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Shu Q, Kenny T, Fan J, Lyon CJ, Cazares LH, Hu TY. Species-specific quantification of circulating ebolavirus burden using VP40-derived peptide variants. PLoS Pathog 2021; 17:e1010039. [PMID: 34748613 PMCID: PMC8601621 DOI: 10.1371/journal.ppat.1010039] [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: 05/25/2021] [Revised: 11/18/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
Six ebolavirus species are reported to date, including human pathogens Bundibugyo virus (BDBV), Ebola virus (EBOV), Sudan virus (SUDV), and Taï Forest virus (TAFV); non-human pathogen Reston virus (RESTV); and the plausible Bombali virus (BOMV). Since there are differences in the disease severity caused by different species, species identification and viral burden quantification are critical for treating infected patients timely and effectively. Here we developed an immunoprecipitation-coupled mass spectrometry (IP-MS) assay for VP40 antigen detection and quantification. We carefully selected two regions of VP40, designated as peptide 8 and peptide12 from the protein sequence that showed minor variations among Ebolavirus species through MS analysis of tryptic peptides and antigenicity prediction based on available bioinformatic tools, and generated high-quality capture antibodies pan-specific for these variant peptides. We applied this assay to human plasma spiked with recombinant VP40 protein from EBOV, SUDV, and BDBV and virus-like particles (VLP), as well as EBOV infected NHP plasma. Sequence substitutions between EBOV and SUDV, the two species with highest lethality, produced affinity variations of 2.6-fold for p8 and 19-fold for p12. The proposed IP-MS assay differentiates four of the six known EBV species in one assay, through a combination of p8 and p12 data. The IP-MS assay limit of detection (LOD) using multiple reaction monitoring (MRM) as signal readout was determined to be 28 ng/mL and 7 ng/mL for EBOV and SUDV respectively, equivalent to ~1.625-6.5×105 Geq/mL, and comparable to the LOD of lateral flow immunoassays currently used for Ebola surveillance. The two peptides of the IP-MS assay were also identified by their tandem MS spectra using a miniature MALDI-TOF MS instrument, greatly increasing the feasibility of high specificity assay in a decentralized laboratory.
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Affiliation(s)
- Qingbo Shu
- Center for Cellular and Molecular Diagnostics, Department of Biochemistry and Molecular Biology, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Tara Kenny
- Systems and Structural Biology Division, Protein Sciences Branch, U.S. Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America
| | - Jia Fan
- Center for Cellular and Molecular Diagnostics, Department of Biochemistry and Molecular Biology, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Christopher J. Lyon
- Center for Cellular and Molecular Diagnostics, Department of Biochemistry and Molecular Biology, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Lisa H. Cazares
- Systems and Structural Biology Division, Protein Sciences Branch, U.S. Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America
| | - Tony Y. Hu
- Center for Cellular and Molecular Diagnostics, Department of Biochemistry and Molecular Biology, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
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2
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Bratcher A, Hoff NA, Doshi RH, Gadoth A, Halbrook M, Mukadi P, Musene K, Ilunga-Kebela B, Spencer D, Bramble MS, McIlwan D, Kelly JD, Mukadi D, Kingebeni PM, Ahuka S, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Zoonotic risk factors associated with seroprevalence of Ebola virus GP antibodies in the absence of diagnosed Ebola virus disease in the Democratic Republic of Congo. PLoS Negl Trop Dis 2021; 15:e0009566. [PMID: 34383755 PMCID: PMC8384205 DOI: 10.1371/journal.pntd.0009566] [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: 01/05/2021] [Revised: 08/24/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ebola virus (EBOV) is a zoonotic filovirus spread through exposure to infected bodily fluids of a human or animal. Though EBOV is capable of causing severe disease, referred to as Ebola Virus Disease (EVD), individuals who have never been diagnosed with confirmed, probable or suspected EVD can have detectable EBOV antigen-specific antibodies in their blood. This study aims to identify risk factors associated with detectable antibody levels in the absence of an EVD diagnosis. METHODOLOGY Data was collected from September 2015 to August 2017 from 1,366 consenting individuals across four study sites in the DRC (Boende, Kabondo-Dianda, Kikwit, and Yambuku). Seroreactivity was determined to EBOV GP IgG using Zaire Ebola Virus Glycoprotein (EBOV GP antigen) ELISA kits (Alpha Diagnostic International, Inc.) in Kinshasa, DRC; any result above 4.7 units/mL was considered seroreactive. Among the respondents, 113 (8.3%) were considered seroreactive. Several zoonotic exposures were associated with EBOV seroreactivity after controlling for age, sex, healthcare worker status, location, and history of contact with an EVD case, namely: ever having contact with bats, ever having contact with rodents, and ever eating non-human primate meat. Contact with monkeys or non-human primates was not associated with seroreactivity. CONCLUSIONS This analysis suggests that some zoonotic exposures that have been linked to EVD outbreaks can also be associated with EBOV GP seroreactivity in the absence of diagnosed EVD. Future investigations should seek to clarify the relationships between zoonotic exposures, seroreactivity, asymptomatic infection, and EVD.
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Affiliation(s)
- Anna Bratcher
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Nicole A. Hoff
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Reena H. Doshi
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Adva Gadoth
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Megan Halbrook
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | - Kamy Musene
- Kinshasa School of Public Health, Kinshasa, DRC
| | - Benoit Ilunga-Kebela
- Direction de lutte contre la maladie-Ministère de la santé Publique, Kinshasa, DRC
| | - D’Andre Spencer
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Matthew S. Bramble
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington DC, United States of America
| | - David McIlwan
- Department of Microbiology and Immunology, Stanford University, Stanford, California, United States of America
| | - J. Daniel Kelly
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Daniel Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | | | - Steve Ahuka
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | | | | | - Anne W. Rimoin
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
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3
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He L, Chaudhary A, Lin X, Sou C, Alkutkar T, Kumar S, Ngo T, Kosviner E, Ozorowski G, Stanfield RL, Ward AB, Wilson IA, Zhu J. Single-component multilayered self-assembling nanoparticles presenting rationally designed glycoprotein trimers as Ebola virus vaccines. Nat Commun 2021; 12:2633. [PMID: 33976149 DOI: 10.1101/2020.08.22.262634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/27/2021] [Accepted: 04/06/2021] [Indexed: 05/27/2023] Open
Abstract
Ebola virus (EBOV) glycoprotein (GP) can be recognized by neutralizing antibodies (NAbs) and is the main target for vaccine design. Here, we first investigate the contribution of the stalk and heptad repeat 1-C (HR1C) regions to GP metastability. Specific stalk and HR1C modifications in a mucin-deleted form (GPΔmuc) increase trimer yield, whereas alterations of HR1C exert a more complex effect on thermostability. Crystal structures are determined to validate two rationally designed GPΔmuc trimers in their unliganded state. We then display a modified GPΔmuc trimer on reengineered protein nanoparticles that encapsulate a layer of locking domains (LD) and a cluster of helper T-cell epitopes. In mice and rabbits, GP trimers and nanoparticles elicit cross-ebolavirus NAbs, as well as non-NAbs that enhance pseudovirus infection. Repertoire sequencing reveals quantitative profiles of vaccine-induced B-cell responses. This study demonstrates a promising vaccine strategy for filoviruses, such as EBOV, based on GP stabilization and nanoparticle display.
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MESH Headings
- Animals
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antigens, Viral/administration & dosage
- Antigens, Viral/genetics
- Antigens, Viral/immunology
- Antigens, Viral/ultrastructure
- B-Lymphocytes/immunology
- Crystallography, X-Ray
- Disease Models, Animal
- Ebola Vaccines/administration & dosage
- Ebola Vaccines/genetics
- Ebola Vaccines/immunology
- Ebolavirus/genetics
- Ebolavirus/immunology
- Epitopes, T-Lymphocyte/administration & dosage
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Epitopes, T-Lymphocyte/ultrastructure
- Female
- Glycoproteins/administration & dosage
- Glycoproteins/genetics
- Glycoproteins/immunology
- Glycoproteins/ultrastructure
- Hemorrhagic Fever, Ebola/blood
- Hemorrhagic Fever, Ebola/immunology
- Hemorrhagic Fever, Ebola/therapy
- Hemorrhagic Fever, Ebola/virology
- Humans
- Mice
- Nanoparticles/chemistry
- Protein Domains/genetics
- Protein Domains/immunology
- Protein Engineering
- Protein Multimerization/genetics
- Protein Multimerization/immunology
- Protein Stability
- Rabbits
- T-Lymphocytes, Helper-Inducer/immunology
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/genetics
- Vaccines, Subunit/immunology
- Viral Proteins/administration & dosage
- Viral Proteins/genetics
- Viral Proteins/immunology
- Viral Proteins/ultrastructure
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Affiliation(s)
- Linling He
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Anshul Chaudhary
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Xiaohe Lin
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Cindy Sou
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Tanwee Alkutkar
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Sonu Kumar
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Timothy Ngo
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ezra Kosviner
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Gabriel Ozorowski
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Robyn L Stanfield
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Andrew B Ward
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ian A Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA.
- Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA, USA.
| | - Jiang Zhu
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA.
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA.
