Mobile laboratories for rapid deployment and their contribution to the containment of emerging diseases in Sub-Saharan Africa, illustrated by the example of Ebola virus disease

Between 2014 and 2016, the three West African countries of Guinea, Liberia and Sierra Leone experienced the deadliest Ebola virus disease (EVD) outbreak in sub-Saharan Africa. Two years later, a tenth epidemic recurred in the Democratic Republic of Congo (DRC), specifically in the North Kivu and Ituri provinces, which lasted until June 2020. Though they occurred in different countries, a review of how the EVD outbreaks in Guinea, Liberia, Sierra Leone, and the DRC were handled by the respective country governments, reveal gaps in disease detection, response and action due to lack of surveillance, an EVD preparedness plan, and weak health systems. This perspective discusses the EVD outbreaks in Guinea, Liberia, Sierra Leone, and the DRC, their effects, and draws attention to gaps that need to be addressed by these countries in order to be better prepared to handle future outbreaks. Acting on the proposed recommendations will not only benefit Guinea, Liberia, Sierra Leone, and the DRC in the future, but will be of benefit to EVD susceptible countries in sub-Saharan Africa, as we live in a global community where diseases are no respecters of boundaries.

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Syndromic detectability of haemorrhagic fever outbreaks

10.1101/2020.03.28.20019463 ◽

2020 ◽

Author(s):

Emma E. Glennon ◽

Freya L. Jephcott ◽

Alexandra Oti ◽

Colin J. Carlson ◽

Fausto A. Bustos Carillo ◽

...

Keyword(s):

Syndromic Surveillance ◽

Ebola Virus ◽

Virus Disease ◽

Sub Saharan Africa ◽

Ebola Virus Disease ◽

Published Data ◽

Case Definitions ◽

Clinical Criteria ◽

Health Infrastructure ◽

Sub Saharan

AbstractLate detection of emerging viral transmission allows outbreaks to spread uncontrolled, the devastating consequences of which are exemplified by recent epidemics of Ebola virus disease. Especially challenging in places with sparse healthcare, limited diagnostic capacity, and public health infrastructure, syndromes with overlapping febrile presentations easily evade early detection. There is a clear need for evidence-based and context-dependent tools to make syndromic surveillance more efficient. Using published data on symptom presentation and incidence of 21 febrile syndromes, we develop a novel algorithm for aetiological identification of case clusters and demonstrate its ability to identify outbreaks of dengue, malaria, typhoid fever, and meningococcal disease based on clinical data from past outbreaks. We then apply the same algorithm to simulated outbreaks to systematically estimate the syndromic detectability of outbreaks of all 21 syndromes. We show that while most rare haemorrhagic fevers are clinically distinct from most endemic fevers in sub-Saharan Africa, VHF detectability is limited even under conditions of perfect syndromic surveillance. Furthermore, even large clusters (20+ cases) of filoviral diseases cannot be routinely distinguished by the clinical criteria present in their case definitions alone; we show that simple syndromic case definitions are insensitive to rare fevers across most of the region. We map the estimated detectability of Ebola virus disease across sub-Saharan Africa, based on geospatially mapped estimates of malaria, dengue, and other fevers with overlapping syndromes. We demonstrate “hidden hotspots” where Ebola virus is likely to spill over from wildlife and also transmit undetected for many cases. Such places may represent both the locations of past unobserved outbreaks and potential future origins for larger epidemics. Finally, we consider the implications of these results for improved locally relevant syndromic surveillance and the consequences of syndemics and under-resourced health infrastructure for infectious disease emergence.

