-2.9], p=0.037). CONCLUSIONS Rhabdomyolysis is associated with AKI and mortality in EVD patients. These findings may inform clinical practice by identifying lab monitoring priorities and highlighting the importance of fluid management.
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Affiliation(s)
- Kasereka Masumbuko Claude
- Department of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge-Omasumbu
- Programme National d'Urgences et Actions Humanitaires (PNUAH), Ministry of Health of the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - François Edidi-Atani
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo Kuamfumu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sabue Mulangu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Olivier Tshiani-Mbaya
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Kambale Malengera Vicky
- Department of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stan Houston
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Zubia Mumtaz
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Kalonji T, Malembi E, Matela JP, Likafi T, Kinganda-Lusamaki E, Vakaniaki EH, Hoff NA, Aziza A, Muyembe F, Kabamba J, Cooreman T, Nguete B, Witte D, Ayouba A, Fernandez-Nuñez N, Roge S, Peeters M, Merritt S, Ahuka-Mundeke S, Delaporte E, Pukuta E, Mariën J, Bangwen E, Lakin S, Lewis C, Doty JB, Liesenborghs L, Hensley LE, McCollum A, Rimoin AW, Muyembe-Tamfum JJ, Shongo R, Kaba D, Mbala-Kingebeni P. Co-Circulating Monkeypox and Swinepox Viruses, Democratic Republic of the Congo, 2022. Emerg Infect Dis 2024; 30:761-765. [PMID: 38526165 PMCID: PMC10977837 DOI: 10.3201/eid3004.231413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
In September 2022, deaths of pigs manifesting pox-like lesions caused by swinepox virus were reported in Tshuapa Province, Democratic Republic of the Congo. Two human mpox cases were found concurrently in the surrounding community. Specific diagnostics and robust sequencing are needed to characterize multiple poxviruses and prevent potential poxvirus transmission.
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Nkuba-Ndaye A, Dilu-Keti A, Tovar-Sanchez T, Diallo MSK, Mukadi-Bamuleka D, Kitenge R, Formenty P, Legand A, Edidi-Atani F, Thaurignac G, Pelloquin R, Mbala-Kingebeni P, Toure A, Ayouba A, Muyembe-Tamfum JJ, Delaporte E, Peeters M, Ahuka-Mundeke S. Effect of anti-Ebola virus monoclonal antibodies on endogenous antibody production in survivors of Ebola virus disease in the Democratic Republic of the Congo: an observational cohort study. Lancet Infect Dis 2024; 24:266-274. [PMID: 38043556 DOI: 10.1016/s1473-3099(23)00552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The use of specific anti-Ebola virus therapy, especially monoclonal antibodies, has improved survival in patients with Ebola virus disease. We aimed to assess the effect of monoclonal antibodies on anti-Ebola virus antibody responses in survivors of the 2018-20 Ebola outbreak in the Democratic Republic of the Congo. METHODS In this observational prospective cohort study, participants were enrolled at three Ebola survivor clinics in Beni, Mangina, and Butembo (Democratic Republic of the Congo). Eligible children and adults notified as survivors of Ebola virus disease (ie, who had confirmed Ebola virus disease [RT-PCR positive in blood sample] and were subsequently declared recovered from the virus [RT-PCR negative in blood sample] with a certificate of recovery from Ebola virus disease issued by an Ebola treatment centre) during the 2018-20 Ebola virus disease outbreak were invited to participate in the study. Participants were recruited on discharge from Ebola treatment centres and followed up for 12-18 months depending on recruitment date. Routine follow-up assessments were done at 1, 3, 6, and 12-18 months after inclusion. We collected sociodemographic (age, sex, visit site), clinical (anti-Ebola virus drugs), and laboratory data (RT-PCR and Ct values). The primary outcome was the antibody concentrations against Ebola virus glycoprotein, nucleoprotein, and 40-kDa viral protein antigens over time assessed in all participants. Antibody concentrations were measured by the multiplex immunoassay, and the association between anti-Ebola virus antibody levels and the relevant exposures, such as anti-Ebola virus disease drugs (ansuvimab, REGN-EB3, ZMapp, or remdesivir), was assessed using both linear and logistic mixed regression models. This study is registered at ClinicalTrials.gov, NCT04409405. FINDINGS Between April 16, 2020, and Oct 18, 2021, 1168 survivors were invited to participate in the Les Vainqueurs d'Ebola cohort study. 787 survivors were included in the study, of whom 358 had data available for antibody responses. 85 (24%) of 358 were seronegative for at least two Ebola virus antigens on discharge from the Ebola treatment centre. The antibody response over time fluctuated but a continuous decrease in an overall linear evolution was observed. Quantitative modelling showed a decrease in nucleoprotein, glycoprotein, and VP-40 antibody concentrations over time (p<0·0001) with the fastest decrease observed for glycoprotein. The probability of being seropositive for at least two antigens after 36 months was 53·6% (95% CI 51·6-55·6) for participants who received ansuvimab, 73·5% (71·5-75·5) for participants who received REGN-EB3, 76·8% (74·8-78·8) for participants who received remdesivir, and 78·5% (76·5-80·5) for participants who received ZMapp. INTERPRETATION Almost a quarter of survivors were seronegative on discharge from the Ebola treatment centre and antibody concentrations decreased rapidly over time. These results indicate that monoclonal antibodies might negatively affect the production of anti-Ebola virus antibodies in survivors of Ebola virus disease which could increase the risk of reinfection or reactivation. FUNDING The French National Agency for AIDS Research-Emergent Infectious Diseases-The French National Institute of Health and Medical Research, the French National Research Institute for Development, and the European and Developing Countries Clinical Trials Partnership. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Antoine Nkuba-Ndaye
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo; TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France.
| | - Angele Dilu-Keti
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Tamara Tovar-Sanchez
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Mamadou Saliou Kalifa Diallo
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France; Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea; Department of Infectious Diseases, Donka National Hospital, Conakry, Guinea
| | - Daniel Mukadi-Bamuleka
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge
- Programme National de Soins et de Suivi des Personnes Guéries, Ministère de Santé Publique, city, Democratic Republic of the Congo
| | | | - Anaïs Legand
- Health Emergencies Program, WHO, Geneva, Switzerland
| | - François Edidi-Atani
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Guillaume Thaurignac
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Raphael Pelloquin
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Placide Mbala-Kingebeni
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Abdoulaye Toure
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea; Department of Infectious Diseases, Donka National Hospital, Conakry, Guinea
| | - Ahidjo Ayouba
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Jean-Jacques Muyembe-Tamfum
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eric Delaporte
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France; Montpellier University Hospital, Montpellier, France
| | - Martine Peeters
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Steve Ahuka-Mundeke
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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Van Dijck C, Crozier I, Vercauteren K, Brosius I, Mbala-Kingebeni P, Dodd L, Bottieau E, Tshiani Mbaya O, Nussenblatt V, Neyts J, Liesenborghs L. Beware of drug resistance: Let's not lose tecovirimat against mpox. Clin Microbiol Infect 2024; 30:276-278. [PMID: 37741622 DOI: 10.1016/j.cmi.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/28/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Koen Vercauteren
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lori Dodd
- National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olivier Tshiani Mbaya
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA; Institut National de Recherche Biomédicale, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Veronique Nussenblatt
- National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium; KU Leuven VirusBank Platform, Leuven, Belgium
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium.
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5
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Kinganda-Lusamaki E, Whitmer S, Lokilo-Lofiko E, Amuri-Aziza A, Muyembe-Mawete F, Makangara-Cigolo JC, Makaya G, Mbuyi F, Whitesell A, Kallay R, Choi M, Pratt C, Mukadi-Bamuleka D, Kavunga-Membo H, Matondo-Kuamfumu M, Mambu-Mbika F, Ekila-Ifinji R, Shoemaker T, Stewart M, Eng J, Rajan A, Soke GN, Fonjungo PN, Otshudiema JO, Folefack GLT, Pukuta-Simbu E, Talundzic E, Shedroff E, Bokete JL, Legand A, Formenty P, Mores CN, Porzucek AJ, Tritsch SR, Kombe J, Tshapenda G, Mulangu F, Ayouba A, Delaporte E, Peeters M, Wiley MR, Montgomery JM, Klena JD, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Mbala-Kingebeni P. 2020 Ebola virus disease outbreak in Équateur Province, Democratic Republic of the Congo: a retrospective genomic characterisation. Lancet Microbe 2024; 5:e109-e118. [PMID: 38278165 PMCID: PMC10849974 DOI: 10.1016/s2666-5247(23)00259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The Democratic Republic of the Congo has had 15 Ebola virus disease (EVD) outbreaks, from 1976 to 2023. On June 1, 2020, the Democratic Republic of the Congo declared an outbreak of EVD in the western Équateur Province (11th outbreak), proximal to the 2018 Tumba and Bikoro outbreak and concurrent with an outbreak in the eastern Nord Kivu Province. In this Article, we assessed whether the 11th outbreak was genetically related to previous or concurrent EVD outbreaks and connected available epidemiological and genetic data to identify sources of possible zoonotic spillover, uncover additional unreported cases of nosocomial transmission, and provide a deeper investigation into the 11th outbreak. METHODS We analysed epidemiological factors from the 11th EVD outbreak to identify patient characteristics, epidemiological links, and transmission modes to explore virus spread through space, time, and age groups in the Équateur Province, Democratic Republic of the Congo. Trained field investigators and health professionals recorded data on suspected, probable, and confirmed cases, including demographic characteristics, possible exposures, symptom onset and signs and symptoms, and potentially exposed contacts. We used blood samples from individuals who were live suspected cases and oral swabs from individuals who were deceased to diagnose EVD. We applied whole-genome sequencing of 87 available Ebola virus genomes (from 130 individuals with EVD between May 19 and Sept 16, 2020), phylogenetic divergence versus time, and Bayesian reconstruction of phylogenetic trees to calculate viral substitution rates and study viral evolution. We linked the available epidemiological and genetic datasets to conduct a genomic and epidemiological study of the 11th EVD outbreak. FINDINGS Between May 19 and Sept 16, 2020, 130 EVD (119 confirmed and 11 probable) cases were reported across 13 Équateur Province health zones. The individual identified as the index case reported frequent consumption of bat meat, suggesting the outbreak started due to zoonotic spillover. Sequencing revealed two circulating Ebola virus variants associated with this outbreak-a Mbandaka variant associated with the majority (97%) of cases and a Tumba-like variant with similarity to the ninth EVD outbreak in 2018. The Tumba-like variant exhibited a reduced substitution rate, suggesting transmission from a previous survivor of EVD. INTERPRETATION Integrating genetic and epidemiological data allowed for investigative fact-checking and verified patient-reported sources of possible zoonotic spillover. These results demonstrate that rapid genetic sequencing combined with epidemiological data can inform responders of the mechanisms of viral spread, uncover novel transmission modes, and provide a deeper understanding of the outbreak, which is ultimately needed for infection prevention and control during outbreaks. FUNDING WHO and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Eddy Kinganda-Lusamaki
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo; TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Shannon Whitmer
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emmanuel Lokilo-Lofiko
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Adrienne Amuri-Aziza
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Francisca Muyembe-Mawete
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Claude Makangara-Cigolo
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Amy Whitesell
- Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ruth Kallay
- Emergency Response and Recovery Branch USA, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Choi
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catherine Pratt
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel Mukadi-Bamuleka
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hugo Kavunga-Membo
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo-Kuamfumu
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard Ekila-Ifinji
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Miles Stewart
- Johns Hopkins University Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Julia Eng
- Johns Hopkins University Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Abraham Rajan
- Johns Hopkins University Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Gnakub N Soke
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Peter N Fonjungo
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | | | | | - Elisabeth Pukuta-Simbu
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Emir Talundzic
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Shedroff
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anaïs Legand
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | - Christopher N Mores
- Global Health Department, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Abigail J Porzucek
- Global Health Department, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sarah R Tritsch
- Global Health Department, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - John Kombe
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | - Felix Mulangu
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Eric Delaporte
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Martine Peeters
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement, INSERM, Montpellier, France
| | - Michael R Wiley
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; PraesensBio, Omaha, NE, USA
| | - Joel M Montgomery
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Klena
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean-Jacques Muyembe-Tamfum
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Pathogen Genomics Laboratory, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
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Kibungu EM, Vakaniaki EH, Kinganda-Lusamaki E, Kalonji-Mukendi T, Pukuta E, Hoff NA, Bogoch II, Cevik M, Gonsalves GS, Hensley LE, Low N, Shaw SY, Schillberg E, Hunter M, Lunyanga L, Linsuke S, Madinga J, Peeters M, Cigolo JCM, Ahuka-Mundeke S, Muyembe JJ, Rimoin AW, Kindrachuk J, Mbala-Kingebeni P, Lushima RS. Clade I-Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo. Emerg Infect Dis 2024; 30:172-176. [PMID: 38019211 PMCID: PMC10756366 DOI: 10.3201/eid3001.231164] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
We report a cluster of clade I monkeypox virus infections linked to sexual contact in the Democratic Republic of the Congo. Case investigations resulted in 5 reverse transcription PCR-confirmed infections; genome sequencing suggest they belonged to the same transmission chain. This finding demonstrates that mpox transmission through sexual contact extends beyond clade IIb.