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4
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Thom R, Tipton T, Strecker T, Hall Y, Akoi Bore J, Maes P, Raymond Koundouno F, Fehling SK, Krähling V, Steeds K, Varghese A, Bailey G, Matheson M, Kouyate S, Coné M, Moussa Keita B, Kouyate S, Richard Ablam A, Laenen L, Vergote V, Guiver M, Timothy J, Atkinson B, Ottowell L, Richards KS, Bosworth A, Longet S, Mellors J, Pannetier D, Duraffour S, Muñoz-Fontela C, Sow O, Koivogui L, Newman E, Becker S, Sprecher A, Raoul H, Hiscox J, Henao-Restrepo AM, Sakoba K, Magassouba N, Günther S, Kader Konde M, Carroll MW. Longitudinal antibody and T cell responses in Ebola virus disease survivors and contacts: an observational cohort study. Lancet Infect Dis 2021; 21:507-516. [PMID: 33065039 PMCID: PMC7553754 DOI: 10.1016/s1473-3099(20)30736-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The 2013-16 Ebola virus disease epidemic in west Africa caused international alarm due to its rapid and extensive spread resulting in a significant death toll and social unrest within the affected region. The large number of cases provided an opportunity to study the long-term kinetics of Zaire ebolavirus-specific immune response of survivors in addition to known contacts of those infected with the virus. METHODS In this observational cohort study, we worked with leaders of Ebola virus disease survivor associations in two regions of Guinea, Guéckédou and Coyah, to recruit survivors of Ebola virus disease, contacts from households of individuals known to have had Ebola virus disease, and individuals who were not knowingly associated with infected individuals or had not had Ebola virus disease symptoms to serve as negative controls. We did Zaire ebolavirus glycoprotein-specific T cell analysis on peripheral blood mononuclear cells (PBMCs) on location in Guinea and transported plasma and PBMCs back to Europe for antibody quantification by ELISA, functional neutralising antibody analysis using live Zaire ebolavirus, and T cell phenotype studies. We report on the longitudinal cellular and humoral response among Ebola virus disease survivors and highlight potentially paucisymptomatic infection. FINDINGS We recruited 117 survivors of Ebola virus disease, 66 contacts, and 23 negative controls. The mean neutralising antibody titre among the Ebola virus disease survivors 3-14 months after infection was 1/174 (95% CI 1/136-1/223). Individual results varied greatly from 1/10 to more than 1/1000 but were on average ten times greater than that induced after 1 month by single dose Ebola virus vaccines. Following reactivation with glycoprotein peptide, the mean T cell responses among 116 Ebola virus disease survivors as measured by ELISpot was 305 spot-forming units (95% CI 257-353). The dominant CD8+ polyfunctional T cell phenotype, as measured among 53 Ebola virus disease survivors, was interferon γ+, tumour necrosis factor+, interleukin-2-, and the mean response was 0·046% of total CD8+ T cells (95% CI 0·021-0·071). Additionally, both neutralising antibody and T cell responses were detected in six (9%) of 66 Ebola virus disease contacts. We also noted that four (3%) of 117 individuals with Ebola virus disease infections did not have circulating Ebola virus-specific antibodies 3 months after infection. INTERPRETATION The continuous high titre of neutralising antibodies and increased T cell response might support the concept of long-term protective immunity in survivors. The existence of antibody and T cell responses in contacts of individuals with Ebola virus disease adds further evidence to the existence of sub-clinical Ebola virus infection. FUNDING US Food & Drug Administration, Horizon 2020 EU EVIDENT, Wellcome, UK Department for International Development. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibodies, Viral/isolation & purification
- Child
- Child, Preschool
- Ebolavirus/immunology
- Ebolavirus/pathogenicity
- Epidemics
- Female
- Guinea/epidemiology
- Hemorrhagic Fever, Ebola/blood
- Hemorrhagic Fever, Ebola/immunology
- Hemorrhagic Fever, Ebola/transmission
- Hemorrhagic Fever, Ebola/virology
- Humans
- Immunity, Cellular
- Immunity, Humoral
- Infant
- Infant, Newborn
- Longitudinal Studies
- Male
- Middle Aged
- Survivors/statistics & numerical data
- T-Lymphocytes/immunology
- Time Factors
- Young Adult
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Affiliation(s)
- Ruth Thom
- National Infection Service, Public Health England, Porton Down, UK
| | - Thomas Tipton
- National Infection Service, Public Health England, Porton Down, UK
| | - Thomas Strecker
- Institute of Virology, Philipps University of Marburg, Marburg, Germany
| | - Yper Hall
- National Infection Service, Public Health England, Porton Down, UK
| | - Joseph Akoi Bore
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea; Ministry of Health Guinea, Conakry, Guinea
| | - Piet Maes
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Fara Raymond Koundouno
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Ministry of Health Guinea, Conakry, Guinea
| | | | - Verena Krähling
- Institute of Virology, Philipps University of Marburg, Marburg, Germany; German Center for Infection Research, Partner Site Gießen-Marburg-Langen, Marburg, Germany
| | - Kimberley Steeds
- National Infection Service, Public Health England, Porton Down, UK
| | - Anitha Varghese
- National Infection Service, Public Health England, Porton Down, UK
| | - Graham Bailey
- Biodiscovery Institute, School of Medicine, University of Nottingham, UK
| | - Mary Matheson
- National Infection Service, Public Health England, Porton Down, UK
| | - Saidou Kouyate
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Moussa Coné
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Balla Moussa Keita
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Sekou Kouyate
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Amento Richard Ablam
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Lies Laenen
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | | | - Malcolm Guiver
- Public Health Laboratory, National Infection Service, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Joseph Timothy
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Barry Atkinson
- National Infection Service, Public Health England, Porton Down, UK
| | - Lisa Ottowell
- National Infection Service, Public Health England, Porton Down, UK
| | - Kevin S Richards
- National Infection Service, Public Health England, Porton Down, UK
| | - Andrew Bosworth
- National Infection Service, Public Health England, Porton Down, UK
| | - Stephanie Longet
- National Infection Service, Public Health England, Porton Down, UK
| | - Jack Mellors
- National Infection Service, Public Health England, Porton Down, UK; Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Sophie Duraffour
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Oumou Sow
- National Ethics Committee for Health Research, Conakry, Guinea
| | | | - Edmund Newman
- National Infection Service, Public Health England, Porton Down, UK
| | - Stephan Becker
- Institute of Virology, Philipps University of Marburg, Marburg, Germany; German Center for Infection Research, Partner Site Gießen-Marburg-Langen, Marburg, Germany
| | | | - Herve Raoul
- P4 Jean Mérieux-Inserm Laboratory, Lyon, France
| | - Julian Hiscox
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Keita Sakoba
- Projet Laboratoire Fièvres Hémorragiques, Conakry, Guinea
| | | | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Mandy Kader Konde
- Center for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Miles W Carroll
- National Infection Service, Public Health England, Porton Down, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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5
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Ottoni MP, Ricciardone JD, Nadimpalli A, Singh S, Katsomya AM, Pokoso LM, Petrucci R. Ebola-negative neonates born to Ebola-infected mothers after monoclonal antibody therapy: a case series. Lancet Child Adolesc Health 2021; 4:884-888. [PMID: 33217357 DOI: 10.1016/s2352-4642(20)30278-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few fetuses survive childbirth when the mother is positive for Ebola virus, with almost all being miscarried or stillborn, or dying shortly after birth. Before 2019, only two infants had been reported surviving past 28 days, of whom one tested positive for Ebola virus and subsequently received experimental therapies. Little is understood regarding the care of surviving neonates born to Ebola virus-positive mothers in the postnatal period and how novel anti-Ebola virus therapies might affect neonatal outcomes. METHODS In this case series, we report on two neonates liveborn during the 2018-20 North Kivu Ebola epidemic in the Democratic Republic of the Congo who, along with their Ebola virus-positive mothers, received investigational monoclonal antibody treatment (mAB114 or REGN-EB3) as part of a randomised controlled trial (NCT03719586). FINDINGS Both infants were born Ebola-negative and progressed well while in the Ebola Treatment Centre. Neither neonate developed evidence of Ebola virus disease during the course of the admission, and both were Ebola-negative at 21 days and remained healthy at discharge. INTERPRETATION To our knowledge these neonates are the first documented as Ebola virus-negative at birth after being born to Ebola virus-positive mothers, and only the third and fourth neonates ever documented to have survived into infancy. Although no conclusions can be drawn from this small case series, and further research is required to investigate the neonatal effects of antibody therapies, these cases warrant review regarding whether post-delivery antibody therapy should be considered for all liveborn neonates of Ebola virus-positive mothers. In the context of a low resource setting, where survival of low-birthweight infants is poor, these cases also highlight the importance of adequate neonatal care. FUNDING None.
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6
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Olu OO, Lako R, Bunga S, Berta K, Kol M, Ramadan PO, Ryan C, Udenweze I, Guyo AG, Conteh I, Huda Q, Gai M, Saulo D, Papowitz H, Gray HJ, Chimbaru A, Wangdi K, Grube SM, Barr BT, Wamala JF. Analyses of the performance of the Ebola virus disease alert management system in South Sudan: August 2018 to November 2019. PLoS Negl Trop Dis 2020; 14:e0008872. [PMID: 33253169 PMCID: PMC7728195 DOI: 10.1371/journal.pntd.0008872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/29/2020] [Revised: 12/10/2020] [Accepted: 10/10/2020] [Indexed: 12/02/2022] Open
Abstract
South Sudan implemented Ebola virus disease preparedness interventions aiming at preventing and rapidly containing any importation of the virus from the Democratic Republic of Congo starting from August 2018. One of these interventions was a surveillance system which included an Ebola alert management system. This study analyzed the performance of this system. A descriptive cross-sectional study of the Ebola virus disease alerts which were reported in South Sudan from August 2018 to November 2019 was conducted using both quantitative and qualitative methods. As of 30 November 2019, a total of 107 alerts had been detected in the country out of which 51 (47.7%) met the case definition and were investigated with blood samples collected for laboratory confirmation. Most (81%) of the investigated alerts were South Sudanese nationals. The alerts were identified by health workers (53.1%) at health facilities, at the community (20.4%) and by screeners at the points of entry (12.2%). Most of the investigated alerts were detected from the high-risk states of Gbudwe (46.9%), Jubek (16.3%) and Torit (10.2%). The investigated alerts commonly presented with fever, bleeding, headache and vomiting. The median timeliness for deployment of Rapid Response Team was less than one day and significantly different between the 6-month time periods (K-W = 7.7567; df = 2; p = 0.0024) from 2018 to 2019. Strengths of the alert management system included existence of a dedicated national alert hotline, case definition for alerts and rapid response teams while the weaknesses were occasional inability to access the alert toll-free hotline and lack of transport for deployment of the rapid response teams which often constrain quick response. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provides evidence to further improve Ebola preparedness in the country. The Democratic Republic of Congo announced its tenth outbreak of the Ebola virus disease on 1st August 2018. As part of the preparedness measures to prevent and rapidly contain any importation of the virus, South Sudan, a neighbouring country to the Democratic Republic of Congo implemented a surveillance system which included an Ebola alert management system. We analyzed the performance of this system with a view to provide information to inform planning and allocation of resources to the other components of Ebola virus disease preparedness and to understand the key issues and challenges with the system. Our findings show that more than half of the reported alerts did not meet the case definition of the disease, alerts were mainly detected in the high-risk states, the commonest source of alert detection were from health facilities and the community and the most common symptoms presented by the alerts were fever, bleeding, headache, vomiting and weakness/fatigue. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provided evidence to further improve Ebola preparedness in the country. We recommend that the observed challenges should be urgently addressed.
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Affiliation(s)
- Olushayo Oluseun Olu
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Richard Lako
- National Ebola virus disease Incident Management Team Ministry of Health, Republic of South Sudan
| | - Sudhir Bunga
- United States Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Kibebu Berta
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Matthew Kol
- National Ebola virus disease Incident Management Team Ministry of Health, Republic of South Sudan
| | - Patrick Otim Ramadan
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Caroline Ryan
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Ifeanyi Udenweze
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Argata Guracha Guyo
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Ishata Conteh
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Qudsia Huda
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Malick Gai
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Dina Saulo
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Heather Papowitz
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Henry John Gray
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Alex Chimbaru
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Kencho Wangdi
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Steven M Grube
- United States Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Beth Tippett Barr
- United States Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Joseph Francis Wamala
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
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7
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Nyakarahuka L, Schafer IJ, Balinandi S, Mulei S, Tumusiime A, Kyondo J, Knust B, Lutwama J, Rollin P, Nichol S, Shoemaker T. A retrospective cohort investigation of seroprevalence of Marburg virus and ebolaviruses in two different ecological zones in Uganda. BMC Infect Dis 2020; 20:461. [PMID: 32611400 PMCID: PMC7329513 DOI: 10.1186/s12879-020-05187-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/06/2020] [Accepted: 06/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Uganda has experienced seven Ebola Virus Disease (EVD) outbreaks and four Marburg Virus Disease (MVD) outbreaks between 2000 and 2019. We investigated the seroprevalence and risk factors for Marburg virus and ebolaviruses in gold mining communities around Kitaka gold mine in Western Uganda and compared them to non-mining communities in Central Uganda. METHODS A questionnaire was administered and human blood samples were collected from three exposure groups in Western Uganda (gold miners, household members of miners, non-miners living within 50 km of Kitaka mine). The unexposed controls group sampled was community members in Central Uganda far away from any gold mining activity which we considered as low-risk for filovirus infection. ELISA serology was used to analyse samples, detecting IgG antibodies against Marburg virus and ebolaviruses (filoviruses). Data were analysed in STATA software using risk ratios and odds ratios. RESULTS Miners in western Uganda were 5.4 times more likely to be filovirus seropositive compared to the control group in central Uganda (RR = 5.4; 95% CI 1.5-19.7) whereas people living in high-risk areas in Ibanda and Kamwenge districts were 3.6 more likely to be seropositive compared to control group in Luweeero district (RR = 3.6; 95% CI 1.1-12.2). Among all participants, filovirus seropositivity was 2.6% (19/724) of which 2.3% (17/724) were reactive to Sudan virus only and 0.1% (1/724) to Marburg virus. One individual seropositive for Sudan virus also had IgG antibodies reactive to Bundibugyo virus. The risk factors for filovirus seropositivity identified included mining (AOR = 3.4; 95% CI 1.3-8.5), male sex (AOR = 3.1; 95% CI 1.01-9.5), going inside mines (AOR = 3.1; 95% CI 1.2-8.2), cleaning corpses (AOR = 3.1; 95% CI 1.04-9.1) and contact with suspect filovirus cases (AOR = 3.9, 95% CI 1.04-14.5). CONCLUSIONS These findings indicate that filovirus outbreaks may go undetected in Uganda and people involved in artisan gold mining are more likely to be exposed to infection with either Marburg virus or ebolaviruses, likely due to increased risk of exposure to bats. This calls for active surveillance in known high-risk areas for early detection and response to prevent filovirus epidemics.
