Abstract
BackgroundEbola virus emerged in West Africa in December 2013. The ease of mobility, porous borders, and lack of public health infrastructure led to the largest Ebola virus disease (EVD) outbreak to date.InterventionThe 2013 EVD outbreak signalled the need for laboratory diagnostic capabilities in areas without strong public health systems. As part of the United States’ Department of Defense response, MRIGlobal was contracted to design, fabricate, equip, deploy, and operate two mobile diagnostic laboratories (MDLs). The first laboratory analysed blood samples from patients in an adjacent Ebola Treatment Centre (ETC) and buccal swabs from the deceased in the community in Moyamba, Sierra Leone. The second laboratory was deployed to support an ETC in Conakry, Guinea. The Department of Defense provided real-time quantitative reverse transcription polymerase chain reaction assays that were deployed and validated on-site.Lessons LearntPrompt and accurate molecular diagnostics reduced sample turn-around times from over 24 h to under 4 h. Experienced laboratory staff tested up to 110 samples per day and on-site engineering proved necessary for MDL setup and operation. As the Ebola response slowed, the sustainment of the MDLs’ operations was prioritised, including staff training and the transition of the MDLs to local governments. Training programmes for local staff were prepared in Sierra Leone and Guinea.RecommendationsThe MRIGlobal MDL team significantly contributed to establishing increased laboratory capacity during the EVD outbreak in West Africa. Using the MDLs for molecular diagnosis is highly recommended until more sustainable solutions can be provided.
Highlights
Ebola virus emerged in West Africa in December 2013
The closest BSL-3 laboratory was in Nigeria and was being used for tuberculosis diagnostics
The closest biosafety level 4 (BSL-4) laboratory was situated in Gabon, 3000 km away from Freetown, and unable to assist with Ebola virus disease (EVD) diagnostics timeously
Summary
In March 2014, the World Health Organization was notified regarding a cluster of disease in Guinea characterised by fever, severe diarrhoea, vomiting, and high fatality rate. The closest BSL-3 laboratory was in Nigeria and was being used for tuberculosis diagnostics. It was not capable of EVD testing, in that it lacked polymerase chain reaction (PCR) machines and had no validated assay and reagents. The United States Department of Defense initiated the Cooperative Biological Engagement Program in West Africa through the Defense Threat Reduction Agency to contain the biological agent (Ebola virus), enhance biosafety and biosecurity, and strengthen the region’s ability to detect, diagnose, and report public health emergencies of international concern to the World Health Organization.[3] MRIGlobal was awarded the contract to design, assemble, equip, and deploy rapid response MDLs for molecular detection of Ebola virus in patient samples. We describe here the deployment of the MDLs for the EVD outbreak response and discuss the successes and challenges experienced
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