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Affiliation(s)
- Emile M. Kibungu
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Emmanuel H. Vakaniaki
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Eddy Kinganda-Lusamaki
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Thierry Kalonji-Mukendi
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Elisabeth Pukuta
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Nicole A. Hoff
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Isaac I. Bogoch
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Muge Cevik
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Gregg S. Gonsalves
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Lisa E. Hensley
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Nicola Low
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Souradet Y. Shaw
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Erin Schillberg
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Mikayla Hunter
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Lygie Lunyanga
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Sylvie Linsuke
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Joule Madinga
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Martine Peeters
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Jean-Claude Makangara Cigolo
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Steve Ahuka-Mundeke
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Jean-Jacques Muyembe
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | | | | | | | | | - International Mpox Research Consortium
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
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7
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Mukadi-Bamuleka D, Nkuba-Ndaye A, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ. Impact of Ebola epidemics on the daily operation of existing systems in Eastern Democratic Republic of the Congo: a brief review. J Med Econ 2024; 27:184-192. [PMID: 38240249 DOI: 10.1080/13696998.2024.2305009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
AIMS to provide insights into the recent Ebola virus disease (EVD) outbreaks on different aspects of daily life in the Democratic Republic of the Congo and propose possible solutions. METHODS We collected information regarding the effects of EVD outbreaks on existing systems in the eastern part of the Democratic Republic of the Congo (DRC). We searched the PubMed database using the terms "impact effect Ebola outbreak system", "Management Ebola Poor Resources Settings", "Health Economic Challenges Ebola" and "Economic impact Ebola systems." Only studies focusing on epidemiology, diagnostics, sequencing, vaccination, therapeutics, ecology, work force, governance, healthcare provision and health system, and social, political, and economic aspects were considered. The search included the electronic archives of EVD outbreak reports from government and partners. RESULTS EVD outbreaks negatively impacts the functions of countries. The disruption in activities is proportional to the magnitude of the epidemic and slows down the transport of goods, decreases the region's tourist appeal, and increases 'brain drain'. Most low- and medium-income countries, such as the DRC, do not have a long-term holistic emergency plan for unexpected situations or sufficient resources to adequately implement countermeasures against EVD outbreaks. Although the DRC has acquired sufficient expertise in diagnostics, genomic sequencing, administration of vaccines and therapeutics, clinical trials, and research activities, deployment, operation, and maintenance of these expertise and associated tools remains a concern. LIMITATIONS Despite the data search extension, additional reports addressing issues related to social aspects of EVD outbreaks in DRC were not retrieved. CONCLUSION National leadership has not yet taken the lead in strategic, operational, or financial aspects. Therefore, national leaders should double their efforts and awareness to encourage local fundraising, sufficient budget al.location, infrastructure construction, equipment provision, and staff training, to effectively support a holistic approach in response to outbreaks, providing effective results, and all types of research activities.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Rodolphe Mérieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Antoine Nkuba-Ndaye
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Department of Virology, Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, Kinshasa Teaching School of Medicine, University of Kinshasa, Democratic Republic of the Congo
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8
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Kasumba DM, Misasi J, Mulangu S, Mbala-Kingebeni P. Exploring host-virus interaction to improve immunotherapy against Ebola virus. Trends Pharmacol Sci 2023; 44:857-861. [PMID: 37845170 DOI: 10.1016/j.tips.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/18/2023]
Abstract
Recent immunological advances have led to the development of FDA-approved immunotherapies against Ebola virus (EBOV). However, patients with high viral loads have not seen as large a benefit as mild cases. Here we discuss areas of investigation that may lead to adjunctive immune therapy for patients with severe EBOV disease.
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Affiliation(s)
- Dacquin M Kasumba
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Axis of Molecular Immunology and Pathogenesis, Molecular Biology Unit, Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - John Misasi
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, MD 20892, USA.
| | - Sabue Mulangu
- Global Medical Affairs, Ridgeback Biotherapeutics, Miami, FL, USA.
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9
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Van Dijck C, Hoff NA, Mbala-Kingebeni P, Low N, Cevik M, Rimoin AW, Kindrachuk J, Liesenborghs L. Emergence of mpox in the post-smallpox era-a narrative review on mpox epidemiology. Clin Microbiol Infect 2023; 29:1487-1492. [PMID: 37574113 DOI: 10.1016/j.cmi.2023.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The 2022 mpox outbreak drew global attention to this neglected pathogen. While most of the world was taken by surprise, some countries have seen this pathogen emerge and become endemic several decades prior to this epidemic. OBJECTIVES This narrative review provides an overview of mpox epidemiology since its discovery through the 2022 global outbreak. SOURCES We searched PubMed for relevant literature about mpox epidemiology and transmission through 28 February 2023. CONTENT The emergence of human mpox is intertwined with the eradication of smallpox and the cessation of the global smallpox vaccination campaign. The first human clade I and II monkeypox virus (MPXV) infections were reported as zoonoses in Central and West Africa, respectively, around 1970 with sporadic infections reported throughout the rest of the decade. Over the next five decades, Clade I MPXV was more common and caused outbreaks of increasing size and frequency, mainly in the Democratic Republic of the Congo. Clade II MPXV was rarely observed, until its re-emergence and ongoing transmission in Nigeria, since 2017. Both clades showed a shift from zoonotic to human-to-human transmission, with potential transmission through sexual contact being observed in Nigeria. In 2022, clade II MPXV caused a large human outbreak which to date has caused over 86,000 cases in 110 countries, with strong evidence of transmission during sexual contact. By February 2023, the global epidemic has waned in most countries, but endemic regions continue to suffer from mpox. IMPLICATIONS The changing epidemiology of mpox demonstrates how neglected zoonosis turned into a global health threat within a few decades. Thus, mpox pathophysiology and transmission dynamics need to be further investigated, and preventive and therapeutic interventions need to be evaluated. Outbreak response systems need to be strengthened and sustained in endemic regions to reduce the global threat of mpox.
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Affiliation(s)
- Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo; Université de Kinshasa, Democratic Republic of Congo
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Muge Cevik
- Division of Infection and Global Health, University of St Andrews, St Andrews, Scotland
| | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Jason Kindrachuk
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
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10
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Schwartz DA, Mbala-Kingebeni P, Patterson K, Huggins JW, Pittman PR. Congenital Mpox Syndrome (Clade I) in Stillborn Fetus after Placental Infection and Intrauterine Transmission, Democratic Republic of the Congo, 2008. Emerg Infect Dis 2023; 29:2198-2022. [PMID: 37705112 PMCID: PMC10617360 DOI: 10.3201/eid2911.230606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
We report the autopsy pathology findings of a 21-week stillborn fetus with congenital mpox syndrome that occurred in the Democratic Republic of the Congo in 2008. The fetus acquired mpox from the mother after intrauterine transplacental monkeypox virus transmission. We confirmed monkeypox virus infection in the mother, fetus, and placenta by using a monkeypox virus-specific quantitative PCR. Subtyping of the virus was not performed, but the mother and fetus were almost certainly infected with the clade I variant that was endemic in the Democratic Republic of the Congo at the time. Risk for intrauterine infection appears to differ between virus clades, but clinicians should be aware of potential for intrauterine monkeypox virus transmission among pregnant persons during ongoing and future mpox outbreaks.
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Affiliation(s)
| | - Placide Mbala-Kingebeni
- Perinatal Pathology Consulting, Atlanta, Georgia, USA (D.A. Schwartz)
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo (P. Mbala-Kingebeni)
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (K. Patterson, J.W. Hudgins, P.R. Pittman)
| | - Kerry Patterson
- Perinatal Pathology Consulting, Atlanta, Georgia, USA (D.A. Schwartz)
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo (P. Mbala-Kingebeni)
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (K. Patterson, J.W. Hudgins, P.R. Pittman)
| | - John W. Huggins
- Perinatal Pathology Consulting, Atlanta, Georgia, USA (D.A. Schwartz)
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo (P. Mbala-Kingebeni)
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (K. Patterson, J.W. Hudgins, P.R. Pittman)
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11
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Tshomba AO, Mukadi-Bamuleka D, De Weggheleire A, Tshiani OM, Kayembe CT, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Chenge FM, Jacobs BKM, Mumba DN, Tshala-Katumbay DD, Mulangu S. Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model. PLoS One 2023; 18:e0293077. [PMID: 37847703 PMCID: PMC10581462 DOI: 10.1371/journal.pone.0293077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND No distinctive clinical signs of Ebola virus disease (EVD) have prompted the development of rapid screening tools or called for a new approach to screening suspected Ebola cases. New screening approaches require evidence of clinical benefit and economic efficiency. As of now, no evidence or defined algorithm exists. OBJECTIVE To evaluate, from a healthcare perspective, the efficiency of incorporating Ebola prediction scores and rapid diagnostic tests into the EVD screening algorithm during an outbreak. METHODS We collected data on rapid diagnostic tests (RDTs) and prediction scores' accuracy measurements, e.g., sensitivity and specificity, and the cost of case management and RDT screening in EVD suspect cases. The overall cost of healthcare services (PPE, procedure time, and standard-of-care (SOC) costs) per suspected patient and diagnostic confirmation of EVD were calculated. We also collected the EVD prevalence among suspects from the literature. We created an analytical decision model to assess the efficiency of eight screening strategies: 1) Screening suspect cases with the WHO case definition for Ebola suspects, 2) Screening suspect cases with the ECPS at -3 points of cut-off, 3) Screening suspect cases with the ECPS as a joint test, 4) Screening suspect cases with the ECPS as a conditional test, 5) Screening suspect cases with the WHO case definition, then QuickNavi™-Ebola RDT, 6) Screening suspect cases with the ECPS at -3 points of cut-off and QuickNavi™-Ebola RDT, 7) Screening suspect cases with the ECPS as a conditional test and QuickNavi™-Ebola RDT, and 8) Screening suspect cases with the ECPS as a joint test and QuickNavi™-Ebola RDT. We performed a cost-effectiveness analysis to identify an algorithm that minimizes the cost per patient correctly classified. We performed a one-way and probabilistic sensitivity analysis to test the robustness of our findings. RESULTS Our analysis found dual ECPS as a conditional test with the QuickNavi™-Ebola RDT algorithm to be the most cost-effective screening algorithm for EVD, with an effectiveness of 0.86. The cost-effectiveness ratio was 106.7 USD per patient correctly classified. The following algorithms, the ECPS as a conditional test with an effectiveness of 0.80 and an efficiency of 111.5 USD per patient correctly classified and the ECPS as a joint test with the QuickNavi™-Ebola RDT algorithm with an effectiveness of 0.81 and a cost-effectiveness ratio of 131.5 USD per patient correctly classified. These findings were sensitive to variations in the prevalence of EVD in suspected population and the sensitivity of the QuickNavi™-Ebola RDT. CONCLUSIONS Findings from this study showed that prediction scores and RDT could improve Ebola screening. The use of the ECPS as a conditional test algorithm and the dual ECPS as a conditional test and then the QuickNavi™-Ebola RDT algorithm are the best screening choices because they are more efficient and lower the number of confirmation tests and overall care costs during an EBOV epidemic.
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Affiliation(s)
- Antoine Oloma Tshomba
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- National Institute for Biomedical Research, Kinshasa, DRC
| | - Daniel Mukadi-Bamuleka
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | | | - Olivier M. Tshiani
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Charles T. Kayembe
- Department of Internal Medicine, University of Kisangani, Kisangani, DRC
| | - Placide Mbala-Kingebeni
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Jean-Jacques Muyembe-Tamfum
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Faustin M. Chenge
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- School of Public Health, University of Lubumbashi, Lubumbashi, RDC
| | - Bart Karl M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dieudonné N. Mumba
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, DRC
| | - Désiré D. Tshala-Katumbay
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Neurology, University of Kinshasa, Kinshasa, DRC
| | - Sabue Mulangu
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
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12
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Nachega JB, Mbala-Kingebeni P, Rosenthal PJ, Rimoin AW, Hoff NA, Liesenborghs L, Vanlerberghe V, Andrei G, Rawat A, Wilson LA, Forrest J, Mills EJ, Hermans MP, Mulangu S, Ntoumi F, Zumla A, Muyembe-Tamfum JJ. The Human Mpox Global Outbreak: Available Control Tools and the Opportunity to Break a Cycle of Neglect in Endemic Countries. Am J Trop Med Hyg 2023; 109:719-724. [PMID: 37580027 PMCID: PMC10551064 DOI: 10.4269/ajtmh.23-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 08/16/2023] Open
Abstract
The 2022 global outbreak of human Mpox (formerly monkeypox) virus (MPXV) infection outside of the usual endemic zones in Africa challenged our understanding of the virus's natural history, transmission dynamics, and risk factors. This outbreak has highlighted the need for diagnostics, vaccines, therapeutics, and implementation research, all of which require more substantial investments in equitable collaborative partnerships. Global multidisciplinary networks need to tackle MPXV and other neglected emerging and reemerging zoonotic pathogens to address them locally and prevent or quickly control their worldwide spread. Political endorsement from individual countries and financial commitments to maintain control efforts will be essential for long-term sustainability.
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Affiliation(s)
- Jean B. Nachega
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
- Center for Global Health, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Placide Mbala-Kingebeni
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Philip J. Rosenthal
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California
| | - Anne W. Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Nicole A. Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | | | | | - Graciela Andrei
- Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Angeli Rawat
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | | | - Edward J. Mills
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Platform Life Sciences, Vancouver, Canada
| | - Michel P. Hermans
- Department of Endocrinology, St-Luc University Hospital, Brussels, Belgium
| | - Sabue Mulangu
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of Congo
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
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13
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Shaw AG, Mampuela TK, Lofiko EL, Pratt C, Troman C, Bujaki E, O'Toole Á, Akello JO, Aziza AA, Lusamaki EK, Makangara JC, Akonga M, Lay Y, Nsunda B, White B, Jorgensen D, Pukuta E, Riziki Y, Rankin KE, Rambaut A, Ahuka-Mundeke S, Muyembe JJ, Martin J, Grassly NC, Mbala-Kingebeni P. Sensitive poliovirus detection using nested PCR and nanopore sequencing: a prospective validation study. Nat Microbiol 2023; 8:1634-1640. [PMID: 37591995 PMCID: PMC10465353 DOI: 10.1038/s41564-023-01453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
Timely detection of outbreaks is needed for poliovirus eradication, but gold standard detection in the Democratic Republic of the Congo takes 30 days (median). Direct molecular detection and nanopore sequencing (DDNS) of poliovirus in stool samples is a promising fast method. Here we report prospective testing of stool samples from suspected polio cases, and their contacts, in the Democratic Republic of the Congo between 10 August 2021 and 4 February 2022. DDNS detected polioviruses in 62/2,339 (2.7%) of samples, while gold standard combination of cell culture, quantitative PCR and Sanger sequencing detected polioviruses in 51/2,339 (2.2%) of the same samples. DDNS provided case confirmation in 7 days (median) in routine surveillance conditions. DDNS enabled confirmation of three serotype 2 circulating vaccine-derived poliovirus outbreaks 23 days (mean) earlier (range 6-30 days) than the gold standard method. The mean sequence similarity between sequences obtained by the two methods was 99.98%. Our data confirm the feasibility of implementing DDNS in a national poliovirus laboratory.