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Affiliation(s)
- Luke Nyakarahuka
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Stephen Balinandi
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Sophia Mulei
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Alex Tumusiime
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Jackson Kyondo
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Barbara Knust
- Centres for Disease Control and Prevention, Atlanta, USA
| | - Julius Lutwama
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Pierre Rollin
- Centres for Disease Control and Prevention, Atlanta, USA
| | - Stuart Nichol
- Centres for Disease Control and Prevention, Atlanta, USA
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Bonney LC, Watson RJ, Slack GS, Bosworth A, Wand NIV, Hewson R. A flexible format LAMP assay for rapid detection of Ebola virus. PLoS Negl Trop Dis 2020; 14:e0008496. [PMID: 32735587 PMCID: PMC7423149 DOI: 10.1371/journal.pntd.0008496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/20/2019] [Revised: 08/12/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The unprecedented 2013/16 outbreak of Zaire ebolavirus (Ebola virus) in West Africa has highighted the need for rapid, high-throughput and POC diagnostic assays to enable timely detection and appropriate triaging of Ebola Virus Disease (EVD) patients. Ebola virus is highly infectious and prompt diagnosis and triage is crucial in preventing further spread within community and healthcare settings. Moreover, due to the ecology of Ebola virus it is important that newly developed diagnostic assays are suitable for use in both the healthcare environment and low resource rural locations. METHODOLOGY/PRINCIPLE FINDINGS A LAMP assay was successfully developed with three detection formats; a real-time intercalating dye-based assay, a real-time probe-based assay to enable multiplexing and an end-point colourimetric assay to simplify interpretation for the field. All assay formats were sensitive and specific, detecting a range of Ebola virus strains isolated in 1976-2014; with Probit analysis predicting limits of detection of 243, 290 and 75 copies/reaction respectively and no cross-detection of related strains or other viral haemorrhagic fevers (VHF's). The assays are rapid, (as fast as 5-7.25 mins for real-time formats) and robust, detecting Ebola virus RNA in presence of minimally diluted bodily fluids. Moreover, when tested on patient samples from the 2013/16 outbreak, there were no false positives and 93-96% of all new case positives were detected, with only a failure to detect very low copy number samples. CONCLUSION/SIGNIFICANCE These are a set of robust and adaptable diagnostic solutions, which are fast, easy-to-perform-and-interpret and are suitable for use on a range of platforms including portable low-power devices. They can be readily transferred to field-laboratory settings, with no specific equipment needs and are therefore ideally placed for use in locations with limited resources.
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Affiliation(s)
- Laura C. Bonney
- Public Health England, National Infection Service, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Robert J. Watson
- Public Health England, National Infection Service, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Gillian S. Slack
- Public Health England, National Infection Service, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Andrew Bosworth
- Public Health England, National Infection Service, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Nadina I. Vasileva Wand
- Public Health England, National Infection Service, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Roger Hewson
- Public Health England, National Infection Service, Porton Down, Salisbury, Wiltshire, United Kingdom
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9
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Abstract
An association between malaria and risk for death among patients with Ebola virus disease has suggested within-host interactions between Plasmodium falciparum parasites and Ebola virus. To determine whether such an interaction might also influence the probability of acquiring either infection, we used a large snapshot surveillance study from rural Gabon to test if past exposure to Ebola virus is associated with current infection with Plasmodium spp. during nonepidemic conditions. We found a strong positive association, on population and individual levels, between seropositivity for antibodies against Ebola virus and the presence of Plasmodium parasites in the blood. According to a multiple regression model accounting for other key variables, antibodies against Ebola virus emerged as the strongest individual-level risk factor for acquiring malaria. Our results suggest that within-host interactions between malaria parasites and Ebola virus may underlie epidemiologic associations.
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10
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Steffen I, Lu K, Yamamoto LK, Hoff NA, Mulembakani P, Wemakoy EO, Muyembe-Tamfum JJ, Ndembi N, Brennan CA, Hackett J, Stramer SL, Switzer WM, Saragosti S, Mbensa GO, Laperche S, Rimoin AW, Simmons G. Serologic Prevalence of Ebola Virus in Equatorial Africa. Emerg Infect Dis 2019; 25:911-918. [PMID: 31002071 PMCID: PMC6478206 DOI: 10.3201/eid2505.180115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We conducted a serologic survey of 2,430 serum samples collected during 1997-2012 for various studies to determine the prevalence of the hemorrhagic fever virus Ebola virus (EBOV) in equatorial Africa. We screened serum samples for neutralizing antibodies by using a pseudotype microneutralization assay and a newly developed luciferase immunoprecipitation system assay. Specimens seroreactive for EBOV were confirmed by using an ELISA. Our results suggest a serologic prevalence of 2%-3.5% in the Republic of the Congo and the Democratic Republic of the Congo, which have reported outbreaks of infection with EBOV. In addition we detected a seroprevalence of 1.3% in southern Cameroon, which indicated a low risk for exposure in this region.
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11
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McElroy AK, Shrivastava-Ranjan P, Harmon JR, Martines RB, Silva-Flannery L, Flietstra TD, Kraft CS, Mehta AK, Lyon GM, Varkey JB, Ribner BS, Nichol ST, Zaki SR, Spiropoulou CF. Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans 1. Emerg Infect Dis 2019; 25:290-298. [PMID: 30666927 PMCID: PMC6346465 DOI: 10.3201/eid2502.181326] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ebola virus disease (EVD) is associated with elevated cytokine levels, and hypercytokinemia is more pronounced in fatal cases. This type of hyperinflammatory state is reminiscent of 2 rheumatologic disorders known as macrophage activation syndrome and hemophagocytic lymphohistiocytosis, which are characterized by macrophage and T-cell activation. An evaluation of 2 cohorts of patients with EVD revealed that a marker of macrophage activation (sCD163) but not T-cell activation (sCD25) was associated with severe and fatal EVD. Furthermore, substantial immunoreactivity of host tissues to a CD163-specific antibody, predominantly in areas of extensive immunostaining for Ebola virus antigens, was observed in fatal cases. These data suggest that host macrophage activation contributes to EVD pathogenesis and that directed antiinflammatory therapies could be beneficial in the treatment of EVD.
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MESH Headings
- Antigens, CD/blood
- Antigens, Differentiation, Myelomonocytic/blood
- Biomarkers
- Ebolavirus/immunology
- Hemorrhagic Fever, Ebola/blood
- Hemorrhagic Fever, Ebola/diagnosis
- Hemorrhagic Fever, Ebola/immunology
- Hemorrhagic Fever, Ebola/virology
- Humans
- Immunoassay
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Liver/immunology
- Liver/metabolism
- Liver/pathology
- Macrophage Activation/immunology
- Macrophages/immunology
- Macrophages/metabolism
- Receptors, Cell Surface/blood
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12
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Paweska JT, Moolla N, Storm N, Msimang V, Conteh O, Weyer J, Vuren PJV. Evaluation of Diagnostic Performance of Three Indirect Enzyme-Linked Immunosorbent Assays for the Detection of IgG Antibodies to Ebola Virus in Human Sera. Viruses 2019; 11:E678. [PMID: 31344850 PMCID: PMC6722596 DOI: 10.3390/v11080678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/29/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 01/02/2023] Open
Abstract
Filovirus serological diagnosis and epidemiological investigations are hampered due to the unavailability of validated immunoassays. Diagnostic performance of three indirect enzyme-linked immunosorbent assays (I-ELISA) was evaluated for the detection of IgG antibody to Ebola virus (EBOV) in human sera. One I-ELISA was based on a whole EBOV antigen (WAg) and two utilized recombinant nucleocapsid (NP) and glycoproteins (GP), respectively. Validation data sets derived from individual sera collected in South Africa (SA), representing an EBOV non-endemic country, and from sera collected during an Ebola disease (EBOD) outbreak in Sierra Leone (SL), were categorized according to the compounded results of the three I-ELISAs and real time reverse-transcription polymerase chain reaction (RT-PCR). At the cut-off values selected at 95% accuracy level by the two-graph receiver operating characteristic analysis, specificity in the SA EBOV negative serum panel (n = 273) ranged from 98.17% (GP ELISA) to 99.27% (WAg ELISA). Diagnostic specificity in the SL EBOV negative panel (n = 676) was 100% by the three ELISAs. The diagnostic sensitivity in 423 RT-PCR confirmed EBOD patients was dependent on the time when the serum was collected after onset of disease. It significantly increased 2 weeks post-onset, reaching 100% sensitivity by WAg and NP and 98.1% by GP I-ELISA.
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Affiliation(s)
- Janusz T Paweska
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg 2131, South Africa.
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa.
| | - Naazneen Moolla
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg 2131, South Africa
| | - Nadia Storm
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg 2131, South Africa
| | - Veerle Msimang
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg 2131, South Africa
| | - Ousman Conteh
- Ministry of Health and Sanitation, Freetown 47235, Sierra Leone
| | - Jacqueline Weyer
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg 2131, South Africa
| | - Petrus Jansen van Vuren
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg 2131, South Africa
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13
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Spengler JR, Welch SR, Genzer SC, Coleman-McCray J, Harmon JR, Nichol ST, Spiropoulou CF. Suboptimal Handling of Piccolo Samples or Reagent Discs for Consideration in Ebola Response. Emerg Infect Dis 2019; 25:1238-1240. [PMID: 30900978 PMCID: PMC6537746 DOI: 10.3201/eid2506.181928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Operating clinical analyzers within recommended parameters can be challenging during outbreak response. Using the Piccolo Xpress point-of-care blood chemistry analyzer on guinea pig blood, we found that values of many analytes are still readily comparable when samples and reagent discs are handled at various conditions outside of manufacturer recommendations.
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14
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Abstract
Ebolaviruses are pathogenic agents associated with a severe, potentially fatal, systemic disease in man and great apes. Four species of ebolaviruses have been identified in west or equatorial Africa. Once the more virulent forms enter the human population, transmission occurs primarily through contact with infected body fluids and can result in major epidemics in under-resourced settings. These viruses cause a disease characterised by systemic viral replication, immune suppression, abnormal inflammatory responses, major fluid and electrolyte losses, and high mortality. Despite recent progress on vaccines, and with no licensed prophylaxis or treatment available, case management is essentially supportive with management of severe multiple organ failure resulting from immune-mediated cell damage. The 2013-16 outbreak was classified by WHO as a Public Health Emergency of International Concern, which drew attention to the challenges of diseases caused by infections with ebolaviruses and questioned scientific, clinical, and societal preparation to handle future epidemics.
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Affiliation(s)
- Denis Malvy
- Department for Infectious and Tropical Diseases, University Hospital Centre of Bordeaux, Bordeaux, France; INSERM 1219, University of Bordeaux, Bordeaux, France.
| | - Anita K McElroy
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Stephan Günther
- Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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15
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Fitzgerald F, Naveed A, Wing K, Gbessay M, Ross JCG, Checchi F, Youkee D, Jalloh MB, Baion D, Mustapha A, Jah H, Lako S, Oza S, Boufkhed S, Feury R, Bielicki JA, Gibb DM, Klein N, Sahr F, Yeung S. Ebola Virus Disease in Children, Sierra Leone, 2014-2015. Emerg Infect Dis 2018; 22:1769-77. [PMID: 27649367 PMCID: PMC5038433 DOI: 10.3201/eid2210.160579] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Children died rapidly, more than half in Ebola holding units before transfer to treatment units. Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014–2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus–positive children 2 days–12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children.
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16
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Brangel P, Sobarzo A, Parolo C, Miller BS, Howes PD, Gelkop S, Lutwama JJ, Dye JM, McKendry RA, Lobel L, Stevens MM. A Serological Point-of-Care Test for the Detection of IgG Antibodies against Ebola Virus in Human Survivors. ACS Nano 2018; 12:63-73. [PMID: 29303554 DOI: 10.1021/acsnano.7b07021] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Ebola virus disease causes widespread and highly fatal epidemics in human populations. Today, there is still great need for point-of-care tests for diagnosis, patient management and surveillance, both during and post outbreaks. We present a point-of-care test comprising an immunochromatographic strip and a smartphone reader, which detects and semiquantifies Ebola-specific antibodies in human survivors. We developed a Sudan virus glycoprotein monoplex platform and validated it using sera from 90 human survivors and 31 local noninfected controls. The performance of the glycoprotein monoplex was 100% sensitivity and 98% specificity compared to standard whole antigen enzyme-linked immunosorbent assay (ELISA), and it was validated with freshly collected patient samples in Uganda. Moreover, we constructed a multiplex test for simultaneous detection of antibodies against three recombinant Sudan virus proteins. A pilot study comprising 15 survivors and 5 noninfected controls demonstrated sensitivity and specificity of 100% compared to standard ELISA. Finally, we developed a second multiplex subtype assay for the identification of exposure to three related EVD species: Sudan virus, Bundibugyo virus and Ebola virus (formerly Zaire) using recombinant viral glycoprotein. This multiplex test could distinguish between the host's immunity to specific viral species and identify cross-reactive immunity. These developed serological platforms consisted of capture ligands with high specificity and sensitivity, in-house developed strips and a compatible smartphone application. These platforms enabled rapid and portable testing, data storage and sharing as well as geographical tagging of the tested individuals in Uganda. This platform holds great potential as a field tool for diagnosis, vaccine development, and therapeutic evaluation.
