Ebola Outbreak In West Africa Research Articles

Special Pathogens Readiness in the United States: From Ebola to COVID-19 to Disease X and Beyond.

Special Pathogens Readiness in the United States: From Ebola to COVID-19 to Disease X and Beyond.

Setting-up an Ebola vaccine trial in a remote area of the Democratic Republic of the Congo: Challenges, mitigations, and lessons learned

Since the largest Ebola outbreak in West Africa (2013–2016) highlighted the potential threat of the Ebola virus to the world, several vaccines have been under development by different pharmaceutical companies. To obtain vaccine licensure, vaccine trials assessing the safety, immunogenicity and efficacy of new vaccines among different populations (e.g. different in age, gender, race, and ethnicity) play a crucial role. However, while this deadly disease mainly affects Central and West Africa, clinical trial regulations are becoming increasingly complex and consequently more expensive, influencing the affected low- and middle-income countries (LMICs) in performing high quality clinical trials. Consequently, the completion of such trials in LMICs takes more time and vaccines and drugs take longer to be licensed. To overcome some of the obstacles faced, the EBOVAC3 consortium, funded by the European Union’s Innovative Medicines Initiative and the Coalition for Epidemic Preparedness Innovations, enabled high quality vaccine trials in Central and West Africa through extensive North-South collaborations. In this article, the encountered challenges, mitigations, recommendations and lessons learned from setting-up an Ebola vaccine trial in a remote area of the Democratic Republic of Congo are presented. These challenges are grouped into eight categories: (1) Regulatory, political and ethical, (2) Trial documents, (3) International collaborations, (4) Local trial staff, (5) Community engagement and sensitization, (6) Logistics, (7) Remoteness and climate conditions, (8) Financial. By sharing the encountered challenges, implemented mitigations and lessons learned for each of these categories, we hope to prepare and inform other researchers aspiring a well-functioning clinical trial unit in similar remote settings in LMICs. ClinicalTrials.gov identifier: NCT04186000.

Epidemics and the Future of International Disaster Law

Abstract This paper explores the relationship between epidemics and International Disaster Law. In particular the paper addresses some selective examples of legal and operational issues pertaining to International Disaster Law where the increasing concern on health emergencies, dated back to the Ebola crisis, have progressively facilitated the management of tailored initiatives. In particular, in relation to prevention and preparedness, challenges experienced to include biological hazards in universal disaster risk reduction frameworks will be introduced, as well as the dedicated attention to preparedness for epidemics progressively experienced in international coordination disaster management systems. In relation to post-hazard phases, some initiatives aimed at facilitating international relief operations in front of epidemics will be explored, as complemented by international financial instruments factoring epidemics in assistance programs. This overview might thus permit to assess some trends in this area, paving the way for potential further reforms eventually based on developments already introduced in the framework of the COVID-19 pandemic.

Spatially-heterogeneous embedded stochastic SEIR models for the 2014–2016 Ebola outbreak in West Africa

The dynamics of human infectious diseases are challenging to understand, particularly when a pathogen spreads spatially over a large region. We present a stochastic, spatially-heterogeneous model framework derived from the foundational SEIR compartmental model. These models utilize a graph structure of spatial locations, facilitating mobility via random walks while progressing through disease states, parameterized by the net probability flux between locations. The analysis is bolstered by Approximate Bayesian Computation, by which epidemiological and mobility parameter distributions are estimated, including an empirically adjusted reproductive number, while model structure proposals are compared using Bayes Factors. The utility of this novel class of models is demonstrated through application to the 2014–2016 Ebola outbreak in West Africa. The flexibility of such models, whose complexity may be adjusted as desired, and complementary methods of analysis enable the exploration of various spatial divisions and mobility schema, while maintaining the essential spatiotemporal disease dynamics.