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Affiliation(s)
- Alexander G Shaw
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Tresor Kabeya Mampuela
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Catherine Pratt
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Catherine Troman
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Erika Bujaki
- Department of Vaccines, National Institute for Biological Standards and Control (NIBSC), Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Áine O'Toole
- Institute of Ecology and Evolution, University of Edinburgh, Ashworth Laboratories, Edinburgh, UK
| | - Joyce Odeke Akello
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Adrienne Amuri Aziza
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Eddy Kinganda Lusamaki
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes), University of Montpellier (UM), French National Research Institute for Sustainable Development (IRD), INSERM, Montpellier, France
| | - Jean Claude Makangara
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Marceline Akonga
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Yvonne Lay
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bibiche Nsunda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bailey White
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Jorgensen
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Elizabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Andrew Rambaut
- Institute of Ecology and Evolution, University of Edinburgh, Ashworth Laboratories, Edinburgh, UK
| | - Steve Ahuka-Mundeke
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Javier Martin
- Department of Vaccines, National Institute for Biological Standards and Control (NIBSC), Medicines and Healthcare products Regulatory Agency, Potters Bar, UK
| | - Nicholas C Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Placide Mbala-Kingebeni
- Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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14
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Kinganda-Lusamaki E, Baketana LK, Ndomba-Mukanya E, Bouillin J, Thaurignac G, Aziza AA, Luakanda-Ndelemo G, Nuñez NF, Kalonji-Mukendi T, Pukuta ES, Nkuba-Ndaye A, Lofiko EL, Kibungu EM, Lushima RS, Ayouba A, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Delaporte E, Peeters M, Ahuka-Mundeke S. Use of Mpox Multiplex Serology in the Identification of Cases and Outbreak Investigations in the Democratic Republic of the Congo (DRC). Pathogens 2023; 12:916. [PMID: 37513764 PMCID: PMC10385798 DOI: 10.3390/pathogens12070916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Human Mpox cases are increasingly reported in Africa, with the highest burden in the Democratic Republic of Congo (DRC). While case reporting on a clinical basis can overestimate infection rates, laboratory confirmation by PCR can underestimate them, especially on suboptimal samples like blood, commonly used in DRC. Here we used a Luminex-based assay to evaluate whether antibody testing can be complementary to confirm cases and to identify human transmission chains during outbreak investigations. We used left-over blood samples from 463 patients, collected during 174 outbreaks between 2013 and 2022, with corresponding Mpox and VZV PCR results. In total, 157 (33.9%) samples were orthopox-PCR positive and classified as Mpox+; 124 (26.8%) had antibodies to at least one of the three Mpox peptides. The proportion of antibody positive samples was significantly higher in Mpox positive samples (36.9%) versus negative (21.6%) (p < 0.001). By combining PCR and serology, 66 additional patients were identified, leading to an Mpox infection rate of 48.2% (223/463) versus 33.9% when only PCR positivity is considered. Mpox infections were as such identified in 14 additional health zones and 23 additional outbreaks (111/174 (63.8%) versus 88/174 (50.6%)). Our findings highlight the urgent need of rapid on-site diagnostics to circumvent Mpox spread.
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Affiliation(s)
- Eddy Kinganda-Lusamaki
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Lionel Kinzonzi Baketana
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Etienne Ndomba-Mukanya
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Julie Bouillin
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Guillaume Thaurignac
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Adrienne Amuri Aziza
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Gradi Luakanda-Ndelemo
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Nicolas Fernandez Nuñez
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Thierry Kalonji-Mukendi
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Elisabeth Simbu Pukuta
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Antoine Nkuba-Ndaye
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Emmanuel Lokilo Lofiko
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Emile Malembi Kibungu
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Robert Shongo Lushima
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Eric Delaporte
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Martine Peeters
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
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15
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Simons E, Nikolay B, Ouedraogo P, Pasquier E, Tiemeni C, Adjaho I, Badjo C, Chamman K, Diomandé M, Dosso M, Doumbia M, Izia YA, Kakompe H, Katsomya AM, Kij V, Akissi VK, Mambula C, Mbala-Kingebeni P, Muzinga J, Ngoy B, Penali L, Pini A, Porten K, Salou H, Sevede D, Luquero F, Gignoux E. Seroprevalence of SARS-CoV-2 antibodies and retrospective mortality in two African settings: Lubumbashi, Democratic Republic of the Congo and Abidjan, Côte d'Ivoire. PLOS Glob Public Health 2023; 3:e0001457. [PMID: 37289736 DOI: 10.1371/journal.pgph.0001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
Although seroprevalence studies have demonstrated the wide circulation of SARS-COV-2 in African countries, the impact on population health in these settings is still poorly understood. Using representative samples of the general population, we evaluated retrospective mortality and seroprevalence of anti-SARS-CoV-2 antibodies in Lubumbashi and Abidjan. The studies included retrospective mortality surveys and nested anti-SARS-CoV-2 antibody prevalence surveys. In Lubumbashi the study took place during April-May 2021 and in Abidjan the survey was implemented in two phases: July-August 2021 and October-November 2021. Crude mortality rates were stratified between pre-pandemic and pandemic periods and further investigated by age group and COVID waves. Anti-SARS-CoV-2 seroprevalence was quantified by rapid diagnostic testing (RDT) and laboratory-based testing (ELISA in Lubumbashi and ECLIA in Abidjan). In Lubumbashi, the crude mortality rate (CMR) increased from 0.08 deaths per 10 000 persons per day (pre-pandemic) to 0.20 deaths per 10 000 persons per day (pandemic period). Increases were particularly pronounced among <5 years old. In Abidjan, no overall increase was observed during the pandemic period (pre-pandemic: 0.05 deaths per 10 000 persons per day; pandemic: 0.07 deaths per 10 000 persons per day). However, an increase was observed during the third wave (0.11 deaths per 10 000 persons per day). The estimated seroprevalence in Lubumbashi was 15.7% (RDT) and 43.2% (laboratory-based). In Abidjan, the estimated seroprevalence was 17.4% (RDT) and 72.9% (laboratory-based) during the first phase of the survey and 38.8% (RDT) and 82.2% (laboratory-based) during the second phase of the survey. Although circulation of SARS-CoV-2 seems to have been extensive in both settings, the public health impact varied. The increases, particularly among the youngest age group, suggest indirect impacts of COVID and the pandemic on population health. The seroprevalence results confirmed substantial underdetection of cases through the national surveillance systems.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Hugues Kakompe
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | - Vicky Kij
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Jacques Muzinga
- Laboratoire National de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Basile Ngoy
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Lou Penali
- Institut Pasteur Cote d'Ivoire, Abidjan, Cote d'Ivoire
| | | | | | | | - Daouda Sevede
- Institut Pasteur Cote d'Ivoire, Abidjan, Cote d'Ivoire
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16
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Otshudiema JO, Folefack GLT, Nsio JM, Kakema CH, Minikulu L, Bafuana A, Kosianza JB, Mfumu AK, Nkwembe E, Munyeku-Bazitama Y, Makiala-Mandanda S, Guinko N, Mbuyi G, Tshilumbu JMK, Saidi GN, Umba-di-Masiala MS, Ebondo AK, Mutonj JJ, Kalombo S, Kabeya J, Mawanda TK, Bile FN, Kasereka GK, Mbala-Kingebeni P, Ahuka-Mundeke S, Karamagi HC, Fai KN, Djiguimde AP. Community-based COVID-19 active case finding and rapid response in the Democratic Republic of the Congo: Improving case detection and response. PLoS One 2023; 18:e0278251. [PMID: 37200322 PMCID: PMC10194859 DOI: 10.1371/journal.pone.0278251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
A community-based coronavirus disease (COVID-19) active case-finding strategy using an antigen-detecting rapid diagnostic test (Ag-RDT) was implemented in the Democratic Republic of Congo (DRC) to enhance COVID-19 case detection. With this pilot community-based active case finding and response program that was designed as a clinical, prospective testing performance, and implementation study, we aimed to identify insights to improve community diagnosis and rapid response to COVID-19. This pilot study was modeled on the DRC's National COVID-19 Response Plan and the COVID-19 Ag-RDT screening algorithm defined by the World Health Organization (WHO), with case findings implemented in 259 health areas, 39 health zones, and 9 provinces. In each health area, a 7-member interdisciplinary field team tested the close contacts (ring strategy) and applied preventive and control measures to each confirmed case. The COVID-19 testing capacity increased from 0.3 tests per 10,000 inhabitants per week in the first wave to 0.4, 1.6, and 2.2 in the second, third, and fourth waves, respectively. From January to November 2021, this capacity increase contributed to an average of 10.5% of COVID-19 tests in the DRC, with 7,110 positive Ag-RDT results for 40,226 suspected cases and close contacts who were tested (53.6% female, median age: 37 years [interquartile range: 26.0-50.0)]. Overall, 79.7% (n = 32,071) of the participants were symptomatic and 7.6% (n = 3,073) had comorbidities. The Ag-RDT sensitivity and specificity were 55.5% and 99.0%, respectively, based on reverse transcription polymerase chain reaction analysis, and there was substantial agreement between the tests (k = 0.63). Despite its limited sensitivity, the Ag-RDT has improved COVID-19 testing capacity, enabling earlier detection, isolation, and treatment of COVID-19 cases. Our findings support the community testing of suspected cases and asymptomatic close contacts of confirmed cases to reduce disease spread and virus transmission.
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Affiliation(s)
| | | | - Justus M. Nsio
- COVID-19 Response, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Cathy H. Kakema
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Luigino Minikulu
- COVID-19 Response, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Aimé Bafuana
- COVID-19 Response, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Joel B. Kosianza
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Antoine K. Mfumu
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Edith Nkwembe
- COVID-19 Laboratory and Epidemiology Team, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Yannick Munyeku-Bazitama
- COVID-19 Laboratory and Epidemiology Team, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- COVID-19 Laboratory and Epidemiology Team, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Noé Guinko
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Gisèle Mbuyi
- COVID-19 Response, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | - Guy N. Saidi
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | | | - Amos K. Ebondo
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Mutonj
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Serge Kalombo
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Jad Kabeya
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Taty K. Mawanda
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Faustin N. Bile
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Gaby K. Kasereka
- COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- COVID-19 Laboratory and Epidemiology Team, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- COVID-19 Laboratory and Epidemiology Team, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
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17
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Mukadi-Bamuleka D, Bulabula-Penge J, Jacobs BKM, De Weggheleire A, Edidi-Atani F, Mambu-Mbika F, Legand A, Klena JD, Fonjungo PN, Mbala-Kingebeni P, Makiala-Mandanda S, Kajihara M, Takada A, Montgomery JM, Formenty P, Muyembe-Tamfum JJ, Ariën KK, van Griensven J, Ahuka-Mundeke S. Head-to-head comparison of diagnostic accuracy of four Ebola virus disease rapid diagnostic tests versus GeneXpert® in eastern Democratic Republic of the Congo outbreaks: a prospective observational study. EBioMedicine 2023; 91:104568. [PMID: 37084479 PMCID: PMC10148093 DOI: 10.1016/j.ebiom.2023.104568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Ebola virus disease (EVD) outbreaks have emerged in Central and West Africa. EVD diagnosis relies principally on RT-PCR testing with GeneXpert®, which has logistical and cost restrictions at the peripheral level of the health system. Rapid diagnostic tests (RDTs) would offer a valuable alternative at the point-of-care to reduce the turn-around time, if they show good performance characteristics. We evaluated the performance of four EVD RDTs against the reference standard GeneXpert® on stored EVD positive and negative blood samples collected between 2018 and 2021 from outbreaks in eastern Democratic Republic of the Congo (DRC). METHODS We conducted a prospective and observational study in the laboratory on QuickNavi-Ebola™, OraQuick® Ebola Rapid Antigen, Coris® EBOLA Ag K-SeT, and Standard® Q Ebola Zaïre Ag RDTs using left-over archived frozen EDTA whole blood samples. We randomly selected 450 positive and 450 negative samples from the EVD biorepositories in DRC, across a range of GeneXpert® cycle threshold values (Ct-values). RDT results were read by three persons and we considered an RDT result as "positive", when it was flagged as positive by at least two out of the three readers. We estimated the sensitivity and specificity through two independent generalized (logistic) linear mixed models (GLMM). FINDINGS 476 (53%) of 900 samples had a positive GeneXpert Ebola result when retested. The QuickNavi-Ebola™ showed a sensitivity of 56.8% (95% CI 53.6-60.0) and a specificity of 97.5% (95% CI 96.2-98.4), the OraQuick® Ebola Rapid Antigen test displayed 61.6% (95% CI 57.0-65.9) sensitivity and 98.1% (95% CI 96.2-99.1) specificity, the Coris® EBOLA Ag K-SeT showed 25.0% (95% CI 22.3-27.9) sensitivity and 95.9% (95% CI 94.2-97.1) specificity, and the Standard® Q Ebola Zaïre Ag displayed 21.6% (95% CI 18.1-25.7) sensitivity and 99.1% (95% CI 97.4-99.7) specificity. INTERPRETATION None of the RDTs evaluated approached the "desired or acceptable levels" for sensitivity set out in the WHO target product profile, while all of the tests met the "desired level" for specificity. Nevertheless, the QuickNavi-Ebola™ and OraQuick® Ebola Rapid Antigen Test demonstrated the most favorable profiles, and may be used as frontline tests for triage of suspected-cases while waiting for RT-qPCR confirmatory testing. FUNDING Institute of Tropical Medicine Antwerp/EDCTP PEAU-EBOV-RDC project.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Rodolphe Mérieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo.
| | - Junior Bulabula-Penge
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | | | | | - François Edidi-Atani
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Rodolphe Mérieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Anaïs Legand
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - John D Klena
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Masahiro Kajihara
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Ayato Takada
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Pierre Formenty
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Kevin K Ariën
- Institute of Tropical Medicine, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
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Nachega JB, Nsanzimana S, Rawat A, Wilson LA, Rosenthal PJ, Siedner MJ, Varma JK, Kilmarx PH, Mutesa L, Tanner M, Binagwaho A, Forrest J, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Ntoumi F, Zumla A, de Oliveira T, Mills EJ. Advancing detection and response capacities for emerging and re-emerging pathogens in Africa. Lancet Infect Dis 2023; 23:e185-e189. [PMID: 36563700 PMCID: PMC10023168 DOI: 10.1016/s1473-3099(22)00723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA; Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA; Department of Medicine, Division of Infectious Diseases, Faculty of Science and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sabin Nsanzimana
- University Teaching Hospital, Butare, Rwanda; University of Global Health Equity, Kigali, Rwanda
| | - Angeli Rawat
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay A Wilson
- Platform Life Sciences, Vancouver, BC, Canada; Department of Real World and Advanced Analytics, Vancouver, Cytel, Vancouver, BC, Canada
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
| | - Mark J Siedner
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jay K Varma
- Department of Population Health Sciences, Weill Cornell Medicine, NY, USA
| | - Peter H Kilmarx
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Leon Mutesa
- Center for Human Genetics, University of Rwanda, Kigali, Rwanda
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | | | - Jamie Forrest
- Platform Life Sciences, Vancouver, BC, Canada; Department of Real World and Advanced Analytics, Vancouver, Cytel, Vancouver, BC, Canada
| | - Placide Mbala-Kingebeni
- National Institute for Bio-Medical Research, Kinshasa, Democratic Republic of the Congo; University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- National Institute for Bio-Medical Research, Kinshasa, Democratic Republic of the Congo; University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of the Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tulio de Oliveira
- School for Data Science and Computational Thinking, Faculty of Science and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Centre for Epidemic Response and Innovation, Faculty of Science and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Edward J Mills
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Platform Life Sciences, Vancouver, BC, Canada
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Christoffels A, Mboowa G, van Heusden P, Makhubela S, Githinji G, Mwangi S, Onywera H, Nnaemeka N, Amoako DG, Olawoye I, Diallo A, Mbala-Kingebeni P, Oyola SO, Adu B, Mvelase C, Ondoa P, Dratibi FA, Sow A, Gumede N, Tessema SK, Ouma AO, Tebeje YK. A pan-African pathogen genomics data sharing platform to support disease outbreaks. Nat Med 2023; 29:1052-1055. [PMID: 37161068 DOI: 10.1038/s41591-023-02266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Alan Christoffels
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia.