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Affiliation(s)
- Polina Brangel
- Department of Materials, Department of Bioengineering and Institute for Biomedical Engineering, Imperial College London , London SW7 2AZ, U.K
| | - Ariel Sobarzo
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva 8410501, Israel
| | - Claudio Parolo
- London Centre for Nanotechnology and Div. of Medicine, University College London , London WC1E 6B, U.K
| | - Benjamin S Miller
- London Centre for Nanotechnology and Div. of Medicine, University College London , London WC1E 6B, U.K
| | - Philip D Howes
- Department of Materials, Department of Bioengineering and Institute for Biomedical Engineering, Imperial College London , London SW7 2AZ, U.K
| | - Sigal Gelkop
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva 8410501, Israel
| | - Julius J Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infection, Uganda Virus Research Institute , Entebbe P.O Box 49, Uganda
| | - John M Dye
- Virology Division, US Army Medical Research Institute of Infectious Diseases , Fort Detrick, Frederick, Maryland 21702, United States
| | - Rachel A McKendry
- London Centre for Nanotechnology and Div. of Medicine, University College London , London WC1E 6B, U.K
| | - Leslie Lobel
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva 8410501, Israel
- Department of Arbovirology, Emerging and Re-emerging Infection, Uganda Virus Research Institute , Entebbe P.O Box 49, Uganda
| | - Molly M Stevens
- Department of Materials, Department of Bioengineering and Institute for Biomedical Engineering, Imperial College London , London SW7 2AZ, U.K
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17
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Speranza E, Altamura LA, Kulcsar K, Bixler SL, Rossi CA, Schoepp RJ, Nagle E, Aguilar W, Douglas CE, Delp KL, Minogue TD, Palacios G, Goff AJ, Connor JH. Comparison of Transcriptomic Platforms for Analysis of Whole Blood from Ebola-Infected Cynomolgus Macaques. Sci Rep 2017; 7:14756. [PMID: 29116224 PMCID: PMC5676990 DOI: 10.1038/s41598-017-15145-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 06/08/2017] [Accepted: 10/17/2017] [Indexed: 11/09/2022] Open
Abstract
Ebola virus disease (EVD) is a serious illness with mortality rates of 20-90% in various outbreaks. EVD is characterized by robust virus replication and strong host inflammatory response. Analyzing host immune responses has increasingly involved multimodal approaches including transcriptomics to profile gene expression. We studied cynomolgus macaques exposed to Ebola virus Makona via different routes with the intent of comparing RNA-Seq to a NanoString nCounter codeset targeting 769 non-human primate (NHP) genes. RNA-Seq analysis of serial blood samples showed different routes led to the same overall transcriptional response seen in previously reported EBOV-exposed NHP studies. Both platforms displayed a strong correlation in gene expression patterns, including a strong induction of innate immune response genes at early times post-exposure, and neutrophil-associated genes at later time points. A 41-gene classifier was tested in both platforms for ability to cluster samples by infection status. Both NanoString and RNA-Seq could be used to predict relative abundances of circulating immune cell populations that matched traditional hematology. This demonstrates the complementarity of RNA-Seq and NanoString. Moreover, the development of an NHP-specific NanoString codeset should augment studies of filoviruses and other high containment infectious diseases without the infrastructure requirements of RNA-Seq technology.
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Affiliation(s)
- Emily Speranza
- Department of Microbiology, Bioinformatics Program, National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, United States
| | - Louis A Altamura
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Kirsten Kulcsar
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Sandra L Bixler
- Molecular and Translational Sciences Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Cynthia A Rossi
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Randal J Schoepp
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Elyse Nagle
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - William Aguilar
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Christina E Douglas
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Korey L Delp
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Timothy D Minogue
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Gustavo Palacios
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States
| | - Arthur J Goff
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, United States.
| | - John H Connor
- Department of Microbiology, Bioinformatics Program, National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, United States.
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18
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Colavita F, Biava M, Mertens P, Gilleman Q, Borlon C, Delli Guanti M, Petrocelli A, Cataldi G, Kamara AT, Kamara SA, Konneh K, Vincenti D, Castilletti C, Abdurahman S, Mirazimi A, Capobianchi MR, Ippolito G, Miccio R, Di Caro A. EBOLA Ag K-SeT rapid test: field evaluation in Sierra Leone. Clin Microbiol Infect 2017; 24:653-657. [PMID: 29107122 DOI: 10.1016/j.cmi.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/07/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Efficient interruption of Ebola virus disease (EVD) transmission chains critically depends on reliable and fast laboratory diagnosis. We evaluated the performance of the EBOLA Virus Antigen Detection K-SeT (EBOLA Ag K-SeT), a new rapid diagnostic antigen test in field settings. METHODS The study was conducted in a field laboratory located in Freetown (Sierra Leone) by the Italian National Institute for Infectious Diseases 'L. Spallanzani' and the EMERGENCY Onlus NGO. The EBOLA Ag K-SeT was tested on 210 residual plasma samples (EVD prevalence 50%) from patients hospitalized at the EMERGENCY Ebola treatment center in Goderich (Freetown), comparing the results with quantitative real-time PCR. RESULTS Overall, the sensitivity of EBOLA Ag K-SeT was 88.6% (95% confidence interval (CI), 82.5-94.7), and the corresponding specificity was 98.1% (95% CI, 95.5-100.7). The positive and negative predictive values were 97.9% (95% CI, 95.0-100.8) and 89.6% (95% CI, 84-95.2), respectively. The sensitivity strongly increased up to 98.7% (95% CI, 96.1-101.2) for those samples with high virus load (≥6.2 log RNA copies/mL). CONCLUSIONS Our results suggest that EBOLA Ag K-SeT could represent a new effective diagnostic tool for EVD, meeting a need for resource-poor settings and rapid diagnosis for individuals with suspected EVD.
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Affiliation(s)
- F Colavita
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy
| | - M Biava
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy
| | | | | | - C Borlon
- Coris BioConcept, Gembloux, Belgium
| | | | | | | | - A T Kamara
- EMERGENCY Onlus NGO, Milan, Italy; Diagnostic Ebola Virus Diseases Laboratory, 'Princess Christian Maternity Hospital', Freetown, Sierra Leone
| | - S A Kamara
- EMERGENCY Onlus NGO, Milan, Italy; Diagnostic Ebola Virus Diseases Laboratory, 'Princess Christian Maternity Hospital', Freetown, Sierra Leone
| | - K Konneh
- EMERGENCY Onlus NGO, Milan, Italy; Diagnostic Ebola Virus Diseases Laboratory, 'Princess Christian Maternity Hospital', Freetown, Sierra Leone
| | - D Vincenti
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy
| | - C Castilletti
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy
| | - S Abdurahman
- Public Health Agency of Sweden, Stockholm, Sweden
| | - A Mirazimi
- Public Health Agency of Sweden, Stockholm, Sweden; National Veterinary Institute, Uppsala, Sweden; Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - M R Capobianchi
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy
| | - G Ippolito
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy
| | - R Miccio
- EMERGENCY Onlus NGO, Milan, Italy
| | - A Di Caro
- National Institute for Infectious Diseases 'L. Spallanzani' IRCCS, Rome, Italy.
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Honko AN, Johnson JC, Marchand JS, Huzella L, Adams RD, Oberlander N, Torzewski LM, Bennett RS, Hensley LE, Jahrling PB, Olinger GG. High dose sertraline monotherapy fails to protect rhesus macaques from lethal challenge with Ebola virus Makona. Sci Rep 2017; 7:5886. [PMID: 28725019 PMCID: PMC5517626 DOI: 10.1038/s41598-017-06179-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/10/2017] [Accepted: 06/07/2017] [Indexed: 11/09/2022] Open
Abstract
The recent epidemic of Ebola virus disease in West Africa resulted in an unprecedented number of cases and deaths. Due to the scope of the outbreak combined with the lack of available approved treatment options, there was strong motivation to investigate any potential drug which had existing data reporting anti-Ebola activity. Drugs with demonstrated antiviral activity in the nonhuman primate models already approved for another indication or for which there was existing safety data were considered to be priorities for evaluation by the World Health Organization. Sertraline hydrochloride was reported to have anti-Ebola activity in vitro alone and in combination with other approved drugs. Although the efficacy was less than 100% in the murine model, the established safety profile of this product, the potential benefit alone and in combination, as well as the lack of other available options prioritized this compound for testing in the Ebola virus intramuscular rhesus macaque challenge model. Using a blinded dosing strategy, we demonstrated that high dose sertraline monotherapy provided no benefit for the prevention of Ebola virus disease in rhesus macaques with regards to reduction of viral load, morbidity, or survival highlighting the challenges of translating results between in vitro and in vivo models.
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Affiliation(s)
- Anna N Honko
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA.
| | - Joshua C Johnson
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Jonathan S Marchand
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Louis Huzella
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Ricky D Adams
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Nicholas Oberlander
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
- BD Technologies/Charles River Labs, Research Triangle Park, 27709, North Carolina, USA
| | - Lisa M Torzewski
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Richard S Bennett
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Lisa E Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Peter B Jahrling
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
| | - Gene G Olinger
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, 21702, Maryland, USA
- MRIGlobal-Global Health Surveillance and Diagnostics, Gaithersburg, Maryland, 20878, USA
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20
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Affiliation(s)
| | - John M Dye
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD
| | - Akin Abayomi
- Stellenbosch University, Stellenbosch, South Africa
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21
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Pettitt J, Higgs E, Fallah M, Nason M, Stavale E, Marchand J, Reilly C, Jensen K, Dighero-Kemp B, Tuznik K, Logue J, Bolay F, Hensley L. Assessment and Optimization of the GeneXpert Diagnostic Platform for Detection of Ebola Virus RNA in Seminal Fluid. J Infect Dis 2017; 215:547-553. [PMID: 28003349 PMCID: PMC6075475 DOI: 10.1093/infdis/jiw599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 08/29/2016] [Accepted: 12/01/2016] [Indexed: 11/14/2022] Open
Abstract
Recent studies have suggested that Ebola virus (EBOV) ribonucleic acid (RNA) potentially present in the semen of a large number of survivors of Ebola virus disease (EVD) in Western Africa may contribute to sexual transmission of EVD and generate new clusters of cases in regions previously declared EVD-free. These findings drive the immediate need for a reliable, rapid, user-friendly assay for detection of EBOV RNA in semen that is deployable to multiple sites across Western Africa. In this study, we optimized the Xpert EBOV assay for semen samples by adding dithiothreitol. Compared to the assays currently in use in Liberia (including Ebola Zaire Target 1, major groove binder real-time-polymerase chain reaction assays, and original Xpert EBOV assay), the modified Xpert EBOV assay demonstrated greater sensitivity than the comparator assays. Thus, the modified Xpert EBOV assay is optimal for large-scale monitoring of EBOV RNA persistence in male survivors.