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COVID-19 Response in Sub-Saharan Africa: Lessons From Uganda

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.248 ◽

2020 ◽

Vol 14 (3) ◽

pp. e46-e48 ◽

Cited By ~ 1

Author(s):

Ivan Lumu

Keyword(s):

Decision Making ◽

Ebola Virus ◽

Virus Disease ◽

Sub Saharan Africa ◽

Disease Spread ◽

East African ◽

Limited Disease ◽

African Countries ◽

Response Team ◽

Sub Saharan

ABSTRACTThe prolongation of the Ebola epidemic may have allowed some countries to prepare and respond to the coronavirus disease (COVID-19) outbreak. In Uganda, the surveillance structure built for Ebola virus disease (EVD) has become a pillar in the COVID-19 response. This testing and tracing apparatus has limited disease spread to clusters with zero mortality compared with the neighboring East African countries. As more sub-Saharan countries implement social distancing to contain the outbreak, the interventions should be phased and balanced with health risk and socioeconomic situation. However, having a decision-making matrix would better guide the response team. These initial lessons from EVD-experienced Uganda may be helpful to other countries in the region.

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Ocular Manifestations of Ebola Virus Disease: An Ophthalmologist’s Guide to Prevent Infection and Panic

BioMed Research International ◽

10.1155/2015/487073 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Enzo Maria Vingolo ◽

Giuseppe Alessio Messano ◽

Serena Fragiotta ◽

Leopoldo Spadea ◽

Stefano Petti

Keyword(s):

Ebola Virus ◽

Virus Disease ◽

Clinical Signs ◽

Case Fatality ◽

Hemorrhagic Fever ◽

Ebola Virus Disease ◽

Ocular Manifestations ◽

Ebola Hemorrhagic Fever ◽

Sub Saharan ◽

The Moment

Ebola virus disease (EVD—formerly known as Ebola hemorrhagic fever) is a severe hemorrhagic fever caused by lipid-enveloped, nonsegmented, negative-stranded RNA viruses belonging to the genusEbolavirus. Case fatality rates may reach up to 76% of infected individuals, making this infection a deadly health problem in the sub-Saharan population. At the moment, there are still no indications on ophthalmological clinical signs and security suggestions for healthcare professionals (doctors and nurses or cooperative persons). This paper provides a short but complete guide to reduce infection risks.

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Pre-Ebola virus disease laboratory system and related challenges in Liberia

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v5i3.508 ◽

2016 ◽

Vol 5 (3) ◽

Cited By ~ 1

Author(s):

Stephen B. Kennedy ◽

John B. Dogba ◽

Christine L. Wasunna ◽

Philip Sahr ◽

Candace B. Eastman ◽

...

Keyword(s):

Infectious Diseases ◽

Ebola Virus ◽

Virus Disease ◽

Emerging Infectious Diseases ◽

Health Facilities ◽

Sub Saharan Africa ◽

Ebola Virus Disease ◽

Reference Laboratory ◽

Laboratory System ◽

Human Resource Capacity

Prior to the Ebola virus disease outbreak in Liberia, the laboratory system was duplicativefragmented and minimally coordinated. The National Reference Laboratory was conceptualisedto address the existing challenges by promoting the implementation of effective and sustainablelaboratory services in Liberia. However, in a resource-limited environment such as Liberiaprogress regarding the rebuilding of the health system can be relatively slow, while efforts tosustain the transient gains remain a key challenge for the Ministry of Health. In this paper, wedescribe the pre-Ebola virus disease laboratory system in Liberia and its prevailing efforts toaddress future emerging infectious diseases, as well as current Infectious diseases, all of whichare exacerbated by poverty. We conclude that laboratory and diagnostic services in Liberiahave encountered numerous challenges regarding its efforts to strengthen the healthcaredelivery system. These challenges include limited trained human resource capacity, inadequateinfrastructure, and a lack of coordination. As with most countries in sub-Saharan Africa, whencomparing urban and rural settings, diagnostic and clinical services are generally skewedtoward urban health facilities and private, faith-based health facilities. We recommend thatstructured policy be directed at these challenges for national institutions to develop guidelinesto improve, strengthen and sustain diagnostic and curative laboratory services to effectivelyaddress current infectious diseases and prepare for future emerging and re-emerging infectiousdiseases.