- South African National Bioinformatics Institute, SAMRC Bioinformatics Unit, University of the Western Cape, Cape Town, South Africa.
| | - Gerald Mboowa
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | - Peter van Heusden
- South African National Bioinformatics Institute, SAMRC Bioinformatics Unit, University of the Western Cape, Cape Town, South Africa
| | | | - George Githinji
- KEMRI-Wellcome Trust Research Programme/KEMRI-CGMR-C, Kilifi, Kenya
| | - Sarah Mwangi
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | - Harris Onywera
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | | | - Daniel Gyamfi Amoako
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Idowu Olawoye
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | | | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Samuel O Oyola
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Bright Adu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Pascale Ondoa
- African Society for Laboratory Medicine (ASLM), Addis Ababa, Ethiopia
| | | | | | - Nicksy Gumede
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Sofonias K Tessema
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia.
| | - Ahmed Ogwell Ouma
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
| | - Yenew Kebede Tebeje
- Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia
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McNeil AJ, House DW, Mbala-Kingebeni P, Mbaya OT, Dodd LE, Cowen EW, Nussenblatt V, Bonnett T, Chen Z, Saknite I, Dawant BM, Tkaczyk ER. Counting Monkeypox Lesions in Patient Photographs: Limits of Agreement of Manual Counts and Artificial Intelligence. J Invest Dermatol 2023; 143:347-350.e4. [PMID: 36116509 PMCID: PMC9534148 DOI: 10.1016/j.jid.2022.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Andrew J. McNeil
- Dermatology Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA,Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Department of Electrical and Computer Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - David W. House
- Dermatology Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA,Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Olivier Tshiani Mbaya
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo,Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Lori E. Dodd
- Clinical Trials Research Section, Division of Clinical Research, National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Edward W. Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Véronique Nussenblatt
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Ziche Chen
- Dermatology Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA,Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Inga Saknite
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
| | - Benoit M. Dawant
- Department of Electrical and Computer Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA,Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Eric R. Tkaczyk
- Dermatology Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA,Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA,Corresponding author
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21
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Mukadi-Bamuleka D, Mambu-Mbika F, De Weggheleire A, Edidi-Atani F, Bulabula-Penge J, Mfumu MMK, Legand A, Nkuba-Ndaye A, N’kasar YTT, Mbala-Kingebeni P, Klena JD, Montgomery JM, Muyembe-Tamfum JJ, Formenty P, van Griensven J, Ariën KK, Ahuka-Mundeke S. Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018–2020. Emerg Infect Dis 2023. [DOI: 10.3201/2901.221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Mukadi-Bamuleka D, Mambu-Mbika F, De Weggheleire A, Edidi-Atani F, Bulabula-Penge J, Mfumu MMK, Legand A, Nkuba-Ndaye A, N'kasar YTT, Mbala-Kingebeni P, Klena JD, Montgomery JM, Muyembe-Tamfum JJ, Formenty P, van Griensven J, Ariën KK, Ahuka-Mundeke S. Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018-2020. Emerg Infect Dis 2023; 29:1-9. [PMID: 36573642 PMCID: PMC9796222 DOI: 10.3201/eid2901.221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo, the Institut National de Recherche Biomédicale strategically positioned 13 decentralized field laboratories with dedicated equipment to quickly detect cases as the outbreak evolved. The laboratories were operated by national staff, who quickly handed over competencies and skills to local persons to successfully manage future outbreaks. Laboratories analyzed ≈230,000 Ebola diagnostic samples under stringent biosafety measures, documentation, and database management. Field laboratories diversified their activities (diagnosis, chemistry and hematology, survivor follow-up, and genomic sequencing) and shipped 127,993 samples from the field to a biorepository in Kinshasa under good conditions. Deploying decentralized and well-equipped laboratories run by local personnel in at-risk countries for Ebola virus disease outbreaks is an efficient response; all activities are quickly conducted in the field.
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23
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Tshomba AO, Mukadi-Bamuleka DR, De Weggheleire A, Tshiani OM, Kitenge RO, Kayembe CT, Jacobs BKM, Lynen L, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Mumba DN, Tshala-Katumbay DD, Mulangu S. Development of Ebola virus disease prediction scores: Screening tools for Ebola suspects at the triage-point during an outbreak. PLoS One 2022; 17:e0278678. [PMID: 36525443 PMCID: PMC9757576 DOI: 10.1371/journal.pone.0278678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The control of Ebola virus disease (EVD) outbreaks relies on rapid diagnosis and prompt action, a daunting task in limited-resource contexts. This study develops prediction scores that can help healthcare workers improve their decision-making at the triage-point of EVD suspect-cases during EVD outbreaks. METHODS We computed accuracy measurements of EVD predictors to assess their diagnosing ability compared with the reference standard GeneXpert® results, during the eastern DRC EVD outbreak. We developed predictive scores using the Spiegelhalter-Knill-Jones approach and constructed a clinical prediction score (CPS) and an extended clinical prediction score (ECPS). We plotted the receiver operating characteristic curves (ROCs), estimated the area under the ROC (AUROC) to assess the performance of scores, and computed net benefits (NB) to assess the clinical utility (decision-making ability) of the scores at a given cut-off. We performed decision curve analysis (DCA) to compare, at a range of threshold probabilities, prediction scores' decision-making ability and to quantify the number of unnecessary isolation. RESULTS The analysis was done on data from 10432 subjects, including 651 EVD cases. The EVD prevalence was 6.2% in the whole dataset, 14.8% in the subgroup of suspects who fitted the WHO Ebola case definition, and 3.2% for the set of suspects who did not fit this case definition. The WHO clinical definition yielded 61.6% sensitivity and 76.4% specificity. Fatigue, difficulty in swallowing, red eyes, gingival bleeding, hematemesis, confusion, hemoptysis, and a history of contact with an EVD case were predictors of EVD. The AUROC for ECPS was 0.88 (95%CI: 0.86-0.89), significantly greater than this for CPS, 0.71 (95%CI: 0.69-0.73) (p < 0.0001). At -1 point of score, the CPS yielded a sensitivity of 85.4% and specificity of 42.3%, and the ECPS yielded sensitivity of 78.8% and specificity of 81.4%. The diagnostic performance of the scores varied in the three disease contexts (the whole, fitting or not fitting the WHO case definition data sets). At 10% of threshold probability, e.g. in disease-adverse context, ECPS gave an NB of 0.033 and a net reduction of unnecessary isolation of 67.1%. Using ECPS as a joint approach to isolate EVD suspects reduces the number of unnecessary isolations by 65.7%. CONCLUSION The scores developed in our study showed a good performance as EVD case predictors since their use improved the net benefit, i.e., their clinical utility. These rapid and low-cost tools can help in decision-making to isolate EVD-suspicious cases at the triage point during an outbreak. However, these tools still require external validation and cost-effectiveness evaluation before being used on a large scale.
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Affiliation(s)
- Antoine Oloma Tshomba
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- * E-mail:
| | - Daniel-Ricky Mukadi-Bamuleka
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anja De Weggheleire
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olivier M. Tshiani
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard O. Kitenge
- National Emergency Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Charles T. Kayembe
- Department of Internal Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Bart K. M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Placide Mbala-Kingebeni
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Dieudonné N. Mumba
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Désiré D. Tshala-Katumbay
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Neurology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sabue Mulangu
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Kjaldgaard L, Claude KM, Mukadi-Bamuleka D, Kitenge-Omasumbu R, Dixit D, Edidi-Atani F, Kuamfumu MM, Bulabula-Penge J, Mambu-Mbika F, Tshiani-Mbaya O, Diaz J, Mulangu S, Legand A, Mbala-Kingebeni P, Formenty P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Hawkes MT. Virus kinetics and biochemical derangements among children with Ebolavirus disease. EClinicalMedicine 2022; 53:101638. [PMID: 36105872 PMCID: PMC9465268 DOI: 10.1016/j.eclinm.2022.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A paucity of data is available on virologic and biochemical characteristics of paediatric Ebolavirus disease (EVD), compared to adults. METHODS We conducted a retrospective chart review of children (<16 years old) and a comparator group of young adults (16-44 years) from two treatment centres during the 2018-2020 EVD epidemic in Eastern Democratic Republic of the Congo. Statistical methods included chi-squared and Fisher's exact tests (dichotomous and categorical variables), Mann-Whitney U-test (continuous variables), multivariable linear regression (for determinants of admission viral load), linear mixed-effects models (for analysis of longitudinal viral load), and Cox proportional hazard models (to examine risk factors for mortality). FINDINGS We included 73 children and 234 adults admitted from April to October 2019. Paediatric patients commonly had electrolytes imbalances: hypokalaemia in 26/73 (36%), hyperkalaemia in 38/73 (52%), and hyponatraemia in 54/73 (74%). Hypoglycaemia occurred in 20/73 (27%), acute kidney injury in 43/73 (59%), and rhabdomyolysis in 35/73 (48%). Biochemical abnormalities were detected in a similar proportion of children and adults. The viral load (VL, log10 copies/mL) at admission (7.2 versus 6.5, p=0.0001), the peak viral load (7.5 versus 6.7, p=<0.0001), and the time for viraemia clearance (16 days versus 12 days, p=<0.0001) were significantly different in children. The duration of hospital stay was prolonged in children (20 versus 16 days, p=<0.0001). Risk factors for mortality in children were: VL >7.6 log10copies/mL, alanine transaminase >525 U/L, C-reactive protein >100 mg/L, blood urea nitrogen >7.5 mmol/L, rhabdomyolysis, and.acute kidney injury. INTERPRETATION Paediatric EVD patients, like adults, experience multiorgan dysfunction with life-threatening electrolyte imbalances, hypoglycaemia, kidney injury, liver injury, and rhabdomyolysis. Paediatric patients have significantly higher VLs throughout the course of EVD than adults. FUNDING This study was not funded.
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Affiliation(s)
- Lindsey Kjaldgaard
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
- Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge-Omasumbu
- Programme National d'Urgences et Actions Humanitaires (PNUAH), Ministry of Health of the Democratic Republic of the Congo (DRC), Democratic Republic of the Congo
| | - Devika Dixit
- Department of Medicine, Division of Infectious Diseases, University of Saskatchewan, Saskatoon, SK, Canada
| | - François Edidi-Atani
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo Kuamfumu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Junior Bulabula-Penge
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Olivier Tshiani-Mbaya
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Janet Diaz
- World Health Organization (WHO), Geneva, Switzerland
| | - Sabue Mulangu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Anais Legand
- World Health Organization (WHO), Geneva, Switzerland
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | | | - Michael T. Hawkes
- Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, AB, Canada
- Corresponding author at: Department of Paediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
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Malta M, Mbala-Kingebeni P, Rimoin AW, Strathdee SA. Monkeypox and Global Health Inequities: A Tale as Old as Time…. Int J Environ Res Public Health 2022; 19:13380. [PMID: 36293973 PMCID: PMC9602921 DOI: 10.3390/ijerph192013380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Infectious disease outbreaks can quickly become global in what has increasingly become a closely interconnected world, influenced by what is considered to be an unprecedented era of technological, demographic, and climatic change [...].
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Affiliation(s)
- Monica Malta
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Placide Mbala-Kingebeni
- National Institute of Biomedical Research, Cliniques Universitaires De Kinshasa, Kinshasa, Congo
| | - Anne W. Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding, School of Public Health, University of California, Los Angeles, CA 90095, USA
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Strathdee SA, Smith DM, Halbrook M, Mbala-Kingebeni P, Abeles S, Torriani F, Rimoin A. The rapidly evolving monkeypox epidemic: A call to action to leave no one behind. PLoS Med 2022; 19:e1004128. [PMID: 36315599 PMCID: PMC9662950 DOI: 10.1371/journal.pmed.1004128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 11/14/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
- * E-mail:
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Megan Halbrook
- Fielding School of Public Health, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of Congo
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Shira Abeles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Francesca Torriani
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Anne Rimoin
- Fielding School of Public Health, University of California—Los Angeles, Los Angeles, California, United States of America
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Keita M, Polonsky J, Finci I, Mbala-Kingebeni P, Ilumbulumbu MK, Dakissaga A, Ngwama JK, Tosalisana MK, Ahuka-Mundeke S, Gueye AS, Dagron S, Keiser O, Fall IS. Investigation of and Strategies to Control the Final Cluster of the 2018-2020 Ebola Virus Disease Outbreak in the Eastern Democratic Republic of Congo. Open Forum Infect Dis 2022; 9:ofac329. [PMID: 36168547 PMCID: PMC9499850 DOI: 10.1093/ofid/ofac329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background On April 10, 2020, while the independent committee of the International Health Regulation was meeting to decide whether the 10th Ebola outbreak in the Demogratic Republic of Congo still constituted a Public Health Emergency of International Concern, a new confirmed case was reported in the city of Beni, the last epicenter of the epidemic. This study aimed to understand the source of this cluster and learn from the implemented control strategies for improved response in the future. Methods We conducted a combined epidemiological and genomic investigation to understand the origins and dynamics of transmission within this cluster and describe the strategy that successfully controlled the outbreak. Results Eight cases were identified as belonging to this final cluster. A total of 1028 contacts were identified. Whole-genome sequencing revealed that all cases belonged to the same cluster, the closest sequence to which was identified as a case from the Beni area with symptom onset in July 2019 and a difference of just 31 nucleotides. Outbreak control measures included community confinement of high-risk contacts. Conclusions This study illustrates the high risk of additional flare-ups in the period leading to the end-of-outbreak declaration and the importance of maintaining enhanced surveillance and confinement activities to rapidly control Ebola outbreaks.