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Affiliation(s)
- James Pettitt
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Elizabeth Higgs
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Martha Nason
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, USA
| | - Eric Stavale
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Jonathan Marchand
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Cavan Reilly
- Division of Biostatistics, University of Minnesota School of Public Health, Minnesota, USA
| | - Kenneth Jensen
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Bonnie Dighero-Kemp
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Kaylie Tuznik
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - James Logue
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Fatorma Bolay
- Liberian Institute of Biomedical Research, Charlesville, Liberia
| | - Lisa Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
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22
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Loftis AJ, Quellie S, Chason K, Sumo E, Toukolon M, Otieno Y, Ellerbrok H, Hobbs MM, Hoover D, Dube K, Wohl DA, Fischer WA. Validation of the Cepheid GeneXpert for Detecting Ebola Virus in Semen. J Infect Dis 2017; 215:344-350. [PMID: 27932614 PMCID: PMC5965086 DOI: 10.1093/infdis/jiw562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 09/27/2016] [Accepted: 11/12/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ebola virus (EBOV) RNA persistence in semen, reported sexual transmission, and sporadic clusters at the end of the 2013-2016 epidemic have prompted recommendations that male survivors refrain from unprotected sex unless their semen is confirmed to be EBOV free. However, there is no fully validated assay for EBOV detection in fluids other than blood. METHODS The Cepheid Xpert Ebola assay for EBOV RNA detection was validated for whole semen and blood using samples obtained from uninfected donors and spiked with inactivated EBOV. The validation procedure incorporated standards from Clinical and Laboratory Standards Institute and Good Clinical Laboratory Practices guidelines for evaluating molecular devices for use in infectious disease testing. RESULTS The assay produced limits of detection of 1000 copies/mL in semen and 275 copies/mL in blood. Limits of detection for both semen and blood increased with longer intervals between collection and testing, with acceptable results obtained up to 72 hours after specimen collection. CONCLUSIONS The Cepheid Xpert Ebola assay is accurate and precise for detecting EBOV in whole semen. A validated assay for EBOV RNA detection in semen informs the care of male survivors of Ebola, as well as recommendations for public health.
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Affiliation(s)
- Amy James Loftis
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | | | - Kelly Chason
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill
| | - Emmanuel Sumo
- Phebe Hospital PCR Laboratory, Suokoko, Bong County, Liberia
| | - Mason Toukolon
- Phebe Hospital PCR Laboratory, Suokoko, Bong County, Liberia
| | - Yonnie Otieno
- Clinical Research Management, Africa, Hinckley, Ohio
| | | | - Marcia M Hobbs
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | - David Hoover
- Clinical Research Management, Africa, Hinckley, Ohio
| | - Karine Dube
- Clinical Research Management, Africa, Hinckley, Ohio
| | - David A Wohl
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill
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23
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Affiliation(s)
| | - Tansy Edwards
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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24
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van den Wijngaard JPHM, Bakker JA, Gillis JMEP, Ballieux BEPB, de Vries JJC, Schenk PW, Cobbaert CM. Keeping Ebola out of the lab: a practical solution on how to analyze Ebola associated blood anomalies. Clin Chem Lab Med 2016; 54:e353-e357. [PMID: 27092649 DOI: 10.1515/cclm-2015-1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/01/2016] [Indexed: 11/15/2022]
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25
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Richardson ET, Kelly JD, Barrie MB, Mesman AW, Karku S, Quiwa K, Marsh RH, Koedoyoma S, Daboh F, Barron KP, Grady M, Tucker E, Dierberg KL, Rutherford GW, Barry M, Jones JH, Murray MB, Farmer PE. Minimally Symptomatic Infection in an Ebola 'Hotspot': A Cross-Sectional Serosurvey. PLoS Negl Trop Dis 2016; 10:e0005087. [PMID: 27846221 PMCID: PMC5112953 DOI: 10.1371/journal.pntd.0005087] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 05/24/2016] [Accepted: 09/30/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Evidence for minimally symptomatic Ebola virus (EBOV) infection is limited. During the 2013-16 outbreak in West Africa, it was not considered epidemiologically relevant to published models or projections of intervention effects. In order to improve our understanding of the transmission dynamics of EBOV in humans, we investigated the occurrence of minimally symptomatic EBOV infection in quarantined contacts of reported Ebola virus disease cases in a recognized 'hotspot.' METHODOLOGY/PRINCIPAL FINDINGS We conducted a cross-sectional serosurvey in Sukudu, Kono District, Sierra Leone, from October 2015 to January 2016. A blood sample was collected from 187 study participants, 132 negative controls (individuals with a low likelihood of previous exposure to Ebola virus), and 30 positive controls (Ebola virus disease survivors). IgG responses to Ebola glycoprotein and nucleoprotein were measured using Alpha Diagnostic International ELISA kits with plasma diluted at 1:200. Optical density was read at 450 nm (subtracting OD at 630nm to normalize well background) on a ChroMate 4300 microplate reader. A cutoff of 4.7 U/mL for the anti-GP ELISA yielded 96.7% sensitivity and 97.7% specificity in distinguishing positive and negative controls. We identified 14 seropositive individuals not known to have had Ebola virus disease. Two of the 14 seropositive individuals reported only fever during quarantine while the remaining 12 denied any signs or symptoms during quarantine. CONCLUSIONS/SIGNIFICANCE By using ELISA to measure Zaire Ebola virus antibody concentrations, we identified a significant number of individuals with previously undetected EBOV infection in a 'hotspot' village in Sierra Leone, approximately one year after the village outbreak. The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection. These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak. Further studies are needed to understand the potential risk of transmission and clinical sequelae in individuals with previously undetected EBOV infection.
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Affiliation(s)
- Eugene T. Richardson
- Department of Anthropology, Stanford University, Stanford, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States of America
- Partners In Health, Sierra Leone
| | - J. Daniel Kelly
- Partners In Health, Sierra Leone
- UCSF School of Medicine, San Francisco, United States of America
| | - Mohamed Bailor Barrie
- Partners In Health, Sierra Leone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
| | | | | | | | - Regan H. Marsh
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States of America
- Partners In Health, Sierra Leone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
| | | | | | | | | | - Elizabeth Tucker
- Kono District Health Management Team (DHMT), Koidu, Sierra Leone
| | - Kerry L. Dierberg
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States of America
- Partners In Health, Sierra Leone
| | | | - Michele Barry
- Stanford University School of Medicine, Stanford, United States of America
| | - James Holland Jones
- Department of Anthropology, Stanford University, Stanford, United States of America
| | - Megan B. Murray
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
| | - Paul E. Farmer
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States of America
- Partners In Health, Sierra Leone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
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26
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Delamou A, Haba NY, Mari-Saez A, Gallian P, Ronse M, Jacobs J, Camara BS, Kadio KJJO, Guemou A, Kolie JP, De Crop M, Chavarin P, Jacquot C, Lazaygues C, De Weggheleire A, Lynen L, van Griensven J. Organizing the Donation of Convalescent Plasma for a Therapeutic Clinical Trial on Ebola Virus Disease: The Experience in Guinea. Am J Trop Med Hyg 2016; 95:647-653. [PMID: 27430546 PMCID: PMC5014273 DOI: 10.4269/ajtmh.15-0890] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/06/2016] [Indexed: 11/07/2022] Open
Abstract
Although convalescent plasma (CP) transfusion was prioritized among potential Ebola treatments by the World Health Organization, there were concerns on the feasibility of its implementation. We report on the successful organization of donor mobilization and plasma collection as part of the Ebola-Tx clinical trial from November 2014 to July 2015 in Conakry, Guinea. Project implementation registers, tools and reports, mission reports, and minutes of research team meetings were used to reconstruct the sequence of events on how donor mobilization was organized, plasmapheresis was set up, and how effective this approach was in collecting CP. An initial needs assessment of the Guinean National Blood Transfusion Center resulted in targeted training of staff on site, resulting in autonomy and independent production of CP within 3 months. The Conakry Ebola Survivors Association played a direct role in donor mobilization and organization of CP donations. A total of 98 Ebola survivors were screened for plasma donation, of which 84 were found eligible for plasmapheresis. Of these, 26 (30.9%) were excluded. The remaining 58 donors made a total of 90 donations, corresponding to 50.9 L of CP. This sufficed to treat the 99 eligible patients enrolled in the trial. Within a poor resource emergency context, transfusion capacity could be rapidly improved through the strengthening of local capacities and gradual transfer of skills coupled with active involvement of Ebola survivors. However, large-scale plasma collection or multisite studies may require further adaptations of both strategy and logistics. The Ebola-Tx trial was funded by the European Union and others.
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Affiliation(s)
- Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Pierre Gallian
- Etablissement Français du Sang, La Plaine Stade de France, France
| | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | - Achille Guemou
- Association des Personnes Guéries et Affectées d'Ebola en Guinée, Conakry, Guinea
| | - Jean Pe Kolie
- Association des Personnes Guéries et Affectées d'Ebola en Guinée, Conakry, Guinea
| | | | | | - Chantal Jacquot
- Etablissement Français du Sang, La Plaine Stade de France, France
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27
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Reynard O, Jacquot F, Evanno G, Mai HL, Salama A, Martinet B, Duvaux O, Bach JM, Conchon S, Judor JP, Perota A, Lagutina I, Duchi R, Lazzari G, Le Berre L, Perreault H, Lheriteau E, Raoul H, Volchkov V, Galli C, Soulillou JP. Anti-EBOV GP IgGs Lacking α1-3-Galactose and Neu5Gc Prolong Survival and Decrease Blood Viral Load in EBOV-Infected Guinea Pigs. PLoS One 2016; 11:e0156775. [PMID: 27280712 PMCID: PMC4900587 DOI: 10.1371/journal.pone.0156775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 02/10/2016] [Accepted: 05/19/2016] [Indexed: 01/13/2023] Open
Abstract
Polyclonal xenogenic IgGs, although having been used in the prevention and cure of severe infectious diseases, are highly immunogenic, which may restrict their usage in new applications such as Ebola hemorrhagic fever. IgG glycans display powerful xenogeneic antigens in humans, for example α1–3 Galactose and the glycolyl form of neuraminic acid Neu5Gc, and IgGs deprived of these key sugar epitopes may represent an advantage for passive immunotherapy. In this paper, we explored whether low immunogenicity IgGs had a protective effect on a guinea pig model of Ebola virus (EBOV) infection. For this purpose, a double knock-out pig lacking α1–3 Galactose and Neu5Gc was immunized against virus-like particles displaying surface EBOV glycoprotein GP. Following purification from serum, hyper-immune polyclonal IgGs were obtained, exhibiting an anti-EBOV GP titer of 1:100,000 and a virus neutralizing titer of 1:100. Guinea pigs were injected intramuscularly with purified IgGs on day 0 and day 3 post-EBOV infection. Compared to control animals treated with IgGs from non-immunized double KO pigs, the anti-EBOV IgGs-treated animals exhibited a significantly prolonged survival and a decreased virus load in blood on day 3. The data obtained indicated that IgGs lacking α1–3 Galactose and Neu5Gc, two highly immunogenic epitopes in humans, have a protective effect upon EBOV infection.
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Affiliation(s)
- Olivier Reynard
- Molecular Basis of Viral Pathogenicity, CIRI, INSERM U1111—CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Ecole Normale supérieure de Lyon, Lyon, France
| | | | | | - Hoa Le Mai
- INSERM, UMR 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- Université de Nantes, Nantes, France
| | | | - Bernard Martinet
- INSERM, UMR 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- Université de Nantes, Nantes, France
| | | | - Jean-Marie Bach
- Xenothera, Nantes, France
- IECM, EA4644 Université de Nantes, ONIRIS, USC1383 INRA, Nantes, France
| | - Sophie Conchon
- INSERM, UMR 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- Université de Nantes, Nantes, France
| | - Jean-Paul Judor
- INSERM, UMR 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- Université de Nantes, Nantes, France
| | - Andrea Perota
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
| | - Irina Lagutina
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
| | - Roberto Duchi
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
| | - Giovanna Lazzari
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
- Avantea Foundation, Cremona, Italy
| | - Ludmilla Le Berre
- INSERM, UMR 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- Université de Nantes, Nantes, France
| | | | | | - Hervé Raoul
- Inserm-Jean Mérieux BSL4 Laboratory, US003 Inserm, Lyon, France
- * E-mail: (JPS); (VV); ; (HR)
| | - Viktor Volchkov
- Molecular Basis of Viral Pathogenicity, CIRI, INSERM U1111—CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Ecole Normale supérieure de Lyon, Lyon, France
- * E-mail: (JPS); (VV); ; (HR)
| | - Cesare Galli
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
- Avantea Foundation, Cremona, Italy
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano Emilia, Italy
- * E-mail: (JPS); (VV); ; (HR)
| | - Jean-Paul Soulillou
- Xenothera, Nantes, France
- Université de Nantes, Nantes, France
- * E-mail: (JPS); (VV); ; (HR)
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28
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Wang Q, Zhang Y, Wang HY, DU HJ, Nie K, Song JD, Xiao K, Lei WW, Guo JQ, Wei HJ, Cai K, Wang YH, Wu J, Bangura G, Kamara IL, Dong XP. Detection and Analysis of Ebola Virus in Sierra Leone-China Friendship Biosafety Laboratory from March 11 to April 20, 2015. Biomed Environ Sci 2016; 29:443-447. [PMID: 27470105 DOI: 10.3967/bes2016.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
Ebola virus disease reemerged in Western Africa in 2014. Chinese Center for Disease Control and Prevention dispatched the first Ebola virus (EBOV) detection team to run newly established Sierra Leone-China Friendship Biological Safety Laboratory. The aims of study were to understand epidemiology, clinical manifestations and survival time of EBOV in patient's blood. A total of 913 specimens were tested between March 11 and April 20, 2015. EBOV positivity occurred in 7.37% of the blood and 0.53% in throat swabs. Most commonly reported symptoms of laboratory confirmed patients were intense fatigue, anorexia, and fever. EBOV RNAs persisted in blood for almost 4 weeks and the real-time RT-PCR Ct values showed close correlation with the sampling time after onset.