Pandemics and Management of “Dangerous Communities”: Ebola, COVID-19, and Africans in China

How do we unpack and make sense of anti-African/Black sentiments in the pandemic control and mitigation practices in China? This article responds to the question by drawing a parallel between the experiences of Africans in China during the Ebola virus disease and COVID-19 outbreaks. Focusing specifically on Nigerians as a subsection of the African community in Guangzhou City, China, it explores how the COVID-19-inspired discrimination against Africans reflects much of the experiences of Africans in China during the Ebola crisis of 2014. The article combines sixteen “Ebola experience” data points, obtained from Nigerians in Guangzhou in 2017, with four COVID-19 experience virtual interviews, media reports, and social media archive and netnographic analysis covering April to June 2020. The experiences of Africans in Guangzhou in the early months of the COVID-19 outbreak reflect a patterned response to Africans and Blackness in the context of pandemic in China. The article contributes to the literature by examining the question of racial discrimination and the construction of African immigrant community in China as dangerous within the new geography of Afro-mobilities in East Asia.

Understanding One Health through biological and behavioral risk surveillance in Liberia: a cross-sectional study

BackgroundThe 2014 Ebola crisis in West Africa mainly affected Guinea, Liberia, and Sierra Leone, claiming the lives of over 11 000 people, including health-care workers. Following this crisis, the Ebola Host Project worked to identify the wildlife reservoir for the virus that started the epidemic, to detect other related filoviruses, and to better understand ecological and human behavioral dynamics that could inform future risk reduction and prevention strategies. Here, we report key ecological and behavioral results for Liberia. MethodsIn Liberia, this cross-sectional study was conducted in 13 sites throughout eight counties. The project used a One Health biological-behavioral surveillance approach that included catch-and-release wildlife sampling and behavioral risk surveys. These sites were chosen from counties with forested areas inhabited by bats and rodents and included counties that were both severely and minimally impacted by the Ebola crisis. The analysis included 5000 bat and rodent biological samples, and the behavioural risk survey included 585 enrolled human participants from eight counties. Participants were selected from villages within a 5 km range of the 18 sampling sites, and they provided writteninformed consent. In addition to US based approvals, the Liberian National Ethical and Review Board, the Liberian Forest Development Authority and local government authorities approved the study and community work. FindingsThis sampling effort led to the first-time discovery of an Ebolavirus in a west African bat (Miniopterus inflatus) in January 2019. Across five of the eight counties, including Nimba County where the infected Miniopterus inflatus was sampled, mosquitos and tsetse flies were also identified as present vectors. Respondents reported the ways in which they interfaced with taxa of interest such as rodents. These interactions included wildlife consumption and proximity to human dwellings—interactions that present the risk of zoonotic infections that may go misdiagnosed as fevers of unknown origin. Respondents additionally described gaps in knowledge around topics such as the aetiology of Ebola in Liberia, as well as changes in the level of concern towards Ebola risk, which rose during the crisis but later returned to pre-crisis levels. InterpretationOur results highlight how, against the backdrop of human-wildlife interactions in these Liberian communities that present spillover risk, there exist opportunities to bridge knowledge gaps and create cues to encourage continued vigilance against transmission. FundingThis project was funded by USAID, and analysis with regard to the risk of acute febrile illnesses continues with funding from the US Defense Threat Reduction Agency.

Negotiating the Role of Anthropological Evidence in Medical Research during Health Emergencies

The 2014–2016 West African Ebola outbreak is often cited as a watershed moment for the social science of epidemics. Anthropologists played a key role in clarifying the social, economic and political dimensions of the epidemic, highlighting both how outbreak control measures were disrupting social practices and how they could be adapted to reflect local realities and experiences. Whilst undoubtedly significant, this narrative of anthropology’s successful integration risks obscuring the fraught position of the anthropologist within the Ebola response. Taking debates about public anthropology and the balance of action and critique as a starting point, we offer reflexive considerations from our work in the Ebola vaccine trials in Sierra Leone. We look at the involvement of social scientists in HIV clinical trials, which led to the inclusion of a social science component in the Ebola trials, through to the everyday discussions on how to integrate ethnographic insights into the running of operations. In so doing, we highlight the importance of foregrounding participants’ and communities’ voices, and confront what gets lost in translation. Keeping this tension in focus, we consider the consequences of this complex position for the possibility of a ‘critically embedded’ anthropology of clinical research in health emergencies.

"Is There Anything Else You Would Like to Add?": The Ethics of (Not) Addressing Research Participants' Top Concerns in Public Health Emergency Health Research.