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Affiliation(s)
- Mory Keita
- Regional Office for Africa, World Health Organization, Brazzaville, Congo.,Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jonathan Polonsky
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.,World Health Organization, Geneva, Switzerland
| | - Iris Finci
- European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Michel Kalongo Ilumbulumbu
- Division Provinciale de la Santé du Nord-Kivu, Ministère de la Santé, Goma, Democratic Republic of Congo
| | - Adama Dakissaga
- Ministère de la Santé, Direction Régionale de la Santé du Plateau central, Ziniaré, Burkina Faso
| | - John Kombe Ngwama
- Direction Générale de la Lutte contre la Maladie, Ministère de la Santé, Kinshasa, Democratic Republic of Congo
| | - Michel Kasereka Tosalisana
- Division Provinciale de la Santé du Nord-Kivu, Ministère de la Santé, Goma, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of Congo
| | - Abdou Salam Gueye
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Stephanie Dagron
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
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Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JJM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, Langenegger E. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis. Clin Infect Dis 2022; 75:1950-1961. [PMID: 36130257 PMCID: PMC9214158 DOI: 10.1093/cid/ciac294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
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Affiliation(s)
- Jean B Nachega
- Correspondence: J. B. Nachega, University of Pittsburgh School of Public Health, Department of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health 130 DeSoto Street, A532 Crabtree Hall, Pittsburgh, PA 15261 ()
| | | | - Rhoderick N Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya,Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Akwasi Baafuor Opoku
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aminatu Umar Makarfi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chibueze Adirieje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Marc B Tshilanda
- Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - John Ditekemena
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Christopher Nsereko
- Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Michael Yaw Yeboah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Denis M Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Etienne Kajibwami Birindwa
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Serge Zigabe Mushamuka
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Edward J Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judith N Wasserheit
- Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark J Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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Mukadi-Bamuleka D, Bulabula-Penge J, De Weggheleire A, Jacobs BKM, Edidi-Atani F, Mambu-Mbika F, Mbala-Kingebeni P, Makiala-Mandanda S, Faye M, Diagne CT, Diagne MM, Faye O, Kajihara M, Faye O, Takada A, Sall AA, Muyembe-Tamfum JJ, van Griensven J, Ariën KK, Ahuka-Mundeke S. Field performance of three Ebola rapid diagnostic tests used during the 2018-20 outbreak in the eastern Democratic Republic of the Congo: a retrospective, multicentre observational study. Lancet Infect Dis 2022; 22:891-900. [PMID: 35298901 DOI: 10.1016/s1473-3099(21)00675-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo has confronted 13 outbreaks of Ebola virus disease since 1976. Rapid diagnostic tests (RDTs) detecting viral antigens have been developed to circumvent difficulties encountered with RT-PCR for diagnosis in remote low-resource settings, but there is still uncertainty about their performance characteristics and usability during outbreaks. We aimed to assess the field performance of three antigen detection RDTs compared with the gold-standard Cepheid GeneXpert Ebola assay results. METHODS We conducted a retrospective, multicentre observational study using complete and de-identified databases of five mobile laboratories (managed by the Institut National de Recherche Biomédicale) to assess the performance of three Ebola virus disease RDTs (QuickNavi-Ebola, OraQuick Ebola Rapid Antigen Test, and Coris EBOLA Ag K-SeT rapid test) run on blood samples of patients with suspected Ebola virus disease in direct comparison with the Cepheid GeneXpert Ebola assay reference test during the 2018-20 outbreak in the eastern Democratic Republic of the Congo. We estimated the sensitivity and specificity of each test through generalised linear mixed models against the GeneXpert Ebola assay reference test and corrected for cycle threshold value and random site effects. FINDINGS 719 (7·9%) of 9157 samples had a positive GeneXpert Ebola assay result. The QuickNavi-Ebola RDT had a sensitivity of 87·4% (95% CI 63·6-96·8) around the mean cycle threshold value and a specificity of 99·6% (99·3-99·8). The OraQuick Ebola Rapid Antigen Test had a sensitivity of 57·4% (95% CI 38·8-75·8) and specificity of 98·3% (97·5-99·0), and the Coris EBOLA Ag K-SeT rapid test had a sensitivity of 38·9% (23·0-63·6) against the GeneXpert Ebola assay reference and specificity of 97·4% (85·3-99·6). The QuickNavi-Ebola RDT showed a robust performance with good sensitivity, particularly with increasing viral loads (ie, low cycle threshold values), and specificity. INTERPRETATION The three RDTs evaluated did not achieve the desired sensitivity and specificity of the WHO target product profile. Although the RDTs cannot triage and rule out Ebola virus infection among clinical suspects, they can still help to sort people with suspected Ebola virus disease into high-risk and low-risk groups while waiting for GeneXpert Ebola assay reference testing. FUNDING None. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Junior Bulabula-Penge
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anja De Weggheleire
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Edidi-Atani
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Oumar Faye
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Masahiro Kajihara
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Ayato Takada
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Jean-Jacques Muyembe-Tamfum
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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Nachega JB, Sam-Agudu NA, Machekano RN, Rabie H, van der Zalm MM, Redfern A, Dramowski A, O’Connell N, Pipo MT, Tshilanda MB, Byamungu LN, Masekela R, Jeena PM, Pillay A, Gachuno OW, Kinuthia J, Ishoso DK, Amoako E, Agyare E, Agbeno EK, Martyn-Dickens C, Sylverken J, Enimil A, Jibril AM, Abdullahi AM, Amadi O, Umar UM, Sigwadhi LN, Hermans MP, Otokoye JO, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Zumla A, Sewankambo NK, Aanyu HT, Musoke P, Suleman F, Adejumo P, Noormahomed EV, Deckelbaum RJ, Fowler MG, Tshilolo L, Smith G, Mills EJ, Umar LW, Siedner MJ, Kruger M, Rosenthal PJ, Mellors JW, Mofenson LM. Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries. JAMA Pediatr 2022; 176:e216436. [PMID: 35044430 PMCID: PMC8771438 DOI: 10.1001/jamapediatrics.2021.6436] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
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Affiliation(s)
- Jean B. Nachega
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria,Institute of Human Virology, University of Maryland School of Medicine, Baltimore,Department of Pediatrics, University of Maryland School of Medicine, Baltimore,Department of Pediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Rhoderick N. Machekano
- Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Helena Rabie
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Natasha O’Connell
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Michel Tshiasuma Pipo
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Marc B. Tshilanda
- Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Liliane Nsuli Byamungu
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Prakash Mohan Jeena
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Onesmus W. Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Katuashi Ishoso
- Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Emmanuella Amoako
- Department of Pediatrics, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Evans K. Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Justice Sylverken
- Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana,Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Enimil
- Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana,Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aishatu Mohammed Jibril
- Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Asara M. Abdullahi
- Department of Internal Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Oma Amadi
- Department of Pediatrics, Asokoro District Hospital, Abuja, Nigeria
| | - Umar Mohammed Umar
- Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Michel P. Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - John Otshudiema Otokoye
- Health Emergencies Program, COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Services Foundation Trust, London, United Kingdom
| | - Nelson K. Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Philippa Musoke
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | | | - Richard J. Deckelbaum
- Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Léon Tshilolo
- Department of Pediatrics, Official University of Mbuji-Mayi, Kinshasa, Democratic Republic of the Congo,Le Centre de Formation et d'Appui Sanitaire, Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Gerald Smith
- Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada
| | - Edward J. Mills
- Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawal W. Umar
- Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Mark J. Siedner
- Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, Boston,Department of Medicine, School of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Philip J. Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco
| | - John W. Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
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Nkuba-Ndaye A, Mukadi-Bamuleka D, Bulabula-Penge J, Thaurignac G, Edidi-Atani F, Mambu-Mbika F, Danga-Yema B, Matondo-Kuamfumu M, Kinganda-Lusamaki E, Bisento N, Lumembe-Numbi R, Kabamba-Lungenyi G, Kitsa-Mutsumbirwa D, Kambale-Sivihwa N, Boillot F, Delaporte E, Mbala-Kingebeni P, Ayouba A, Peeters M, Ahuka-Mundeke S. Added value of an anti-Ebola serology for the management of clinically suspect Ebola virus disease patients discharged as negative in an epidemic context. J Infect Dis 2022; 226:352-356. [PMID: 35176762 PMCID: PMC9400424 DOI: 10.1093/infdis/jiac057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
Background Survivors from Ebola virus disease (EVD) may be at the origin of EVD resurgence. Methods Simultaneous reactivity to at least 2 Ebola virus or Zaire ebolavirus (EBOV) antigens was detected in 11 of 488 (2.3%; 95% confidence interval [CI], 1.1–4.0) suspected EVD patients who were discharged as negative after 2 consecutive negative tests during the 10th Ebola outbreak in the Democratic Republic of the Congo. Results After extrapolating the total number of individuals discharged as negative during the entire outbreak, we estimated a total of 1314 additional missed Ebola cases. Conclusions These findings emphasize the usefulness of an EBOV serology analysis and the importance of extending epidemic surveillance to clinically suspected cases who were discharged as negative.
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Affiliation(s)
- Antoine Nkuba-Ndaye
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France.,Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Daniel Mukadi-Bamuleka
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Junior Bulabula-Penge
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Guillaume Thaurignac
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - François Edidi-Atani
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Bernice Danga-Yema
- Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo-Kuamfumu
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eddy Kinganda-Lusamaki
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France.,Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nella Bisento
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Raphaël Lumembe-Numbi
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Gabriel Kabamba-Lungenyi
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Divine Kitsa-Mutsumbirwa
- Laboratoire mobile pour MVE, Institut National de Recherche Biomédicale, Butembo, Nord-Kivu, Democratic Republic of the Congo
| | - Nelson Kambale-Sivihwa
- Laboratoire mobile pour MVE, Institut National de Recherche Biomédicale, Beni, Nord-Kivu, Democratic Republic of the Congo
| | | | - Eric Delaporte
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Placide Mbala-Kingebeni
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Martine Peeters
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Steve Ahuka-Mundeke
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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De Weggheleire A, Nkuba-Ndaye A, Mbala-Kingebeni P, Mariën J, Kindombe-Luzolo E, Ilombe G, Mangala-Sonzi D, Binene-Mbuka G, De Smet B, Vogt F, Selhorst P, Matungala-Pafubel M, Nkawa F, Vulu F, Mossoko M, Pukuta-Simbu E, Kinganda-Lusamaki E, Van Bortel W, Wat’senga-Tezzo F, Makiala-Mandanda S, Ahuka-Mundeke S. A Multidisciplinary Investigation of the First Chikungunya Virus Outbreak in Matadi in the Democratic Republic of the Congo. Viruses 2021; 13:v13101988. [PMID: 34696418 PMCID: PMC8541179 DOI: 10.3390/v13101988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Abstract
Early March 2019, health authorities of Matadi in the Democratic Republic of the Congo alerted a sudden increase in acute fever/arthralgia cases, prompting an outbreak investigation. We collected surveillance data, clinical data, and laboratory specimens from clinical suspects (for CHIKV-PCR/ELISA, malaria RDT), semi-structured interviews with patients/caregivers about perceptions and health seeking behavior, and mosquito sampling (adult/larvae) for CHIKV-PCR and estimation of infestation levels. The investigations confirmed a large CHIKV outbreak that lasted February–June 2019. The total caseload remained unknown due to a lack of systematic surveillance, but one of the two health zones of Matadi notified 2686 suspects. Of the clinical suspects we investigated (n = 220), 83.2% were CHIKV-PCR or IgM positive (acute infection). One patient had an isolated IgG-positive result (while PCR/IgM negative), suggestive of past infection. In total, 15% had acute CHIKV and malaria. Most adult mosquitoes and larvae (>95%) were Aedes albopictus. High infestation levels were noted. CHIKV was detected in 6/11 adult mosquito pools, and in 2/15 of the larvae pools. This latter and the fact that 2/6 of the CHIKV-positive adult pools contained only males suggests transovarial transmission. Interviews revealed that healthcare seeking shifted quickly toward the informal sector and self-medication. Caregivers reported difficulties to differentiate CHIKV, malaria, and other infectious diseases resulting in polypharmacy and high out-of-pocket expenditure. We confirmed a first major CHIKV outbreak in Matadi, with main vector Aedes albopictus. The health sector was ill-prepared for the information, surveillance, and treatment needs for such an explosive outbreak in a CHIKV-naïve population. Better surveillance systems (national level/sentinel sites) and point-of-care diagnostics for arboviruses are needed.
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Affiliation(s)
- Anja De Weggheleire
- Outbreak Research Team, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (J.M.); (B.D.S.); (F.V.); (P.S.); (W.V.B.)
- Correspondence: ; Tel.: +32-494-368-535
| | - Antoine Nkuba-Ndaye
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
- Department of Medical Biology, University of Kinshasa, B.P. 127 Kinshasa IX, Democratic Republic of the Congo; (D.M.-S.); (M.M.-P.); (F.V.)
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier University, 34090 Montpellier, France
| | - Placide Mbala-Kingebeni
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
- Department of Medical Biology, University of Kinshasa, B.P. 127 Kinshasa IX, Democratic Republic of the Congo; (D.M.-S.); (M.M.-P.); (F.V.)
| | - Joachim Mariën
- Outbreak Research Team, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (J.M.); (B.D.S.); (F.V.); (P.S.); (W.V.B.)
| | - Esaie Kindombe-Luzolo
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
| | - Gillon Ilombe
- Department of Entomology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (G.I.); (G.B.-M.); (F.W.-T.)
- Global Health Institute, Antwerp University, 2000 Antwerp, Belgium
| | - Donatien Mangala-Sonzi
- Department of Medical Biology, University of Kinshasa, B.P. 127 Kinshasa IX, Democratic Republic of the Congo; (D.M.-S.); (M.M.-P.); (F.V.)
| | - Guillaume Binene-Mbuka
- Department of Entomology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (G.I.); (G.B.-M.); (F.W.-T.)
| | - Birgit De Smet
- Outbreak Research Team, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (J.M.); (B.D.S.); (F.V.); (P.S.); (W.V.B.)
| | - Florian Vogt
- Outbreak Research Team, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (J.M.); (B.D.S.); (F.V.); (P.S.); (W.V.B.)