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Affiliation(s)
- Qin Wang
- Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Yong Zhang
- Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Huan Yu Wang
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China
| | - Hai Jun DU
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China
| | - Kai Nie
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Jing Dong Song
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China
| | - Kang Xiao
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China; Collaborative Innovation Center Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Wen Wen Lei
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China
| | - Jian Qiang Guo
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - He Jiang Wei
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Kun Cai
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Yan Hai Wang
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Jiang Wu
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China
| | - Gerald Bangura
- Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone
| | - Idrissa Laybohr Kamara
- Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone
| | - Xiao Ping Dong
- National Institute for Viral Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Sierra Leone-China Friendship Biological Safety Laboratory, Freetown 999127, Sierra-Leone; State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China; Collaborative Innovation Center Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang, China; Chinese Academy of Sciences Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
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Semper AE, Broadhurst MJ, Richards J, Foster GM, Simpson AJH, Logue CH, Kelly JD, Miller A, Brooks TJG, Murray M, Pollock NR. Performance of the GeneXpert Ebola Assay for Diagnosis of Ebola Virus Disease in Sierra Leone: A Field Evaluation Study. PLoS Med 2016; 13:e1001980. [PMID: 27023868 PMCID: PMC4811569 DOI: 10.1371/journal.pmed.1001980] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/11/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Throughout the Ebola virus disease (EVD) epidemic in West Africa, field laboratory testing for EVD has relied on complex, multi-step real-time reverse transcription PCR (RT-PCR) assays; an accurate sample-to-answer RT-PCR test would reduce time to results and potentially increase access to testing. We evaluated the performance of the Cepheid GeneXpert Ebola assay on clinical venipuncture whole blood (WB) and buccal swab (BS) specimens submitted to a field biocontainment laboratory in Sierra Leone for routine EVD testing by RT-PCR ("Trombley assay"). METHODS AND FINDINGS This study was conducted in the Public Health England EVD diagnostic laboratory in Port Loko, Sierra Leone, using residual diagnostic specimens remaining after clinical testing. EDTA-WB specimens (n = 218) were collected from suspected or confirmed EVD patients between April 1 and July 20, 2015. BS specimens (n = 71) were collected as part of a national postmortem screening program between March 7 and July 20, 2015. EDTA-WB and BS specimens were tested with Xpert (targets: glycoprotein [GP] and nucleoprotein [NP] genes) and Trombley (target: NP gene) assays in parallel. All WB specimens were fresh; 84/218 were tested in duplicate on Xpert to compare WB sampling methods (pipette versus swab); 43/71 BS specimens had been previously frozen. In all, 7/218 (3.2%) WB and 7/71 (9.9%) BS samples had Xpert results that were reported as "invalid" or "error" and were excluded, leaving 211 WB and 64 BS samples with valid Trombley and Xpert results. For WB, 22/22 Trombley-positive samples were Xpert-positive (sensitivity 100%, 95% CI 84.6%-100%), and 181/189 Trombley-negative samples were Xpert-negative (specificity 95.8%, 95% confidence interval (CI) 91.8%-98.2%). Seven of the eight Trombley-negative, Xpert-positive (Xpert cycle threshold [Ct] range 37.7-43.4) WB samples were confirmed to be follow-up submissions from previously Trombley-positive EVD patients, suggesting a revised Xpert specificity of 99.5% (95% CI 97.0%-100%). For Xpert-positive WB samples (n = 22), Xpert NP Ct values were consistently lower than GP Ct values (mean difference -4.06, 95% limits of agreement -6.09, -2.03); Trombley (NP) Ct values closely matched Xpert NP Ct values (mean difference -0.04, 95% limits of agreement -2.93, 2.84). Xpert results (positive/negative) for WB sampled by pipette versus swab were concordant for 78/79 (98.7%) WB samples, with comparable Ct values for positive results. For BS specimens, 20/20 Trombley-positive samples were Xpert-positive (sensitivity 100%, 95% CI 83.2%-100%), and 44/44 Trombley-negative samples were Xpert-negative (specificity 100%, 95% CI 92.0%-100%). This study was limited to testing residual diagnostic samples, some of which had been frozen before use; it was not possible to test the performance of the Xpert Ebola assay at point of care. CONCLUSIONS The Xpert Ebola assay had excellent performance compared to an established RT-PCR benchmark on WB and BS samples in a field laboratory setting. Future studies should evaluate feasibility and performance outside of a biocontainment laboratory setting to facilitate expanded access to testing.
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Affiliation(s)
| | | | - Jade Richards
- Public Health England Laboratory, Port Loko, Sierra Leone
- Mid Essex Hospital Services NHS Trust, Chelmsford, United Kingdom
| | - Geraldine M. Foster
- Public Health England Laboratory, Port Loko, Sierra Leone
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrew J. H. Simpson
- Public Health England, Porton Down, United Kingdom
- Public Health England Laboratory, Port Loko, Sierra Leone
| | | | | | - Ann Miller
- Partners In Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tim J. G. Brooks
- Public Health England, Porton Down, United Kingdom
- Public Health England Laboratory, Port Loko, Sierra Leone
| | - Megan Murray
- Partners In Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nira R. Pollock
- Partners In Health, Boston, Massachusetts, United States of America
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Abstract
Current care for Ebola patients in resource poor countries is hampered by a lack of resources to isolate patients and their close contacts. The current Ebola epidemic offers the opportunity to harvest convalescent serum to help contain this and future outbreaks. A systemic and just process to accomplish this goal can incorporate procedures to improve care for current Ebola patients and their close contacts.
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Affiliation(s)
- Neil J Nusbaum
- VA Central Western Massachusetts Healthcare System, Leeds, MA, 01053, USA,
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Pinsky BA, Sahoo MK, Sandlund J, Kleman M, Kulkarni M, Grufman P, Nygren M, Kwiatkowski R, Baron EJ, Tenover F, Denison B, Higuchi R, Van Atta R, Beer NR, Carrillo AC, Naraghi-Arani P, Mire CE, Ranadheera C, Grolla A, Lagerqvist N, Persing DH. Analytical Performance Characteristics of the Cepheid GeneXpert Ebola Assay for the Detection of Ebola Virus. PLoS One 2015; 10:e0142216. [PMID: 26562786 PMCID: PMC4643052 DOI: 10.1371/journal.pone.0142216] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The recently developed Xpert® Ebola Assay is a novel nucleic acid amplification test for simplified detection of Ebola virus (EBOV) in whole blood and buccal swab samples. The assay targets sequences in two EBOV genes, lowering the risk for new variants to escape detection in the test. The objective of this report is to present analytical characteristics of the Xpert® Ebola Assay on whole blood samples. METHODS AND FINDINGS This study evaluated the assay's analytical sensitivity, analytical specificity, inclusivity and exclusivity performance in whole blood specimens. EBOV RNA, inactivated EBOV, and infectious EBOV were used as targets. The dynamic range of the assay, the inactivation of virus, and specimen stability were also evaluated. The lower limit of detection (LoD) for the assay using inactivated virus was estimated to be 73 copies/mL (95% CI: 51-97 copies/mL). The LoD for infectious virus was estimated to be 1 plaque-forming unit/mL, and for RNA to be 232 copies/mL (95% CI 163-302 copies/mL). The assay correctly identified five different Ebola viruses, Yambuku-Mayinga, Makona-C07, Yambuku-Ecran, Gabon-Ilembe, and Kikwit-956210, and correctly excluded all non-EBOV isolates tested. The conditions used by Xpert® Ebola for inactivation of infectious virus reduced EBOV titer by ≥6 logs. CONCLUSION In summary, we found the Xpert® Ebola Assay to have high analytical sensitivity and specificity for the detection of EBOV in whole blood. It offers ease of use, fast turnaround time, and remote monitoring. The test has an efficient viral inactivation protocol, fulfills inclusivity and exclusivity criteria, and has specimen stability characteristics consistent with the need for decentralized testing. The simplicity of the assay should enable testing in a wide variety of laboratory settings, including remote laboratories that are not capable of performing highly complex nucleic acid amplification tests, and during outbreaks where time to detection is critical.
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Affiliation(s)
- Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Malaya K. Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Johanna Sandlund
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States of America
- Clinical Microbiology Laboratory, Stanford Health Care and Stanford Children’s Health, Palo Alto, California, United States of America
| | | | - Medha Kulkarni
- Cepheid, Sunnyvale, California, United States of America
| | | | | | | | - Ellen Jo Baron
- Cepheid, Sunnyvale, California, United States of America
| | - Fred Tenover
- Cepheid, Sunnyvale, California, United States of America
| | - Blake Denison
- Cepheid, Sunnyvale, California, United States of America
| | | | - Reuel Van Atta
- Cepheid, Sunnyvale, California, United States of America
| | - Neil Reginald Beer
- Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Alda Celena Carrillo
- Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Pejman Naraghi-Arani
- Lawrence Livermore National Laboratory, Livermore, California, United States of America
| | - Chad E. Mire
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Charlene Ranadheera
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Allen Grolla
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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de La Vega MA, Caleo G, Audet J, Qiu X, Kozak RA, Brooks JI, Kern S, Wolz A, Sprecher A, Greig J, Lokuge K, Kargbo DK, Kargbo B, Di Caro A, Grolla A, Kobasa D, Strong JE, Ippolito G, Van Herp M, Kobinger GP. Ebola viral load at diagnosis associates with patient outcome and outbreak evolution. J Clin Invest 2015; 125:4421-8. [PMID: 26551677 DOI: 10.1172/jci83162] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ebola virus (EBOV) causes periodic outbreaks of life-threatening EBOV disease in Africa. Historically, these outbreaks have been relatively small and geographically contained; however, the magnitude of the EBOV outbreak that began in 2014 in West Africa has been unprecedented. The aim of this study was to describe the viral kinetics of EBOV during this outbreak and identify factors that contribute to outbreak progression. METHODS From July to December 2014, one laboratory in Sierra Leone processed over 2,700 patient samples for EBOV detection by quantitative PCR (qPCR). Viremia was measured following patient admission. Age, sex, and approximate time of symptom onset were also recorded for each patient. The data was analyzed using various mathematical models to find trends of potential interest. RESULTS The analysis revealed a significant difference (P = 2.7 × 10(-77)) between the initial viremia of survivors (4.02 log10 genome equivalents [GEQ]/ml) and nonsurvivors (6.18 log10 GEQ/ml). At the population level, patient viral loads were higher on average in July than in November, even when accounting for outcome and time since onset of symptoms. This decrease in viral loads temporally correlated with an increase in circulating EBOV-specific IgG antibodies among individuals who were suspected of being infected but shown to be negative for the virus by PCR. CONCLUSIONS Our results indicate that initial viremia is associated with outcome of the individual and outbreak duration; therefore, care must be taken in planning clinical trials and interventions. Additional research in virus adaptation and the impacts of host factors on EBOV transmission and pathogenesis is needed.