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Awareness and Education on Viral Infections in Nigeria Using Edutainment

Advances in Electronic Government, Digital Divide, and Regional Development - Impacts of the Media on African Socio-Economic Development ◽

10.4018/978-1-5225-1859-4.ch016 ◽

2017 ◽

pp. 245-260

Author(s):

Suleimanu Usaini ◽

Tolulope Kayode-Adedeji ◽

Olufunke Omole ◽

Tunji Oyedepo

Keyword(s):

Ebola Virus ◽

Viral Infections ◽

Virus Disease ◽

Medical Science ◽

Sub Saharan Africa ◽

Immunodeficiency Virus ◽

Public Health Challenge ◽

Sub Saharan ◽

Hepatitis C Viruses ◽

Means Of Transmission

Researches in clinical and medical science have shown that Human Immunodeficiency Virus (HIV), Hepatitis B, and to some extent Hepatitis C viruses, constitute a major public health challenge in the Sub-Saharan Africa. This is without prejudice to the Ebola virus disease (EVD) that is more deadly than the other three put together, and had affected some countries in West Africa- Liberia, Sierra Leone and Guinea. There is little awareness and education via the mass media on some common viral infections in Nigeria like Hepatitis compared to HIV. Therefore, there is dire need for information, sensitisation and education on the viruses, means of transmission, preventive measures and also therapy. Edutainment is the fusion of education into entertainment programming which can come in form of drama, music, poetry and lots more, and it had been used as a platform to create awareness for positive reproductive health and HIV/AIDS by leading health organisations like WHO, USAID, DFID, SFH, and UNFPA. This paper therefore, examines why edutainment should be used and how it can be used to educate media audience in Nigeria on some viral infections that pose serious health risks and how they can live healthy lives.

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Biosafety level-2 laboratory diagnosis of Zaire Ebola virus disease imported from Liberia to Nigeria

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v5i1.468 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 2

Author(s):

Olumuyiwa B. Salu ◽

Ayorinde B. James ◽

Bamidele O. Oke ◽

Mercy R. Orenolu ◽

Roosevelt A. Anyanwu ◽

...

Keyword(s):

Ebola Virus ◽

Virus Disease ◽

Rna Extraction ◽

Molecular Techniques ◽

Viral Rna ◽

Sub Saharan Africa ◽

Ebola Virus Disease ◽

Rt Pcr ◽

Route Of Transmission ◽

Biosafety Level

Introduction: Global travel is an efficient route of transmission for highly infectious pathogens and increases the chances of such pathogens moving from high disease-endemic areas to new regions. We describe the rapid and safe identification of the first imported case of Ebola virus disease in a traveler to Lagos, Nigeria, using conventional reverse transcription polymerase chain reaction (RT-PCR) in a biosafety level (BSL)-2 facility.Case presentation: On 20 July 2014, a traveler arrived from Liberia at Lagos International Airport and was admitted to a private hospital in Lagos, with clinical suspicion of Ebola virus disease.Methodology and Outcome: Blood and urine specimens were collected, transported to the Virology Unit Laboratory at the College of Medicine, University of Lagos, and processed under stringent biosafety conditions for viral RNA extraction. RT-PCR was set-up to query the Ebola, Lassa and Dengue fever viruses. Amplicons for pan-filoviruses were detected as 300 bp bands on a 1.5% agarose gel image; there were no detectable bands for Lassa and Dengue viral RNA. Nucleotide BLAST and phylogenetic analysis of sequence data of the RNA-dependent RNA polymerase (L) gene confirmed the sequence to be Zaire ebolavirus (EBOV/Hsap/ NGA/2014/LIB-NIG 01072014; Genbank: KM251803.1).Conclusion: Our BSL-2 facility in Lagos, Nigeria, was able to safely detect Ebola virus disease using molecular techniques, supporting the reliability of molecular detection of highly infectious viral pathogens under stringent safety guidelines in BSL-2 laboratories. This is a significant lesson for the many under-facilitated laboratories in resource-limited settings, as is predominantly found in sub-Saharan Africa.

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