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
| | - Philippe Selhorst
- Outbreak Research Team, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (J.M.); (B.D.S.); (F.V.); (P.S.); (W.V.B.)
| | - Mathy Matungala-Pafubel
- Department of Medical Biology, University of Kinshasa, B.P. 127 Kinshasa IX, Democratic Republic of the Congo; (D.M.-S.); (M.M.-P.); (F.V.)
| | - Frida Nkawa
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
| | - Fabien Vulu
- Department of Medical Biology, University of Kinshasa, B.P. 127 Kinshasa IX, Democratic Republic of the Congo; (D.M.-S.); (M.M.-P.); (F.V.)
| | - Mathias Mossoko
- Direction de Lutte contre la Maladie, Ministry of Health, B.P. 3040 Kinshasa I, Democratic Republic of the Congo;
| | - Elisabeth Pukuta-Simbu
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
| | - Eddy Kinganda-Lusamaki
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
| | - Wim Van Bortel
- Outbreak Research Team, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (J.M.); (B.D.S.); (F.V.); (P.S.); (W.V.B.)
| | - Francis Wat’senga-Tezzo
- Department of Entomology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (G.I.); (G.B.-M.); (F.W.-T.)
| | - Sheila Makiala-Mandanda
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
| | - Steve Ahuka-Mundeke
- Department of Virology, National Institute of Biomedical Research, B.P. 1197 Kinshasa I, Democratic Republic of the Congo; (A.N.-N.); (P.M.-K.); (E.K.-L.); (F.N.); (E.P.-S.); (E.K.-L.); (S.M.-M.); (S.A.-M.)
- Department of Medical Biology, University of Kinshasa, B.P. 127 Kinshasa IX, Democratic Republic of the Congo; (D.M.-S.); (M.M.-P.); (F.V.)
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34
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Mbala-Kingebeni P, Vogt F, Miwanda B, Sundika T, Mbula N, Pankwa I, Lubula L, Vanlerberghe V, Magazani A, Afoumbom MT, Muyembe-Tamfum JJ. Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak. PLoS Negl Trop Dis 2021; 15:e0009477. [PMID: 34237058 PMCID: PMC8266059 DOI: 10.1371/journal.pntd.0009477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera. Methodology/Principal findings We recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases’ place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors. The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9–5.2) to often (OR 4.0, 95% CI 1.6–9.9) to very often (OR 4.1, 95% CI 1.0–16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera. Conclusions/Significance Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa. Cholera is a diarrheal disease caused by ingestion of the Vibrio cholerae bacterium. Outbreaks in urban areas are becoming increasingly frequent in Sub-Saharan Africa. Risk factors for cholera have been studied in rural settings but not sufficiently in urban areas. Understanding context-specific risk factors is key for successful outbreak response. During a cholera outbreak in Kinshasa, the Democratic Republic of the Congo we were able to identify a previously unknown behavioural risk factor of particular relevance in urban settings–the consumption of drinking water from plastic sachets. Water sachets are sold on the streets of all major cities in Sub-Saharan Africa. It requires biting off an edge and sucking out the water, and we think that external contamination of these sachets was an important transmission route in the Kinshasa outbreak. Water sachets are predominantly consumed by socio-economically disadvantaged groups who lack piped water supply in their homes and have poor access to sanitary infrastructure. This makes our findings particularly relevant because these are the very populations who are at increased risk of getting and transmitting cholera. Health messaging and response measures should include consumption of water sachets as a potential risk factor during future cholera outbreaks in urban low-resource settings.
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Affiliation(s)
| | - Florian Vogt
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Berthe Miwanda
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Nancy Mbula
- FELTP DRC, Kinshasa, Democratic Republic of the Congo
| | - Isaac Pankwa
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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35
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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] [What about the content of this article? (0)] [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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36
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Selhorst P, Makiala-Mandanda S, De Smet B, Mariën J, Anthony C, Binene-Mbuka G, De Weggheleire A, Ilombe G, Kinganda-Lusamaki E, Pukuta-Simbu E, Lubula L, Mbala-Kingebeni P, Nkuba-Ndaye A, Vogt F, Watsenga F, Van Bortel W, Vanlerberghe V, Ariën KK, Ahuka-Mundeke S. Molecular characterization of chikungunya virus during the 2019 outbreak in the Democratic Republic of the Congo. Emerg Microbes Infect 2021; 9:1912-1918. [PMID: 32787529 PMCID: PMC8284967 DOI: 10.1080/22221751.2020.1810135] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Early 2019, a chikungunya virus (CHIKV) outbreak hit the Democratic Republic of the Congo (DRC). Though seldomly deadly, this mosquito-borne disease presents as an acute febrile (poly)arthralgia often followed by long-term sequelae. Although Aedes aegypti is the primary vector, an amino acid substitution in the viral envelope gene E1 (A226V) is causing concern as it results in increased transmission by Aedes albopictus, a mosquito with a much wider geographical distribution. Between January and March 2019, we collected human and mosquito samples in Kinshasa and Kongo Central province (Kasangulu and Matadi). Of the patients that were tested within 7 days of symptom onset, 49.7% (87/175) were RT–qPCR positive, while in the mosquito samples CHIKV was found in 1/2 pools in Kinshasa, 5/6 pools in Kasangulu, and 8/26 pools in Matadi. Phylogenetic analysis on whole-genome sequences showed that the circulating strain formed a monophyletic group within the ECSA2 lineage and harboured the A226V mutation. Our sequences did not cluster with sequences from previously reported outbreaks in the DRC nor with other known A226V-containing ECSA2 strains. This indicates a scenario of convergent evolution where A226V was acquired independently in response to a similar selection pressure for transmission by Ae. albopictus. This is in line with our entomological data where we detected Ae. albopictus more frequently than Ae. aegypti in two out of three affected areas. In conclusion, our findings suggest that CHIKV is adapting to the increased presence of Aedes albopictus in DRC.
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Affiliation(s)
- Philippe Selhorst
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,The Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sheila Makiala-Mandanda
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Birgit De Smet
- The Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joachim Mariën
- The Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Colin Anthony
- Department of Pathology, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Guillaume Binene-Mbuka
- Department of Entomology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Anja De Weggheleire
- The Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gillon Ilombe
- Department of Entomology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,University of Antwerp, Antwerp, Belgium
| | - Eddy Kinganda-Lusamaki
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Elisabeth Pukuta-Simbu
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Leopold Lubula
- Direction Generale de Lutte contre la Maladie (DGLM), Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoine Nkuba-Ndaye
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Florian Vogt
- The Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Francis Watsenga
- Department of Entomology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Wim Van Bortel
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,The Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium
| | - Veerle Vanlerberghe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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37
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Kinganda-Lusamaki E, Black A, Mukadi DB, Hadfield J, Mbala-Kingebeni P, Pratt CB, Aziza A, Diagne MM, White B, Bisento N, Nsunda B, Akonga M, Faye M, Faye O, Edidi-Atani F, Matondo-Kuamfumu M, Mambu-Mbika F, Bulabula J, Di Paola N, Pauthner MG, Andersen KG, Palacios G, Delaporte E, Sall AA, Peeters M, Wiley MR, Ahuka-Mundeke S, Bedford T, Tamfum JJM. Integration of genomic sequencing into the response to the Ebola virus outbreak in Nord Kivu, Democratic Republic of the Congo. Nat Med 2021; 27:710-716. [PMID: 33846610 PMCID: PMC8549801 DOI: 10.1038/s41591-021-01302-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 03/02/2021] [Indexed: 12/29/2022]
Abstract
On 1 August 2018, the Democratic Republic of the Congo (DRC) declared its tenth Ebola virus disease (EVD) outbreak. To aid the epidemiologic response, the Institut National de Recherche Biomédicale (INRB) implemented an end-to-end genomic surveillance system, including sequencing, bioinformatic analysis and dissemination of genomic epidemiologic results to frontline public health workers. We report 744 new genomes sampled between 27 July 2018 and 27 April 2020 generated by this surveillance effort. Together with previously available sequence data (n = 48 genomes), these data represent almost 24% of all laboratory-confirmed Ebola virus (EBOV) infections in DRC in the period analyzed. We inferred spatiotemporal transmission dynamics from the genomic data as new sequences were generated, and disseminated the results to support epidemiologic response efforts. Here we provide an overview of how this genomic surveillance system functioned, present a full phylodynamic analysis of 792 Ebola genomes from the Nord Kivu outbreak and discuss how the genomic surveillance data informed response efforts and public health decision making.
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Affiliation(s)
- Eddy Kinganda-Lusamaki
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Allison Black
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel B Mukadi
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - James Hadfield
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Catherine B Pratt
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amuri Aziza
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Bailey White
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nella Bisento
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Bibiche Nsunda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Marceline Akonga
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | | | - Francois Edidi-Atani
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo-Kuamfumu
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Junior Bulabula
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, 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
| | - Matthias G Pauthner
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA, USA
| | - Kristian G Andersen
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA, USA
| | - Gustavo Palacios
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, 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
| | | | - Martine Peeters
- TransVIHMI, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Michael R Wiley
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, Omaha, NE, 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
| | - Trevor Bedford
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 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
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38
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Mbala-Kingebeni P, Pratt C, Ruffin MM, Pauthner MG, Bile F, Nkuba Ndaye A, Black A, Kinganda Lusamaki E, Faye M, Aziza A, Diagne MM, Mukadi D, White B, Hadfield J, Gangavarapu K, Bisento N, Kazadi D, Nsunda B, Akonga M, Tshiani O, Misasi J, Ploquin A, Epaso V, Sana Paka E, N’kasar YTT, Mambu F, Edidi F, Matondo M, Bula Bula J, Diallo B, Keita M, Belizaire MRD, Fall IS, Yam A, Sabue M, Rimion AW, Salfati E, Torkamani A, Suchard MA, Crozier I, Hensley L, Rambaut A, Faye O, Sall A, Sullivan NJ, Bedford T, Andersen KG, Wiley MR, Ahuka-Mundeke S, Muyembe Tamfum JJ. Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease. N Engl J Med 2021; 384:1240-1247. [PMID: 33789012 PMCID: PMC7888312 DOI: 10.1056/nejmoa2024670] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
During the 2018-2020 Ebola virus disease (EVD) outbreak in North Kivu province in the Democratic Republic of Congo, EVD was diagnosed in a patient who had received the recombinant vesicular stomatitis virus-based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) (Merck). His treatment included an Ebola virus (EBOV)-specific monoclonal antibody (mAb114), and he recovered within 14 days. However, 6 months later, he presented again with severe EVD-like illness and EBOV viremia, and he died. We initiated epidemiologic and genomic investigations that showed that the patient had had a relapse of acute EVD that led to a transmission chain resulting in 91 cases across six health zones over 4 months. (Funded by the Bill and Melinda Gates Foundation and others.).
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Affiliation(s)
- Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
- University of Kinshasa, Kinshasa, DRC
| | | | | | | | | | - Antoine Nkuba Ndaye
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
- University of Kinshasa, Kinshasa, DRC
| | - Allison Black
- Fred Hutchinson Cancer Research Center, Seattle,
WA, USA
| | | | | | - Amuri Aziza
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
| | | | - Daniel Mukadi
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
| | - Bailey White
- University of Nebraska Medical Center, Omaha, NE,
USA
| | - James Hadfield
- Fred Hutchinson Cancer Research Center, Seattle,
WA, USA
| | | | - Nella Bisento
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
| | | | - Bibiche Nsunda
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
| | | | | | - John Misasi
- Vaccine Research Center, National Institute of
Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH),
Bethesda, Maryland, USA
| | - Aurelie Ploquin
- Vaccine Research Center, National Institute of
Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH),
Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mulangu Sabue
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
| | | | | | | | | | - Ian Crozier
- Clinical Monitoring Research Program Directorate,
Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Lisa Hensley
- Integrated Research Facility at Fort Detrick,
National Institute of Allergy and Infectious Diseases, National Institutes of
Health, Frederick, MD, USA
| | | | | | | | - Nancy J. Sullivan
- Vaccine Research Center, National Institute of
Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH),
Bethesda, Maryland, USA
| | - Trevor Bedford
- Fred Hutchinson Cancer Research Center, Seattle,
WA, USA
| | | | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale,
Kinshasa, DRC
- University of Kinshasa, Kinshasa, DRC
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39
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Sam-Agudu NA, Rabie H, Pipo MT, Byamungu LN, Masekela R, van der Zalm MM, Redfern A, Dramowski A, Mukalay A, Gachuno OW, Mongweli N, Kinuthia J, Ishoso DK, Amoako E, Agyare E, Agbeno EK, Jibril AM, Abdullahi AM, Amadi O, Umar UM, Ayele BT, Machekano RN, Nyasulu PS, Hermans MP, Otshudiema JO, Bongo-Pasi Nswe C, Kayembe JMN, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Aanyu HT, Musoke P, Fowler MG, Sewankambo N, Suleman F, Adejumo P, Tsegaye A, Mteta A, Noormahomed EV, Deckelbaum RJ, Zumla A, Mavungu Landu DJ, Tshilolo L, Zigabe S, Goga A, Mills EJ, Umar LW, Kruger M, Mofenson LM, Nachega JB. The Critical Need for Pooled Data on Coronavirus Disease 2019 in African Children: An AFREhealth Call for Action Through Multicountry Research Collaboration. Clin Infect Dis 2021; 73:1913-1919. [PMID: 33580256 PMCID: PMC7929059 DOI: 10.1093/cid/ciab142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.