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Lanini S, Portella G, Vairo F, Kobinger GP, Pesenti A, Langer M, Kabia S, Brogiato G, Amone J, Castilletti C, Miccio R, Zumla A, Capobianchi MR, Di Caro A, Strada G, Ippolito G. Blood kinetics of Ebola virus in survivors and nonsurvivors. J Clin Invest 2015; 125:4692-8. [PMID: 26551684 DOI: 10.1172/jci83111] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%-70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak. METHODS Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors. RESULTS In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (cp/ml) (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsurvivors (7.46 log cp/ml; 95% CI, 7.17-7.76 vs. 8.60 log cp/ml; 95% CI, 8.27-8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors. CONCLUSION Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome. FUNDING Italian Ministry of Health; Italian Ministry of Foreign Affairs; EMERGENCY's private donations; and Royal Engineers for DFID-UK.
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Nicholson-Roberts T, Fletcher T, Rees P, Dickson S, Hinsley D, Bailey M, Lamb L, Ardley C. Ebola virus disease managed with blood product replacement and point of care tests in Sierra Leone. QJM 2015; 108:571-2. [PMID: 25956391 DOI: 10.1093/qjmed/hcv092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Nicholson-Roberts
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - T Fletcher
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - P Rees
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - S Dickson
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - D Hinsley
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - M Bailey
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - L Lamb
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
| | - C Ardley
- From the Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD, UK and Academic Department of Military Medicine, Royal Centre for Defence Medicine (Academia and Research), Medical Directorate, Joint Medical Command, ICT Centre, Birmingham Research Park, B15 2SQ Birmingham, UK
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McElroy AK, Erickson BR, Flietstra TD, Rollin PE, Nichol ST, Towner JS, Spiropoulou CF. Biomarker correlates of survival in pediatric patients with Ebola virus disease. Emerg Infect Dis 2015; 20:1683-90. [PMID: 25279581 PMCID: PMC4193175 DOI: 10.3201/eid2010.140430] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Children who had certain endothelial and immune function markers were more likely to survive infection. Outbreaks of Ebola virus disease (EVD) occur sporadically in Africa and are associated with high case-fatality rates. Historically, children have been less affected than adults. The 2000–2001 Sudan virus–associated EVD outbreak in the Gulu district of Uganda resulted in 55 pediatric and 161 adult laboratory-confirmed cases. We used a series of multiplex assays to measure the concentrations of 55 serum analytes in specimens from patients from that outbreak to identify biomarkers specific to pediatric disease. Pediatric patients who survived had higher levels of the chemokine regulated on activation, normal T-cell expressed and secreted marker and lower levels of plasminogen activator inhibitor 1, soluble intracellular adhesion molecule, and soluble vascular cell adhesion molecule than did pediatric patients who died. Adult patients had similar levels of these analytes regardless of outcome. Our findings suggest that children with EVD may benefit from different treatment regimens than those for adults.
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Moyen N, Thirion L, Emmerich P, Dzia-Lepfoundzou A, Richet H, Boehmann Y, Dimi Y, Gallian P, Gould EA, Günther S, de Lamballerie X. Risk Factors Associated with Ebola and Marburg Viruses Seroprevalence in Blood Donors in the Republic of Congo. PLoS Negl Trop Dis 2015; 9:e0003833. [PMID: 26047124 PMCID: PMC4457487 DOI: 10.1371/journal.pntd.0003833] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background Ebola and Marburg viruses (family Filoviridae, genera Ebolavirus and Marburgvirus) cause haemorrhagic fevers in humans, often associated with high mortality rates. The presence of antibodies to Ebola virus (EBOV) and Marburg virus (MARV) has been reported in some African countries in individuals without a history of haemorrhagic fever. In this study, we present a MARV and EBOV seroprevalence study conducted amongst blood donors in the Republic of Congo and the analysis of risk factors for contact with EBOV. Methodology and Findings In 2011, we conducted a MARV and EBOV seroprevalence study amongst 809 blood donors recruited in rural (75; 9.3%) and urban (734; 90.7%) areas of the Republic of Congo. Serum titres of IgG antibodies to MARV and EBOV were assessed by indirect double-immunofluorescence microscopy. MARV seroprevalence was 0.5% (4 in 809) without any identified risk factors. Prevalence of IgG to EBOV was 2.5%, peaking at 4% in rural areas and in Pointe Noire. Independent risk factors identified by multivariate analysis were contact with bats and exposure to birds. Conclusions/Significance This MARV and EBOV serological survey performed in the Republic of Congo identifies a probable role for environmental determinants of exposure to EBOV. It highlights the requirement for extending our understanding of the ecological and epidemiological risk of bats (previously identified as a potential ecological reservoir) and birds as vectors of EBOV to humans, and characterising the protection potentially afforded by EBOV-specific antibodies as detected in blood donors. Ebola and Marburg viruses cause haemorrhagic fevers often fatal to humans. Here, we looked for antibodies to Ebola and Marburg viruses (i.e., markers of previous contact with these viruses) in Congolese blood donors with no previous history of haemorrhagic fever. We found serologic evidence for contact with Marburg and Ebola viruses in 0.5% and 2.5% of blood donors, respectively. The circulation of Marburg virus occurs at a very low rate without any identified risk factor. In contrast, prevalence to Ebola virus was peaking at 4% in rural areas and in Pointe Noire city. Importantly, we identified that contacts with bats and birds constituted two independent environmental determinants of exposure. This study confirms that contact with Ebola virus is not infrequent in Congo and can occur in the absence of haemorrhagic fever. It highlights the requirement for further investigating the role of bats and birds in the ecological cycle of Ebola, and for determining whether asymptomatic contact with Ebola virus can provide subsequent protection against severe forms of the Ebola disease.
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Affiliation(s)
- Nanikaly Moyen
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
- Centre National de Transfusion Sanguine, Brazzaville, Republic of Congo
- IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
- * E-mail:
| | - Laurence Thirion
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
| | - Petra Emmerich
- Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | | | - Hervé Richet
- IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
| | - Yannik Boehmann
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
| | - Yannick Dimi
- Centre National de Transfusion Sanguine, Brazzaville, Republic of Congo
| | - Pierre Gallian
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
- IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
- Etablissement Français du Sang Alpes Méditerranée, Marseille, France
| | - Ernest A. Gould
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
| | - Stephan Günther
- Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Xavier de Lamballerie
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
- IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
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Warfield KL, Dye JM, Wells JB, Unfer RC, Holtsberg FW, Shulenin S, Vu H, Swenson DL, Bavari S, Aman MJ. Homologous and heterologous protection of nonhuman primates by Ebola and Sudan virus-like particles. PLoS One 2015; 10:e0118881. [PMID: 25793502 PMCID: PMC4368629 DOI: 10.1371/journal.pone.0118881] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 10/23/2014] [Accepted: 01/23/2015] [Indexed: 11/18/2022] Open
Abstract
Filoviruses cause hemorrhagic fever resulting in significant morbidity and mortality in humans. Several vaccine platforms that include multiple virus-vectored approaches and virus-like particles (VLPs) have shown efficacy in nonhuman primates. Previous studies have shown protection of cynomolgus macaques against homologous infection for Ebola virus (EBOV) and Marburg virus (MARV) following a three-dose vaccine regimen of EBOV or MARV VLPs, as well as heterologous protection against Ravn Virus (RAVV) following vaccination with MARV VLPs. The objectives of the current studies were to determine the minimum number of vaccine doses required for protection (using EBOV as the test system) and then demonstrate protection against Sudan virus (SUDV) and Taï Forest virus (TAFV). Using the EBOV nonhuman primate model, we show that one or two doses of VLP vaccine can confer protection from lethal infection. VLPs containing the SUDV glycoprotein, nucleoprotein and VP40 matrix protein provide complete protection against lethal SUDV infection in macaques. Finally, we demonstrate protective efficacy mediated by EBOV, but not SUDV, VLPs against TAFV; this is the first demonstration of complete cross-filovirus protection using a single component heterologous vaccine within the Ebolavirus genus. Along with our previous results, this observation provides strong evidence that it will be possible to develop and administer a broad-spectrum VLP-based vaccine that will protect against multiple filoviruses by combining only three EBOV, SUDV and MARV components.
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Affiliation(s)
- Kelly L. Warfield
- Integrated Biotherapeutics, Inc., Gaithersburg, Maryland, United States of America
- * E-mail:
| | - John M. Dye
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - Jay B. Wells
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - Robert C. Unfer
- Integrated Biotherapeutics, Inc., Gaithersburg, Maryland, United States of America
| | | | - Sergey Shulenin
- Integrated Biotherapeutics, Inc., Gaithersburg, Maryland, United States of America
| | - Hong Vu
- Integrated Biotherapeutics, Inc., Gaithersburg, Maryland, United States of America
| | - Dana L. Swenson
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - Sina Bavari
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - M. Javad Aman
- Integrated Biotherapeutics, Inc., Gaithersburg, Maryland, United States of America
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Ogawa H, Miyamoto H, Nakayama E, Yoshida R, Nakamura I, Sawa H, Ishii A, Thomas Y, Nakagawa E, Matsuno K, Kajihara M, Maruyama J, Nao N, Muramatsu M, Kuroda M, Simulundu E, Changula K, Hang'ombe B, Namangala B, Nambota A, Katampi J, Igarashi M, Ito K, Feldmann H, Sugimoto C, Moonga L, Mweene A, Takada A. Seroepidemiological Prevalence of Multiple Species of Filoviruses in Fruit Bats (Eidolon helvum) Migrating in Africa. J Infect Dis 2015; 212 Suppl 2:S101-8. [PMID: 25786916 DOI: 10.1093/infdis/jiv063] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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: 11/12/2022] Open
Abstract
Fruit bats are suspected to be a natural reservoir of filoviruses, including Ebola and Marburg viruses. Using an enzyme-linked immunosorbent assay based on the viral glycoprotein antigens, we detected filovirus-specific immunoglobulin G antibodies in 71 of 748 serum samples collected from migratory fruit bats (Eidolon helvum) in Zambia during 2006-2013. Although antibodies to African filoviruses (eg, Zaire ebolavirus) were most prevalent, some serum samples showed distinct specificity for Reston ebolavirus, which that has thus far been found only in Asia. Interestingly, the transition of filovirus species causing outbreaks in Central and West Africa during 2005-2014 seemed to be synchronized with the change of the serologically dominant virus species in these bats. These data suggest the introduction of multiple species of filoviruses in the migratory bat population and point to the need for continued surveillance of filovirus infection of wild animals in sub-Saharan Africa, including hitherto nonendemic countries.
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Affiliation(s)
- Hirohito Ogawa
- Hokudai Center for Zoonosis Control in Zambia Departments of Disease Control
| | | | | | | | | | - Hirofumi Sawa
- Departments of Disease Control Molecular Pathobiology Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Akihiro Ishii
- Hokudai Center for Zoonosis Control in Zambia Departments of Disease Control
| | - Yuka Thomas
- Hokudai Center for Zoonosis Control in Zambia Departments of Disease Control
| | - Emiko Nakagawa
- Hokudai Center for Zoonosis Control in Zambia Departments of Disease Control
| | - Keita Matsuno
- Divisions of Global Epidemiology Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | | | | | | | | | | | | | - Katendi Changula
- Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka Southern African Centre for Infectious Disease Surveillance, Chuo Kikuu, Morogoro, Tanzania
| | - Bernard Hang'ombe
- Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka Southern African Centre for Infectious Disease Surveillance, Chuo Kikuu, Morogoro, Tanzania
| | - Boniface Namangala
- Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka
| | | | | | - Manabu Igarashi
- Divisions of Global Epidemiology Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Kimihito Ito
- Bioinformatics, Research Center for Zoonosis Control Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Heinz Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Chihiro Sugimoto
- Departments of Disease Control Collaboration and Education Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Ladslav Moonga
- Hokudai Center for Zoonosis Control in Zambia Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka
| | - Aaron Mweene
- Departments of Disease Control Southern African Centre for Infectious Disease Surveillance, Chuo Kikuu, Morogoro, Tanzania
| | - Ayato Takada
- Departments of Disease Control Divisions of Global Epidemiology Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
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Affiliation(s)
| | - Charlotte Gryseels
- Unit of Medical Anthropology, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Alexandre Delamou
- Centre de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea
| | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, The Gambia; London School of Hygiene & Tropical Medicine, London, UK
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Koen Peeters Grietens
- Unit of Medical Anthropology, Institute of Tropical Medicine, Antwerp 2000, Belgium; School of International Health Development, Nagasaki University, Nagasaki, Japan; Partners for Applied Social Sciences International, Tessenderlo, Belgium.