When conducting interviews or focus groups, researchers often end with a simple question; “Is there anything else you would like to add?” This article takes responses to this question provided by participants in a study of “West Africans' Perceptions of Ebola research” as its point of departure. A number of participants in that study accepted the invitation to add on to their interview at its end with details of suffering from the sequelae of Ebola in their communities, and criticisms of state social abandonment. Some explicitly asked the researcher to ensure the suffering of Ebola survivors would be recognized at the international level. These closing words exceeded the objectives of the study within which they emerged. This was a study focused on lived experiences and decision-making to participate in Ebola research during or after the 2013–16 West Africa Ebola outbreak. The study aimed to inform the ethical conduct of research in future public health emergencies. What to do, then, in the face of these participants' entreaties to the interviewer for action to address Ebola survivors' suffering and social abandonment? Can and should the public health emergency or qualitative researcher better anticipate such requests? Where participants' expressed concerns and hopes for the impact of a study exceed its intended scope and the researchers' original intentions, what is at stake ethically in how we respond to those entreaties as researchers? This paper offers reflections on these questions. In doing so, our intention is to open up a space for further consideration and debate on the ethics of how researchers respond to unanticipated requests made to them in the course of research projects, to leverage their power and privilege to advance local priorities.

From viral evolution to spatial contagion: a biologically modulated Hawkes model.

Mutations sometimes increase contagiousness for evolving pathogens. During an epidemic, scientists use viral genome data to infer a shared evolutionary history and connect this history to geographic spread. We propose a model that directly relates a pathogen's evolution to its spatial contagion dynamics-effectively combining the two epidemiological paradigms of phylogenetic inference and self-exciting process modeling-and apply this phylogenetic Hawkes process to a Bayesian analysis of 23 421 viral cases from the 2014 to 2016 Ebola outbreak in West Africa. The proposed model is able to detect individual viruses with significantly elevated rates of spatiotemporal propagation for a subset of 1610 samples that provide genome data. Finally, to facilitate model application in big data settings, we develop massively parallel implementations for the gradient and Hessian of the log-likelihood and apply our high-performance computing framework within an adaptively pre-conditioned Hamiltonian Monte Carlo routine. Supplementary data are available at Bioinformatics online.

A Practical Approach for Quantitative Polymerase Chain Reaction, the Gold Standard in Microbiological Diagnosis

From gene expression studies to identifying microbes, quantitative polymerase chain reaction (qPCR) is widely used in research and medical diagnostics. In transmittable diseases like the Ebola outbreak in West Africa (2014–2016), or the present SARS-CoV2 pandemic qPCR plays a key role in the detection of infected patients. Although the technique itself is decades old with reliable approaches (e.g., TaqMan assay) in the diagnosis of pathogens many people showed distrust in it during the SARS-CoV2 outbreak. This came mainly from not understanding or misunderstanding the principles of qPCR. This situation motivated us to design a simple laboratory practical class, in which students have opportunities to understand the underlying principles of qPCR and its advantages in microbiological diagnosis. Moreover, during the exercise, students can develop skills such as handling experimental assays, and the ability to solve problems, discuss their observations. Finally, this activity brings them closer to the clinical practice and they can see the impact of the science on real life. The class is addressed to undergraduate students of biological sciences.

Lessons from Nigeria's Adaptation of Global Health Initiatives during the COVID-19 Pandemic.

Nigeria receives funds from several global health initiatives that are aimed at addressing elevated risks and overall burden of infectious disease outbreaks. These funds include the Global Fund to Fight AIDS, Tuberculosis and Malaria; US President's Emergency Plan for AIDS Relief; US President's Malaria Initiative; and Global Polio Eradication Initiative. These initiatives have contributed to a substantial reduction in illness and death from HIV, tuberculosis, malaria, and polio. However, Nigeria has experienced mixed success with leveraging the capacities built through these donor-funded vertical programs to respond to new health threats. This report describes experiences using resources from vertical disease programs by the Nigeria Centre for Disease Control in response to the 2014-2016 Ebola outbreak in West Africa and the COVID-19 pandemic. Integrating resources from different disease programs with government-led systems and institutions will improve responses to endemic outbreaks and preparedness for future pandemics in Nigeria.