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Affiliation(s)
- Nadia A Sam-Agudu
- Pediatric and Adolescent HIV Unit and International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria,Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Helena Rabie
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Michel Tshiasuma Pipo
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - Liliane Nsuli Byamungu
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Marieke M van der Zalm
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Nancy Mongweli
- Department of Research and Programs and Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya,Department of Research and Programs and Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Katuashi Ishoso
- Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Emmanuella Amoako
- Department of Pediatrics, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Evans K Agbeno
- Department of Obstetrics & Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Aishatu Mohammed Jibril
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Oma Amadi
- Department of Pediatrics, Asokoro District Hospital, Abuja, Nigeria
| | - Umar Mohammed Umar
- Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria
| | - Birhanu T Ayele
- Division of Epidemiology and Biostatics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University Cape Town, South Africa
| | - Rhoderick N Machekano
- Division of Epidemiology and Biostatics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - John Otokoye Otshudiema
- World Health Organization Health Emergencies Program, COVID-19 Response, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - Jean-Marie N Kayembe
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- National Institute of Biomedical Research (INRB) and Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- National Institute of Biomedical Research (INRB) and Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Philippa Musoke
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala Uganda
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nelson Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Don Jethro Mavungu Landu
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - Léon Tshilolo
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo,Department of Pediatrics, Official University of Mbuji-Mayi, Kinshasa, Democratic Republic of the Congo,Sickle Cell Disease Research Center et le Centre de Formation et d'Appui Sanitaire, Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Serge Zigabe
- Hôpital Provincial Général de Référence de Bukavu, Département de Pédiatrie, Service de Néonatologie, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Ameena Goga
- South African Medical Research Council, Cape Town, South Africa,Department of Pediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Edward J Mills
- Department of Real World & Advanced Analytics, Cytel, Vancouver, Canada,Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Jean B Nachega
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa,Departments of Epidemiology & International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, PA, USA,Address for Correspondence: Jean B. Nachega, M.D., Ph.D., M.P.H., D.T.M & H., F.A.A.S, Stellenbosch University Faculty of Medicine and Health Sciences, Professor Extraordinary, Department of Medicine and Centre for Infectious Diseases, Francie van Zijl Drive, Parow 7505, Clinical Building, 3rd Floor, Room No. 3149, Cape Town, South Africa, Tel: +27 21 938 9119; E-mail:
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Raulino R, Thaurignac G, Butel C, Villabona-Arenas CJ, Foe T, Loul S, Ndimbo-Kumugo SP, Mbala-Kingebeni P, Makiala-Mandanda S, Ahuka-Mundeke S, Kerkhof K, Delaporte E, Ariën KK, Foulongne V, Mpoudi Ngole E, Peeters M, Ayouba A. Multiplex detection of antibodies to Chikungunya, O'nyong-nyong, Zika, Dengue, West Nile and Usutu viruses in diverse non-human primate species from Cameroon and the Democratic Republic of Congo. PLoS Negl Trop Dis 2021; 15:e0009028. [PMID: 33476338 PMCID: PMC7853492 DOI: 10.1371/journal.pntd.0009028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/02/2021] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background Epidemic arbovirus transmission occurs among humans by mosquito bites and the sylvatic transmission cycles involving non-human primates (NHPs) still exists. However, limited data are available on the extent in NHPs infections and their role. In this study, we have developed and validated a high-throughput serological screening tool to study the circulation of multiple arboviruses that represent a significant threat to human health, in NHPs in Central Africa. Methodology/Principal findings Recombinant proteins NS1, envelope domain-3 (DIII) for the dengue (DENV), yellow fever (YFV), usutu (USUV), west nile (WNV) and zika (ZIKV) and envelope 2 for the chikungunya (CHIKV) and o'nyong-nyong (ONNV) were coupled to Luminex beads to detect IgG directed against these viruses. Evaluation of test performance was made using 161 human sera of known arboviral status (66 negative and 95 positive). The sensitivity and specificity of each antigen were determined by statistical methods and ROC curves (except for ONNV and USUV). All NS1 antigens (except NS1-YFV), CHIKV-E2 and WNV-DIII had sensitivities and specificities > 95%. For the other DIII antigens, the sensitivity was low, limiting the interest of their use for seroprevalence studies. Few simultaneous reactions were observed between the CHIKV+ samples and the NS1 antigens to the non-CHIKV arboviruses. On the other hand, the DENV+ samples crossed-reacted with NS1 of all the DENV serotypes (1 to 4), as well as with ZIKV, USUV and to a lesser extent with YFV. A total of 3,518 samples of 29 species of NHPs from Cameroon and the Democratic Republic of Congo (DRC) were tested against NS1 (except YFV), E2 (CHIKV/ONNV) and DIII (WNV) antigens. In monkeys (n = 2,100), the global prevalence varied between 2 and 5% for the ten antigens tested. When we stratified by monkey’s biotope, the arboreal species showed the highest reactivity. In monkeys from Cameroon, the highest IgG prevalence were observed against ONNV-E2 and DENV2-NS1 with 3.95% and 3.40% respectively and in DRC, ONNV-E2 (6.63%) and WNV-NS1 (4.42%). Overall prevalence was low in apes (n = 1,418): ranging from 0% for USUV-NS1 to 2.6% for CHIKV-E2. However, a very large disparity was observed among collection site and ape species, e.g. 18% (9/40) and 8.2% (4/49) of gorillas were reactive with CHIKV-E2 or WNV-NS1, respectively in two different sites in Cameroon. Conclusions/Significance We have developed a serological assay based on Luminex technology, with high specificity and sensitivity for simultaneous detection of antibodies to 10 antigens from 6 different arboviruses. This is the first study that evaluated on a large scale the presence of antibodies to arboviruses in NHPs to evaluate their role in sylvatic cycles. The overall low prevalence (<5%) in more than 3,500 NHPs samples from Cameroon and the DRC does not allow us to affirm that NHP are reservoirs, but rather, intermediate hosts of these viruses. In the last decades, chikungunya, zika, yellow fever, usutu and dengue viruses have (re)-emerged in different parts of the world and many of these outbreaks occur in resource-limited countries with limited or under-equipped health facilities and where endemic malaria with very similar clinical symptoms confounds surveillance. Most arboviruses that circulate today likely originated in Africa where sporadic human outbreaks occur. In this work, we developed a serological tool that allows simultaneous detection of IgG antibodies to multiple arbovirus in a biological sample. With this highly sensitive and specific multiplex assay, we screened more than 3,500 samples collected from 29 species of monkeys and apes in Africa. We found a global IgG antibody prevalence of less than 5%. However, this seroprevalence varied by collection site, NPHs species and virus type. Given these findings, we concluded that African non-human primates are most likely not the reservoirs, but rather are intermediate hosts.
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Affiliation(s)
- Raisa Raulino
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Guillaume Thaurignac
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Christelle Butel
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Christian Julian Villabona-Arenas
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Thomas Foe
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Severin Loul
- Centre de Recherches sur les Maladies Émergentes, Ré-émergentes et la Médecine Nucléaire, Institut de Recherches Médicales et D'études des Plantes Médicinales, Yaoundé, Cameroun
| | | | | | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicales, Kinshasa, République Démocratique du Congo
| | - Karen Kerkhof
- Department of Biomedical Sciences, Virology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Delaporte
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Kevin K. Ariën
- Department of Biomedical Sciences, Virology Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Foulongne
- Département de bactériologie-virologie, CHU de Montpellier, Montpellier, France
| | - Eitel Mpoudi Ngole
- Centre de Recherches sur les Maladies Émergentes, Ré-émergentes et la Médecine Nucléaire, Institut de Recherches Médicales et D'études des Plantes Médicinales, Yaoundé, Cameroun
| | - Martine Peeters
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
| | - Ahidjo Ayouba
- Recherches Translationnelles sur le VIH et Maladies Infectieuses/INSERM U1175, Institut de Recherche pour le Développement et Université de Montpellier, France
- * E-mail:
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Nachega JB, Sam-Agudu NA, Budhram S, Taha TE, Vannevel V, Somapillay P, Ishoso DK, Tshiasuma Pipo M, Bongo-Pasi Nswe C, Ditekemena J, Ayele BT, Machekano RN, Gachuno OW, Kinuthia J, Mwongeli N, Sekikubo M, Musoke P, Agbeno EK, Umar LW, Ntakwinja M, Mukwege DM, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Kayembe JMN, Mavungu Landu DJ, Muyembe Tamfum JJ, Zumla A, Langenegger EJ, Mofenson LM. Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration. Am J Trop Med Hyg 2020; 104:461-465. [PMID: 33372651 PMCID: PMC7866362 DOI: 10.4269/ajtmh.20-1553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health's COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.
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Affiliation(s)
- Jean B. Nachega
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Department of Pediatrics and Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Valerie Vannevel
- UP/SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine, Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Daniel Katuashi Ishoso
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Tshiasuma Pipo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
| | - Christian Bongo-Pasi Nswe
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - John Ditekemena
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Birhanu T. Ayele
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick N. Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W. Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, University of Cape Coast, Cape Coast, Ghana
| | - Lawal W. Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Denis M. Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Eduard J. Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean-Marie N. Kayembe
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Don Jethro Mavungu Landu
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Eduard J. Langenegger
- Department of Obstetrics and Gynecology, Tyberberg Teaching Hospital, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - for the AFREhealth COVID-19 Research Collaboration Working Group
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- International Research Center of Excellence, Department of Pediatrics and Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
- UP/SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
- Maternal Foetal Medicine, Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, University of Cape Coast, Cape Coast, Ghana
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
- Department of Obstetrics and Gynecology, Tyberberg Teaching Hospital, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
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Nachega JB, Ishoso DK, Otokoye JO, Hermans MP, Machekano RN, Sam-Agudu NA, Bongo-Pasi Nswe C, Mbala-Kingebeni P, Madinga JN, Mukendi S, Kolié MC, Nkwembe EN, Mbuyi GM, Nsio JM, Mukeba Tshialala D, Tshiasuma Pipo M, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Mofenson L, Smith G, Mills EJ, Mellors JW, Zumla A, Mavungu Landu DJ, Kayembe JM. Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo. Am J Trop Med Hyg 2020; 103:2419-2428. [PMID: 33009770 PMCID: PMC7695108 DOI: 10.4269/ajtmh.20-1240] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Little is known about the clinical features and outcomes of SARS-CoV-2 infection in Africa. We conducted a retrospective cohort study of patients hospitalized for COVID-19 between March 10, 2020 and July 31, 2020 at seven hospitals in Kinshasa, Democratic Republic of the Congo (DRC). Outcomes included clinical improvement within 30 days (primary) and in-hospital mortality (secondary). Of 766 confirmed COVID-19 cases, 500 (65.6%) were male, with a median (interquartile range [IQR]) age of 46 (34-58) years. One hundred ninety-one (25%) patients had severe/critical disease requiring admission in the intensive care unit (ICU). Six hundred twenty patients (80.9%) improved and were discharged within 30 days of admission. Overall in-hospital mortality was 13.2% (95% CI: 10.9-15.8), and almost 50% among those in the ICU. Independent risk factors for death were age < 20 years (adjusted hazard ratio [aHR] = 6.62, 95% CI: 1.85-23.64), 40-59 years (aHR = 4.45, 95% CI: 1.83-10.79), and ≥ 60 years (aHR = 13.63, 95% CI: 5.70-32.60) compared with those aged 20-39 years, with obesity (aHR = 2.30, 95% CI: 1.24-4.27), and with chronic kidney disease (aHR = 5.33, 95% CI: 1.85-15.35). In marginal structural model analysis, there was no statistically significant difference in odds of clinical improvement (adjusted odds ratio [aOR] = 1.53, 95% CI: 0.88-2.67, P = 0.132) nor risk of death (aOR = 0.65, 95% CI: 0.35-1.20) when comparing the use of chloroquine/azithromycin versus other treatments. In this DRC study, the high mortality among patients aged < 20 years and with severe/critical disease is of great concern, and requires further research for confirmation and targeted interventions.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel Katuashi Ishoso
- Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - John Otshudiema Otokoye
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Rhoderick Neri Machekano
- African Center of Biostatistics Excellence (ACBE), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nadia A Sam-Agudu
- Department of Paediatrics, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.,International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christian Bongo-Pasi Nswe
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo.,Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Joule Ntwan Madinga
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Stéphane Mukendi
- Department of Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie Claire Kolié
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Edith N Nkwembe
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Gisele M Mbuyi
- Direction Surveillance Épidémiologique (DSE), Direction Générale de Lutte contre la Maladie (DGLM), Ministère de la Santé Publique et Riposte COVID-19, Kinshasa, Democratic Republic of the Congo
| | - Justus M Nsio
- Direction Surveillance Épidémiologique (DSE), Direction Générale de Lutte contre la Maladie (DGLM), Ministère de la Santé Publique et Riposte COVID-19, Kinshasa, Democratic Republic of the Congo
| | | | - Michel Tshiasuma Pipo
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - Gerald Smith
- Department of Real World & Advanced Analytics, Cytel, Vancouver, Canada
| | - Edward J Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Alimuddin Zumla
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom
| | - Don Jethro Mavungu Landu
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo.,Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo
| | - Jean-Marie Kayembe
- Department of Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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43
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Nachega JB, Mbala-Kingebeni P, Otshudiema J, Mobula LM, Preiser W, Kallay O, Michaels-Strasser S, Breman JG, Rimoin AW, Nsio J, Ahuka-Mundeke S, Zumla A, Muyembe Tam-Fum JJ. Responding to the Challenge of the Dual COVID-19 and Ebola Epidemics in the Democratic Republic of Congo-Priorities for Achieving Control. Am J Trop Med Hyg 2020; 103:597-602. [PMID: 32563272 PMCID: PMC7410434 DOI: 10.4269/ajtmh.20-0642] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
As of June 11, 2020, the Democratic Republic of the Congo (DRC) has reported 4,258 COVID-19 cases with 90 deaths. With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. The DRC recently controlled its tenth Ebola virus disease (EVD) outbreak, but COVID-19 and a new EVD outbreak beginning on June 1, 2020 in the northwest Équateur Province have added an additional burden to health services. Although the epidemiology and transmission of EVD and COVID-19 differ, leveraging the public health infrastructures and experiences from coordinating the EVD response to guide the public health response to COVID-19 is critical. Building on the DRC’s 40 years of experience with 10 previous EVD outbreaks, we highlight the DRC’s multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. We also highlight remaining challenges and discuss the way forward for achieving control of both COVID-19 and EVD in the DRC.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - John Otshudiema
- Health Emergencies Program, COVID-19 Response, Epidemiological Surveillance Team, World Health Organisation, Kinshasa, Democratic Republic of the Congo
| | - Linda M Mobula
- Ebola Response Team, Health, Nutrition and Population, Global Practice, World Bank Group, Washington, District of Columbia
| | - Wolfgang Preiser
- National Health Laboratory Service (NHLS), Cape Town, South Africa.,Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oscar Kallay
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Joel G Breman
- American Society of Tropical Medicine and Hygiene and United States National Institutes of Health, Fogarty International Center, Bethesda, Maryland
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Justus Nsio
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom.,Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
| | - Jean-Jacques Muyembe Tam-Fum
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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44
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Mbala-Kingebeni P, Villabona-Arenas CJ, Vidal N, Likofata J, Nsio-Mbeta J, Makiala-Mandanda S, Mukadi D, Mukadi P, Kumakamba C, Djokolo B, Ayouba A, Delaporte E, Peeters M, Muyembe Tamfum JJ, Ahuka-Mundeke S. Rapid Confirmation of the Zaire Ebola Virus in the Outbreak of the Equateur Province in the Democratic Republic of Congo: Implications for Public Health Interventions. Clin Infect Dis 2020; 68:330-333. [PMID: 29961823 PMCID: PMC6321851 DOI: 10.1093/cid/ciy527] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 12/22/2022] Open
Abstract
Ten days after the declaration of the Ebola outbreak in the Democratic Republic of Congo, rapid identification of the species Zaire Ebola virus using partial gene amplification and nanopore sequencing backed up the use of the recombinant vesicular stomatitis virus–Zaire Ebola virus vaccine in the recommended ring vaccination strategy.