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40
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Jackson A. Ebola, dogs and a vaccine. Aust Vet J 2015; 92:N8. [PMID: 25577809 DOI: 10.1111/avj.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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42
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Safe handling of Ebola samples: guidance from the CDC. MLO Med Lab Obs 2014; 46:18-9. [PMID: 25665241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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43
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Nau JY. [Ebola: "survivors' blood" gets into the official therapeutic arsenal]. Rev Med Suisse 2014; 10:1730-1731. [PMID: 25322506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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44
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Affiliation(s)
- Anita K McElroy
- Emory Pediatric Infectious Disease US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
| | - Christina F Spiropoulou
- US Centers for Disease Control and Prevention, Viral Special Pathogens Branch, Atlanta, Georgia
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45
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Nidom CA, Nakayama E, Nidom RV, Alamudi MY, Daulay S, Dharmayanti INLP, Dachlan YP, Amin M, Igarashi M, Miyamoto H, Yoshida R, Takada A. Serological evidence of Ebola virus infection in Indonesian orangutans. PLoS One 2012; 7:e40740. [PMID: 22815803 PMCID: PMC3399888 DOI: 10.1371/journal.pone.0040740] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/12/2012] [Indexed: 11/18/2022] Open
Abstract
Ebola virus (EBOV) and Marburg virus (MARV) belong to the family Filoviridae and cause severe hemorrhagic fever in humans and nonhuman primates. Despite the discovery of EBOV (Reston virus) in nonhuman primates and domestic pigs in the Philippines and the serological evidence for its infection of humans and fruit bats, information on the reservoirs and potential amplifying hosts for filoviruses in Asia is lacking. In this study, serum samples collected from 353 healthy Bornean orangutans (Pongo pygmaeus) in Kalimantan Island, Indonesia, during the period from December 2005 to December 2006 were screened for filovirus-specific IgG antibodies using a highly sensitive enzyme-linked immunosorbent assay (ELISA) with recombinant viral surface glycoprotein (GP) antigens derived from multiple species of filoviruses (5 EBOV and 1 MARV species). Here we show that 18.4% (65/353) and 1.7% (6/353) of the samples were seropositive for EBOV and MARV, respectively, with little cross-reactivity among EBOV and MARV antigens. In these positive samples, IgG antibodies to viral internal proteins were also detected by immunoblotting. Interestingly, while the specificity for Reston virus, which has been recognized as an Asian filovirus, was the highest in only 1.4% (5/353) of the serum samples, the majority of EBOV-positive sera showed specificity to Zaire, Sudan, Cote d'Ivoire, or Bundibugyo viruses, all of which have been found so far only in Africa. These results suggest the existence of multiple species of filoviruses or unknown filovirus-related viruses in Indonesia, some of which are serologically similar to African EBOVs, and transmission of the viruses from yet unidentified reservoir hosts into the orangutan populations. Our findings point to the need for risk assessment and continued surveillance of filovirus infection of human and nonhuman primates, as well as wild and domestic animals, in Asia.
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Affiliation(s)
- Chairul A. Nidom
- Avian Influenza-zoonosis Research Center, Airlangga University, Surabaya, Indonesia
- Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Eri Nakayama
- Division of Global Epidemiology, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Reviany V. Nidom
- Avian Influenza-zoonosis Research Center, Airlangga University, Surabaya, Indonesia
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Mohamad Y. Alamudi
- Avian Influenza-zoonosis Research Center, Airlangga University, Surabaya, Indonesia
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Syafril Daulay
- Center for Diagnostic Standard of Agriculture Quarantine, Ministry of Agriculture, Jakarta, Indonesia
| | | | - Yoes P. Dachlan
- Tropical Disease Hospital, Airlangga University, Surabaya, Indonesia
| | - Mohamad Amin
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Manabu Igarashi
- Division of Bioinformatics, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Hiroko Miyamoto
- Division of Global Epidemiology, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Reiko Yoshida
- Division of Global Epidemiology, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Ayato Takada
- Division of Global Epidemiology, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
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46
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Rubins KH, Hensley LE, Wahl-Jensen V, Daddario DiCaprio KM, Young HA, Reed DS, Jahrling PB, Brown PO, Relman DA, Geisbert TW. The temporal program of peripheral blood gene expression in the response of nonhuman primates to Ebola hemorrhagic fever. Genome Biol 2008; 8:R174. [PMID: 17725815 PMCID: PMC2375004 DOI: 10.1186/gb-2007-8-8-r174] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [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: 02/12/2007] [Revised: 05/04/2007] [Accepted: 08/28/2007] [Indexed: 11/15/2022] Open
Abstract
Primate blood cells were analysed for changes in global gene expression patterns at several time points following infection with Ebola virus, providing insights into potential mechanisms of viral pathogenesis and host defense. Background Infection with Ebola virus (EBOV) causes a fulminant and often fatal hemorrhagic fever. In order to improve our understanding of EBOV pathogenesis and EBOV-host interactions, we examined the molecular features of EBOV infection in vivo. Results Using high-density cDNA microarrays, we analyzed genome-wide host expression patterns in sequential blood samples from nonhuman primates infected with EBOV. The temporal program of gene expression was strikingly similar between animals. Of particular interest were features of the data that reflect the interferon response, cytokine signaling, and apoptosis. Transcript levels for tumor necrosis factor-α converting enzyme (TACE)/α-disintegrin and metalloproteinase (ADAM)-17 increased during days 4 to 6 after infection. In addition, the serum concentration of cleaved Ebola glycoprotein (GP2 delta) was elevated in late-stage EBOV infected animals. Of note, we were able to detect changes in gene expression of more than 300 genes before symptoms appeared. Conclusion These results provide the first genome-wide ex vivo analysis of the host response to systemic filovirus infection and disease. These data may elucidate mechanisms of viral pathogenesis and host defense, and may suggest targets for diagnostic and therapeutic development.
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Affiliation(s)
- Kathleen H Rubins
- Department of Microbiology and Immunology, 299 Campus Dr., Stanford University School of Medicine, Stanford, California 94305, USA
- Department of Biochemistry, 279 Campus Dr., Stanford University School of Medicine, Stanford, California 94305, USA
- Whitehead Institute for Biomedical Research, Nine Cambridge Center, Cambridge, Massachusetts 02142, USA
| | - Lisa E Hensley
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, Maryland 21702-5011, USA
| | - Victoria Wahl-Jensen
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, Maryland 21702-5011, USA
| | - Kathleen M Daddario DiCaprio
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, Maryland 21702-5011, USA
| | - Howard A Young
- National Cancer Institute - Frederick, 1050 Boyles St., Frederick, Maryland 21702, USA
| | - Douglas S Reed
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, Maryland 21702-5011, USA
| | - Peter B Jahrling
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, Maryland 21702-5011, USA
| | - Patrick O Brown
- Department of Biochemistry, 279 Campus Dr., Stanford University School of Medicine, Stanford, California 94305, USA
- Howard Hughes Medical Institute, 279 Campus Dr., Stanford University School of Medicine, Stanford, California 94305, USA
| | - David A Relman
- Department of Microbiology and Immunology, 299 Campus Dr., Stanford University School of Medicine, Stanford, California 94305, USA
- Department of Medicine, 300 Pasteur Dr., Stanford University School of Medicine, Stanford, California 94305, USA
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California 94304, USA
| | - Thomas W Geisbert
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, Maryland 21702-5011, USA
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47
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Chepurnov AA, Fedosova NI, Egoricheva IN, Poltavchenko AG, Elgh F. [Development of a method for rapid detection of Ebola virus antibodies and antigen]. Vopr Virusol 2007; 52:41-3. [PMID: 17601052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Despite the wide spectrum of reliable methods for identifying Ebola virus, their performance requires highly-skilled personnel, specialized laboratories, complicated equipment, and much time. Therefore, there is a need for a method that allows a physician or a medical attendant to identify the causative agent in field or bedside tests without special equipment as soon as possible. The immunoassay involving nitrocellulose membrane immuno-filtration, by using a fixed antigen (antibodies) or their immunosols, is a tried-and-true method. The time of the analysis is 7-15 min.
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48
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Dadaeva AA, Sizikova LP, Subbotina EL, Chepurnov AA. [Hematological and immunological parameters during Ebola virus passages in guinea-pigs]. Vopr Virusol 2006; 51:32-7. [PMID: 16929596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The trend in hematological and immunological parameters during Ebola virus passages in guinea-pigs indicated that pathophysiological changes occurred just during the second passage and further became stronger. The increase of some parameters and their correlation with the occurrence of fatal outcomes allowed the authors to reveal the most significant changes as increased juvenile platelets, whole blood virus appearance, higher echinocytes, a rise in the pro mil of blast cells and megakaryocytes in the bone marrow, and decreased neutrophilic phagocytic activity. Viral acquisition of the properties of lethality to guinea-pigs depends on the fine mechanisms responsible for viral interaction with host cells, which may lead to viral genetic changes during passages.
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49
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Sanchez A, Lukwiya M, Bausch D, Mahanty S, Sanchez AJ, Wagoner KD, Rollin PE. Analysis of human peripheral blood samples from fatal and nonfatal cases of Ebola (Sudan) hemorrhagic fever: cellular responses, virus load, and nitric oxide levels. J Virol 2004; 78:10370-7. [PMID: 15367603 PMCID: PMC516433 DOI: 10.1128/jvi.78.19.10370-10377.2004] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Peripheral blood samples obtained from patients during an outbreak of Ebola virus (Sudan species) disease in Uganda in 2000 were used to phenotype peripheral blood mononuclear cells (PBMC), quantitate gene expression, measure antigenemia, and determine nitric oxide levels. It was determined that as the severity of disease increased in infected patients, there was a corresponding increase in antigenemia and leukopenia. Blood smears revealed thrombocytopenia, a left shift in neutrophils (in some cases degenerating), and atypical lymphocytes. Infected patients who died had reduced numbers of T cells, CD8(+) T cells, and activated (HLA-DR(+)) CD8(+) T cells, while the opposite was noted for patients who survived the disease. Expression levels of cytokines, Fas antigen, and Fas ligand (TaqMan quantitation) in PBMC from infected patients were not significantly different from those in uninfected patients (treated in the same isolation wards), nor was there a significant increase in expression compared to healthy volunteers (United States). This unresponsive state of PBMC from infected patients despite high levels of circulating antigen and virus replication suggests that some form of immunosuppression had developed. Ebola virus RNA levels (virus load) in PBMC specimens were found to be much higher in infected patients who died than patients who survived the disease. Similarly, blood levels of nitric oxide were much higher in fatal cases (increasing with disease severity), and extremely elevated levels (>/=150 microM) would have negatively affected vascular tone and contributed to virus-induced shock.
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Affiliation(s)
- Anthony Sanchez
- Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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50
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Zabavichene NM, Chepurnov AA. [Dynamics of complement hemolytic activity in experimental Ebola infection]. Vopr Virusol 2004; 49:21-5. [PMID: 15106379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The dynamic hemolytic activity of complements (HAC) was investigated in blood of guinea pigs in lethal and non-lethal Ebola infection. The increasing HAC dynamic activity in the animal blood was found to correlate with the infection lethal course. HAC as observed in animals with lethal infection was sweepingly increasing after they, were infected with Ebola virus, and yet after 15 hours from the infection time the complement activity parameters topped 2-fold the basic values in 100% of guinea pigs. They began to be dropping by the end of day 1, their decrease reached, when the incubation time was over (days 3-4 after infection) the basic value, after which they continued to go down to the zero value in 2-3 days before the lethal outcome. The described phenomenon, like the phenomenon of accelerated death, was even more pronounced, when the animals were infected after a single immunization by activated Ebola virus. In case, guinea pigs were infected by a non-lethal Ebola virus strain, the compliment synthesis was observed to be activated only at the end of the incubation period; the process was accompanied with a gradual raise and with a plateau-type or wave-type increase of the complement during the treatment time--it was equally accompanied with normalizing activity parameters during recovery. The detected specificity could be important in prognosticating a disease outcome. A reliable correlation was demonstrated between the complement hemolytic activity and the level of circulating immune complexes in blood of experimental animals, which can be traced both in lethal and non-lethal infection.
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