Starting points matter: Cash plus training effects on youth entrepreneurship, skills, and resilience during an epidemic

This paper examines the impact of a “cash plus” intervention on youth entrepreneurship and skills formation during the Ebola crisis in Sierra Leone, using evidence from a randomized control trial. The intervention combined a regular stream of modest cash injections with training in either technical skills, business skills, or a combination of these two types of training. The results suggest that such interventions can build resilience to aggregate shocks by increasing employment and entrepreneurship, building cognitive and non-cognitive skills, and protecting household consumption and investments. However, results are heterogeneous. Youth with higher initial noncognitive skills experienced positive labor market and entrepreneurship impacts, while weaker noncognitive ability, poorer youth upgraded skills more extensively, but channeled benefits into more consumption. The findings confirm the age-malleability of noncognitive skills and suggest that, in low-ability contexts, the sensitive years for skill investments may reach into early adulthood. They also highlight dynamic policy trade-offs in productivity gains and poverty reduction and indicate the relevance of noncognitive measures for targeting.

Toward Health System Recovery in the Aftermath of Ebola Outbreak in Guinea: New Approaches for Improved Knowledge of Target Populations at the Community Level.

Background:Before the COVID-19 pandemic, Guinea has been the epicenter of the huge West Africa Ebola outbreak (2014-2016), that impact heavily the health system. Demographic information is one of the most basic data sources for health systems and services delivery, and yet can be very difficult to obtain with any accuracy. The objectives were to contribute among other to: (i) a determination of the catchment area (health coverage area and responsibility) of the Kirikilan health facility (PCM); (ii) geocoded mapping to find out exactly where these populations per sector of Kirikilan neighborhood lives; (iii) an approach for regular and systematic annual demographic follow up of target populations.Methods:The study was a 3-year community-based survey with annual follow up of the population within the quartier of Kirikilan in Dubreka Prefecture in Guinea. It was an exhaustive enumeration of the population, sector by sector of the quartier, then there was no sampling size neither estimation.Results:In October 2017 as a baseline of the study, the enumeration showed the total population was 8824 persons, 936 compounds, 1435 households, and the breakdown by sub quartier (sector) has been performed. It’s showed the interest of the mapping of the target populations with geo-referenced localization. The annual follow up by demographic enumerus showed a dramatic increase of the size of the population, including strong migration of the evicted population due to urbanization purpose in some districts of Conakry, the capital.Conclusion:The study showed the importance of the enumeration and follow up of the target populations, but also of the setting up community data based to improve the district health information system (DHIS 2) in Guinea. The approach has a best practice could be an importunity to improve data sharing, mapping, health quality access, and affordability for a sustainable health toward universal health coverage.

Synthetic Biology Construct of Ebola Virus in Bacteria Surrogate Is Stable and Safe for Rapid Detection Studies in a BSL-2 Laboratory Setting

Rapid detection of virulent pathogens during an outbreak is critical for public health advisories and control of the disease in a population. While many molecular techniques for point of care and clinical diagnosis abound, the US experience with the COVID-19 testing in the early stages of the pandemic underscores the critical importance of determining the appropriate target gene(s) with in-built controls that reliably detect pathogens with high sensitivity and specificity. Assays and research for diagnostics and therapy could be slowed during an epidemic because access to the required BSL-3 and BSL-4 laboratories are limited. So, during the 2014 West Africa Ebola outbreak, we tested the hypothesis that using synthetic cDNA of Ebolavirus in a bacteria surrogate (fit for all lab settings), would remain unmutated and safe after several generations, serving as an effective positive control in research settings, self test and point-of-care detection platforms. Primers were designed for the detection and quantification of the nucleoprotein (NP) gene of the 2014 Makona Ebola strain (KR781608.1, 733 - 1332 bp). To test the stability of artificially inserted translation arrest in the Orf of the model gene, it was edited to include three STOP codons in the RNA transcript using SNAP GENE. The segment was then spliced into a high copy number plasmid, cloned into One ShotTM TOP10 Escherichia coli (Invitrogen), and tested for stability and safety by periodic subculture, extraction and sequencing. Unlike COVID-19, rapid detection of blood-borne etiologies like Ebola requires optimized protocols for blood matrix. Using real-time PCR and newly designed primer pairs, the EBOV surrogate was detected and enumerated in human blood and regular broth and buffers. Based on aligned sequence analysis, the EBOV synthetic NP gene was stable (>99.9999% similarity coefficient) for at least 3 months. Detection sensitivity in broth and blood was at least 100 cells/ml or about 5.8 × 103 to 7.3 × 103 virion equivalents per ml. While the developments of transcription-and-replication-competent virus like particles (trVLP) have made it possible to study the infection and replication cycles of virulent pathogens in BSL-2 laboratories, the simplicity of our model and the reproducibility of detection and enumeration show the utility of synthetic bio-components as positive controls for point of care diagnostic tools. The inserted stop codons remained intact after many generations, suggesting that expressed virulent proteins can be easily silenced in synthetic biology models for research in BSL-1 and 2 and a wide range of pathogens. Synthetic bio-components can thereby aid further research by reducing costs and improving safety for workers and stakeholders.