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Affiliation(s)
- Placide Mbala-Kingebeni
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | - Christian-Julian Villabona-Arenas
- Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | - Nicole Vidal
- Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | | | | | - Sheila Makiala-Mandanda
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
| | - Daniel Mukadi
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
| | - Patrick Mukadi
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
| | - Charles Kumakamba
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,6Metabiota Inc., Kinshasa, Democratic Republic of Congo
| | | | - Ahidjo Ayouba
- Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | - Eric Delaporte
- Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | - Martine Peeters
- Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | - Jean-Jacques Muyembe Tamfum
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- National Institute of Biomedical Research, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
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45
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Deng X, Achari A, Federman S, Yu G, Somasekar S, Bártolo I, Yagi S, Mbala-Kingebeni P, Kapetshi J, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Ahmed AA, Ganesh V, Tamhankar M, Patterson JL, Ndembi N, Mbanya D, Kaptue L, McArthur C, Muñoz-Medina JE, Gonzalez-Bonilla CR, López S, Arias CF, Arevalo S, Miller S, Stone M, Busch M, Hsieh K, Messenger S, Wadford DA, Rodgers M, Cloherty G, Faria NR, Thézé J, Pybus OG, Neto Z, Morais J, Taveira N, Hackett JR, Chiu CY. Author Correction: Metagenomic sequencing with spiked primer enrichment for viral diagnostics and genomic surveillance. Nat Microbiol 2020; 5:525. [PMID: 31965087 PMCID: PMC7608365 DOI: 10.1038/s41564-020-0671-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Xianding Deng
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Asmeeta Achari
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Guixia Yu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Sneha Somasekar
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Inês Bártolo
- Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Shigeo Yagi
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | | | - Jimmy Kapetshi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Asim A Ahmed
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Vijay Ganesh
- Massachussetts General Hospital, Boston, MA, USA
| | - Manasi Tamhankar
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jean L Patterson
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Nicaise Ndembi
- Institute for Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dora Mbanya
- Universite de Yaoundé I, Yaoundé, Cameroon.,University of Bamenda, Bamenda, Cameroon
| | | | | | | | | | - Susana López
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Carlos F Arias
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Shaun Arevalo
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Michael Busch
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Kristina Hsieh
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | - Sharon Messenger
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | - Debra A Wadford
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | | | | | - Nuno R Faria
- Department of Zoology, University of Oxford, Oxford, UK
| | - Julien Thézé
- Department of Zoology, University of Oxford, Oxford, UK
| | | | - Zoraima Neto
- Angolan National Institute of Health Research, Luanda, Angola
| | - Joana Morais
- Angolan National Institute of Health Research, Luanda, Angola
| | - Nuno Taveira
- Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.,Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, Portugal
| | | | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA. .,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA. .,Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA.
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46
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Deng X, Achari A, Federman S, Yu G, Somasekar S, Bártolo I, Yagi S, Mbala-Kingebeni P, Kapetshi J, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Ahmed AA, Ganesh V, Tamhankar M, Patterson JL, Ndembi N, Mbanya D, Kaptue L, McArthur C, Muñoz-Medina JE, Gonzalez-Bonilla CR, López S, Arias CF, Arevalo S, Miller S, Stone M, Busch M, Hsieh K, Messenger S, Wadford DA, Rodgers M, Cloherty G, Faria NR, Thézé J, Pybus OG, Neto Z, Morais J, Taveira N, R Hackett J, Chiu CY. Metagenomic sequencing with spiked primer enrichment for viral diagnostics and genomic surveillance. Nat Microbiol 2020; 5:443-454. [PMID: 31932713 PMCID: PMC7047537 DOI: 10.1038/s41564-019-0637-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/08/2019] [Indexed: 12/27/2022]
Abstract
Metagenomic next-generation sequencing (mNGS), the shotgun sequencing of RNA and DNA from clinical samples, has proved useful for broad-spectrum pathogen detection and the genomic surveillance of viral outbreaks. An additional target enrichment step is generally needed for high-sensitivity pathogen identification in low-titre infections, yet available methods using PCR or capture probes can be limited by high cost, narrow scope of detection, lengthy protocols and/or cross-contamination. Here, we developed metagenomic sequencing with spiked primer enrichment (MSSPE), a method for enriching targeted RNA viral sequences while simultaneously retaining metagenomic sensitivity for other pathogens. We evaluated MSSPE for 14 different viruses, yielding a median tenfold enrichment and mean 47% (±16%) increase in the breadth of genome coverage over mNGS alone. Virus detection using MSSPE arboviral or haemorrhagic fever viral panels was comparable in sensitivity to specific PCR, demonstrating 95% accuracy for the detection of Zika, Ebola, dengue, chikungunya and yellow fever viruses in plasma samples from infected patients. Notably, sequences from re-emerging and/or co-infecting viruses that have not been specifically targeted a priori, including Powassan and Usutu, were successfully enriched using MSSPE. MSSPE is simple, low cost, fast and deployable on either benchtop or portable nanopore sequencers, making this method directly applicable for diagnostic laboratory and field use. This study describes a new method that improves the sensitivity of viral detection compared with next-generation sequencing and enables the detection of emerging flaviviruses not specifically targeted a priori. Metagenomic sequencing with spiked primer enrichment is simple, low cost, fast and deployable on either benchtop or portable nanopore sequencers, making it applicable for diagnostic laboratory and field use.
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Affiliation(s)
- Xianding Deng
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Asmeeta Achari
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Guixia Yu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Sneha Somasekar
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Inês Bártolo
- Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Shigeo Yagi
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | | | - Jimmy Kapetshi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Asim A Ahmed
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Vijay Ganesh
- Massachussetts General Hospital, Boston, MA, USA
| | - Manasi Tamhankar
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jean L Patterson
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Nicaise Ndembi
- Institute for Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dora Mbanya
- Universite de Yaoundé I, Yaoundé, Cameroon.,University of Bamenda, Bamenda, Cameroon
| | | | | | | | | | - Susana López
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Carlos F Arias
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Shaun Arevalo
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Michael Busch
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Kristina Hsieh
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | - Sharon Messenger
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | - Debra A Wadford
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, USA
| | | | | | - Nuno R Faria
- Department of Zoology, University of Oxford, Oxford, UK
| | - Julien Thézé
- Department of Zoology, University of Oxford, Oxford, UK
| | | | - Zoraima Neto
- Angolan National Institute of Health Research, Luanda, Angola
| | - Joana Morais
- Angolan National Institute of Health Research, Luanda, Angola
| | - Nuno Taveira
- Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.,Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, Portugal
| | | | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA. .,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA. .,Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA.
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47
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Mulangu S, Dodd LE, Davey RT, Tshiani Mbaya O, Proschan M, Mukadi D, Lusakibanza Manzo M, Nzolo D, Tshomba Oloma A, Ibanda A, Ali R, Coulibaly S, Levine AC, Grais R, Diaz J, Lane HC, Muyembe-Tamfum JJ, Sivahera B, Camara M, Kojan R, Walker R, Dighero-Kemp B, Cao H, Mukumbayi P, Mbala-Kingebeni P, Ahuka S, Albert S, Bonnett T, Crozier I, Duvenhage M, Proffitt C, Teitelbaum M, Moench T, Aboulhab J, Barrett K, Cahill K, Cone K, Eckes R, Hensley L, Herpin B, Higgs E, Ledgerwood J, Pierson J, Smolskis M, Sow Y, Tierney J, Sivapalasingam S, Holman W, Gettinger N, Vallée D, Nordwall J. A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. N Engl J Med 2019; 381:2293-2303. [PMID: 31774950 PMCID: PMC10680050 DOI: 10.1056/nejmoa1910993] [Citation(s) in RCA: 985] [Impact Index Per Article: 197.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial. METHODS We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase-polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days. RESULTS A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P = 0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P = 0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs. CONCLUSIONS Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks and can help inform the outbreak response. (Funded by the National Institute of Allergy and Infectious Diseases and others; PALM ClinicalTrials.gov number, NCT03719586.).
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Affiliation(s)
- Sabue Mulangu
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Lori E Dodd
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Richard T Davey
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Olivier Tshiani Mbaya
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Michael Proschan
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Daniel Mukadi
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Mariano Lusakibanza Manzo
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Didier Nzolo
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Antoine Tshomba Oloma
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Augustin Ibanda
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Rosine Ali
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Sinaré Coulibaly
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Adam C Levine
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Rebecca Grais
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Janet Diaz
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - H Clifford Lane
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Jean-Jacques Muyembe-Tamfum
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Billy Sivahera
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Modet Camara
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Richard Kojan
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Robert Walker
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Bonnie Dighero-Kemp
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Huyen Cao
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Philippe Mukumbayi
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Placide Mbala-Kingebeni
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Steve Ahuka
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Sarah Albert
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Tyler Bonnett
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Ian Crozier
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Michael Duvenhage
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Calvin Proffitt
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Marc Teitelbaum
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Thomas Moench
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Jamila Aboulhab
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Kevin Barrett
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Kelly Cahill
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Katherine Cone
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Risa Eckes
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Lisa Hensley
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Betsey Herpin
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Elizabeth Higgs
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Julie Ledgerwood
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Jerome Pierson
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Mary Smolskis
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Ydrissa Sow
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - John Tierney
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Sumathi Sivapalasingam
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Wendy Holman
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Nikki Gettinger
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - David Vallée
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
| | - Jacqueline Nordwall
- From Institut National de Recherche Biomédicale, Democratic Republic of Congo (S.M., O.T.M., D.M., M.L.M., D.N., A.T.O., A.I., R.A., J.-J.M.-T.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (L.E.D., R.T.D., M.P., H.C.L.); the Alliance for International Medical Action, Dakar, Senegal (S.C.); International Medical Corps, Los Angeles (A.C.L.); Epicentre, Médecins sans Frontières, Paris (R.G.); and the World Health Organization, Geneva (J.D.).The affiliations of the members of the PALM Writing Group are as follows: the Alliance for International Medical Action (B.S., M.C., R.K.); the Biomedical Advanced Research and Development Authority (R.W.); Battelle (B.D.-K.); Gilead (H.C.); Institut National de Recherche Biomédicale (P.M., P.M.-K., S. Ahuka); Leidos (S. Albert, T.B., I.C., M.D., C.P., M.T.); Mapp Biopharmaceutical (T.M.); the National Institute of Allergy and Infectious Diseases (J.A., K.B., K. Cahill, K. Cone, R.E., L.H., B.H., E.H., J.L., J.P., M.S., Y.S., J.T.); Regeneron (S.S.); Ridgeback Biotherapeutics (W.H.); the Mitchell Group (N.G., D.V.); and University of Minnesota (J.N.)
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Kelly JD, Park J, Harrigan RJ, Hoff NA, Lee SD, Wannier R, Selo B, Mossoko M, Njoloko B, Okitolonda-Wemakoy E, Mbala-Kingebeni P, Rutherford GW, Smith TB, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Rimoin AW, Schoenberg FP. Real-time predictions of the 2018-2019 Ebola virus disease outbreak in the Democratic Republic of the Congo using Hawkes point process models. Epidemics 2019; 28:100354. [PMID: 31395373 PMCID: PMC7358183 DOI: 10.1016/j.epidem.2019.100354] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022] Open
Abstract
As of June 16, 2019, an Ebola virus disease (EVD) outbreak has led to 2136 reported cases in the northeastern region of the Democratic Republic of the Congo (DRC). As this outbreak continues to threaten the lives and livelihoods of people already suffering from civil strife and armed conflict, relatively simple mathematical models and their short-term predictions have the potential to inform Ebola response efforts in real time. We applied recently developed non-parametrically estimated Hawkes point processes to model the expected cumulative case count using daily case counts from May 3, 2018, to June 16, 2019, initially reported by the Ministry of Health of DRC and later confirmed in World Health Organization situation reports. We generated probabilistic estimates of the ongoing EVD outbreak in DRC extending both before and after June 16, 2019, and evaluated their accuracy by comparing forecasted vs. actual outbreak sizes, out-of-sample log-likelihood scores and the error per day in the median forecast. The median estimated outbreak sizes for the prospective thee-, six-, and nine-week projections made using data up to June 16, 2019, were, respectively, 2317 (95% PI: 2222, 2464); 2440 (95% PI: 2250, 2790); and 2544 (95% PI: 2273, 3205). The nine-week projection experienced some degradation with a daily error in the median forecast of 6.73 cases, while the six- and three-week projections were more reliable, with corresponding errors of 4.96 and 4.85 cases per day, respectively. Our findings suggest the Hawkes point process may serve as an easily-applied statistical model to predict EVD outbreak trajectories in near real-time to better inform decision-making and resource allocation during Ebola response efforts.
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Affiliation(s)
- J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; F.I. Proctor Foundation, University of California, San Francisco, CA USA.
| | - Junhyung Park
- Department of Statistics, University of California, Los Angeles, CA, USA
| | - Ryan J Harrigan
- Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Sarita D Lee
- Department of Statistics, University of California, Los Angeles, CA, USA
| | - Rae Wannier
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | | | | | | | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas B Smith
- Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, CA, USA
| | | | | | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles, CA, USA
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Wannier SR, Worden L, Hoff NA, Amezcua E, Selo B, Sinai C, Mossoko M, Njoloko B, Okitolonda-Wemakoy E, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Richardson ET, Rutherford GW, Jones JH, Lietman TM, Rimoin AW, Porco TC, Kelly JD. Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018-2019. Epidemics 2019; 28:100353. [PMID: 31378584 PMCID: PMC7363034 DOI: 10.1016/j.epidem.2019.100353] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/22/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION As of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. METHODS We collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018-2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. RESULTS As of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013-2016 West African outbreak. CONCLUSION The difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak.
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Affiliation(s)
- S Rae Wannier
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lee Worden
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA
| | - Eduardo Amezcua
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bernice Selo
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Cyrus Sinai
- Department of Geography at University of North Carolina, Chapel Hill, NC, USA
| | | | - Bathe Njoloko
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | - Steve Ahuka-Mundeke
- Insitut National de Recherche Biomedicale, Kinshasa, Democratic Republic of Congo
| | | | | | - George W Rutherford
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA
| | - James H Jones
- Department of Earth System Science, Stanford University, Stanford, CA, USA; Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - J Daniel Kelly
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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