Menace of Ebola Virus Disease: A Review

Ebola Virus Disease (EVD) a deadly disease that affect human and apes like gorilla, chimpanzee antelopes and so on. The causative virus is found mostly in Africa. It had been uncovered first in mid 1970s on the brink of the River of Ebola village. Since from the primary inception of the strange disease in Democratic Republic of Congo, there has been a periodic outbreak of the disease in some African countries, affecting many people within the region. A systematic review was conducted using Google search Engine, Cochrane database systemic review (CDSR), Centre for Disease Control and prevention and World Health Organization EVD report Databases. The 2014-2016 Ebola outbreaks in West Africa were the most important and most complex, which began in Guinea and spread to Liberia, Nigeria and Sierra Leone. Before the disease is contained, it kills about 11,000 people and quite 28,000 people being affected from it first mid 1970s detection to late 2016. The virus is transmitted from fruit bat in touch of with other animals and passes on the infection to humans through handling infected, dead or sick animals found within the forest or through direct contact with bats. Human to human transmission occurs through direct contact with the blood, secretions and other body fluids. Symptoms of the virus are: sudden onset of fever, fatigue, muscle pain, headache, sore throat, vomiting, diarrhea, rash, impaired kidney and liver function, and bleeding from body openings. Recent advancements have been carried out in the form of effective Ebola Virus Vaccine Inmazeb and Ebanga for Zaire Ebola Virus and anti-Ebola virus drug rVSV-ZEBOV (Ervebo). However, the rapid geographic propagation, non-specific clinical presentation, lack of adequate vaccine and specific diagnostic assay are the possible challenges to combat the dreaded public health menace of Ebola Virus Disease.

Livelihood Challenges and Mitigation Strategies Adopted During COVID-19 Lockdown Period

Over the past century, apart from COVID-19, human civilization has seen five other significant pandemics such as the H1N1 outbreak in 2009, Ebola outbreak in West Africa in 2014, and subsequent outbreak in Congo in 2019, Zika outbreak in 2016, etc. However, of all these outbreaks, perhaps the COVID-19 pandemic is unparalleled due to the global proportions that it has assumed. The severity of the epidemic can be seen in terms of the number of lives lost and the multi-dimensional impact that COVID-19 has had upon the economies of nations and lives of people. Beyond the physical sphere of human life, COVID-19 has also impacted human life's social, mental, and economic aspects.
 This study was conducted to understand the livelihood challenges faced by the residents of 5 villages in Mulshi taluka during the lockdown period. In-depth interviews were conducted with three respondents from each village (15 respondents). The study drew upon the insights given by key opinion leaders in the towns such as Sarpanch and elected members of the gram panchayat, ASHA workers, ration shop owners etc. Identify the livelihood challenges faced by the people during the lockdown imposed due to COVID-19. Describe the strategies adopted by the people to overcome the challenges to livelihood faced by the people.
 The residents of the village's studies faced various challenges related to agriculture such as lack of manpower to harvest produce, lack of transportation facilities to transport produce to markets, lack of storage facilities to store agricultural produce etc, loss of employment faced by daily wage laborers due to non-operational status of small businesses during the lockdown period and challenges due to reverse migration.

MODELING THE IMPACT OF EDUCATIONAL CAMPAIGN ON THE TRANSMISSION DYNAMICS OF EBOLA

Disease awareness that informs the public about the severity and transmission pathways of infectious diseases such as Ebola is key to curtailing an outbreak. Public health education when available can limit the intensity and duration of an Ebola outbreak in any community if there is compliance. It is important that all population groups be informed about the methods in which Ebola is transmitted to control the disease when there is an outbreak. In this paper, we study the impact of public health education that leads to behavioral changes on the dynamics of Ebola spread. The model is formulated as a system of ordinary differential equations and incorporates direct transmission from infectious, hospitalized, and deceased individuals with Ebola. We establish the existence of a disease free equilibrium and an endemic equilibrium, and investigate them for local and global stability. Model predictions show that a more informed community results in fewer cases, and thus limits the impact of an Ebola outbreak. Further, the model also predicts subsequent outbreak waves within a community in the absence of complete eradication. Lastly, the model successfully captures the dynamics of the 2014–2016 West Africa Ebola outbreak and the 2018–2020 Democratic Republic of Congo Ebola outbreak.

The 2018-2020 Ebola Outbreak in the Democratic Republic of Congo: A Better Response Had Been Achieved Through Inter-State Coordination in Africa.

The Ebola virus disease, formerly known as Ebola hemorrhagic fever, is a severe and often fatal zoonosis in humans. The 2013–2016 West African Ebola outbreak had distinctive characteristics, and it was the largest and most complex epidemic since the virus discovery in 1976. Although the 2018–2020 Ebola outbreak in the Democratic Republic of the Congo had many similarities, there were additional challenges due to the presence of armed rebel groups at the epicenters of the epidemic. Despite these challenges, the extraordinary commitment of the World Health Organization (WHO) regional office for Africa, in collaboration with Africa Union (AU) member states through the Africa Centres for Disease Control and Prevention (Africa CDC), and WHO’s prompt declaration of a Public Health Emergency of International Concern (PHEIC) shepherded an effective coordinated response to contain the epidemic. Learning from previous Ebola virus epidemics and the current Coronavirus disease 2019 (COVID-19) pandemic, the AU member states should strengthen inter-state coordination towards the development and implementation of a preparedness and readiness plan which will enable the continent to build and sustain resilient capacities to prevent, detect, and respond to future outbreaks following the International Health Regulations (IHR).

The Ebola crisis and people with disabilities\u2019 access to healthcare and government services in Liberia

BackgroundThere has been little research on the impact of the 2014-2015 West African Ebola crisis on people with disabilities. This paper outlines the way in which the Ebola Virus Disease (EVD) outbreak in Liberia in 2015 highlighted existing inequalities and exclusion of people with disabilities and their households.MethodsThe results presented here are part of a larger ESRC/DFID-funded mixed methods research project in Liberia (2014-2017) which included a quantitative household survey undertaken in five counties, complemented by qualitative focus group discussions and interviews with people with disabilities and other key stakeholders. Uniquely, this research gathered information about people with disabilities’ experience of the EVD outbreak, as well as additional socioeconomic and inclusion data, that compared their experience with non-disabled community members.ResultsReflections by people with disabilities themselves show knowledge, preparation, and responses to the EVD epidemic was often markedly different among people with disabilities due to limited resources, lack of inclusion by many mainstream public health and medical interventions and pre-existing discrimination, marginalisation and exclusion. Interviews with other key stakeholder revealed a lack of awareness of disability issues or sufficient training to include this population systematically in both Ebola response activities and general health services.Key findings include the need to understand and mitigate direct and indirect health consequences of unequal responses to the epidemic, as well as the limited capacity of healthcare and social services to respond to people with disabilities.ConclusionThere are lessons to be learned from Ebola outbreak around inclusion of people with disabilities, relevant to the current COVID-19 pandemic. Now is the time to undertake measures to ensure that people with disabilities do not continue to be marginalised and excluded during global public health emergencies.

Malaria and COVID-19: A double battle for Burundi.

Malaria has become a serious public health concern in Burundi. An outbreak that has the potential to evolve into an epidemic has eradicated nearly as many individuals as the Ebola crisis within the adjacent Democratic Republic of the Congo. The government's delay to announce a national crisis, increased breeding sites as a result of flooding, and the presence of multi-drug resistant malaria have exacerbated the burden. With a concurrent COVID-19 pandemic, economic complications, and overlap of symptoms between both diseases, these challenges are complex, but not unfamiliar. Organizations such as Médecins Sans Frontières have carried out spraying campaigns, and the government is actively mitigating efforts to handle the pandemic. That being said, there is still a need to enhance preventive measures such as increasing technological capacity and epidemiological surveillance to better withstand challenges.