Support to Ebola in the field and laboratory

TDR news item
23 September 2014

The dramatic spread of the deadly Ebola virus has required a world-wide effort in many different technical areas. It is devastating communities and countries in West Africa, and is threatening global security. WHO is the main United Nations body to coordinate the response, and with TDR’s base at WHO and expertise from both staff and alumni, support is being provided where it can help.

Sierra Leone contact tracing, surveillance and social support

Andy Ramsay, a research project manager, has been seconded to WHO in Kenema City, Sierra Leone for over two months to lead the Ebola Surveillance and Community Support team.

WHO medical staff entering the contaminated areas of the hospital of Kenema, Sierra Leone.
WHO /Stéphane Saporito

Ramsay is from Scotland and has more than 30 years of experience working in health services and public health programmes in low- and middle-income countries . He came to TDR 10 years ago to work on improved diagnosis of tuberculosis.

In Sierra Leone, he has visited small villages that are under quarantine ensuring that they have sufficient provisions. But Ramsay also sees an amazing sharing among researchers and disease control experts in the African countries, what is called south-south cooperation. “There are incredible efforts being made by WHO, UNICEF, Médecins Sans Frontières, the United Nations Food Population Fund and the International Committee of the Red Cross,” he says.

Ramsay is working closely with Monica Musenero, a Ugandan epidemiologist and veteran of several Ebola outbreaks in her native country. “Uganda in particular has sent a lot of experienced Ebola staff, and we’re looking forward to working with those from Cuba soon,” he adds.

As new diagnostic tools become available, Ramsay will have the expertise to help put in place field testing of these valuable tools. And most importantly, each person in the field is learning from each other, working as an international team to the overall goal of controlling this outbreak.

Virus genome sequencing in Nigeria

TDR alumni Christian Happi, a Cameroonian, is leading the Nigerian laboratory that diagnosed the first case of Ebola in Sierra Leone. He’s also part of a team that has just published a paper in Science on the genome sequencing of the virus (see link in the right column).

It was in Happi’s laboratory at Redeemer’s University in Ogun State, Nigeria, where the first case of Ebola from Nigeria was diagnosed. Since then, they have been busy testing up to 20 samples a day that come in from all around Nigeria.

“Because we have sophisticated genomics research laboratories at the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), in Redeemer’s University, we were able to quickly diagnose the virus within hours of receiving the sample of the first Ebola index case in Nigeria,” he explains. “Together with the outreach and contract tracing teams, Nigeria has been able to control the spread of this deadly virus.” He points out that of the 19 cases reported in that country, only 7 have resulted in death.

Tragically, five co-authors in Sierra Leone contracted Ebola and lost their battle with the disease before the manuscript was published: Mohamed Fullah, Mbalu Fonnie, Alex Moigboi, Alice Kovoma, and S. Humarr Khan.

Guinea logistical coordination

The contact tracing team in a village in Guinea where an elderly woman died of Ebola. One form each day for each person who has had contact with this woman has to be completed for 21 consecutive days.
WHO/TDR/Franco Pagnoni

Former TDR staff Franco Pagnoni, who is now with WHO’s Global Malaria Programme, is working in Guinea for a month. He has been to several different areas in the country -- from the capital Conakry where things are more stable, to areas in the Coyah and Dubreka districts, and most recently in N'zerekore, the capital of Guinea’s forest region where in a nearby village 8 members of a team trying to raise awareness about Ebola had been killed by villagers using machetes and clubs in Guinea. Pagnoni is now in Guéckédou, 250 kilometres away and calm, but he sees the power that fear and ignorance play in these countries and the impact that this can have on the containment of the outbreak.

“The Ebola outbreak is more than a medical emergency – you can see the impact of political instability combined with poor health systems here,” Pagnoni says. With his expertise in malaria, he is also supporting national control officers to keep up with that disease as resources get pulled for Ebola.

Supporting new treatments and vaccines

Three TDR staff are members of the WHO Ethical Review Committee, and Piero Olliaro is helping to establish a new platform to identify the potential candidate treatments that will be tested in the West African countries. The platform was just announced and will be funded by the Wellcome Trust and managed by the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) and the Centre for Tropical Medicine and Global Health at the University of Oxford.

An MSF (Médecins Sans Frontières) isolation ward in Kampungu, Democratic Republic of Congo.
WHO

A number of sites will be established where the potential treatments can be formally evaluated in patients with Ebola virus disease in a standardised format. Médecins Sans Frontières (MSF) is currently responsible for the treatment of patients with Ebola in six centres in West Africa and will assess the suitability of these centres as sites for the trials, ensuring that activities do not adversely affect the delivery of patient care, staff welfare and safety, and centre operations. WHO will then facilitate access to the treatments, and rapid ethical review and implementation of the trials in affected countries.

Several candidate treatments are under consideration and a group of independent experts appointed by WHO will recommend which to prioritise based on factors such as which is likely to work best, availability, the ability to safely administer the intervention in treatment centre settings, and the capacity for manufacture to a useful scale. A number of pharmaceutical companies including Mapp Biopharmaceutical, Tekmira, and Sarepta are collaborating in the initiative and are providing key data on efficacy, safety, and production abilities for a number of potential treatments.

While awaiting the WHO recommendation on the products to be tested first, Olliaro will be working with the consortium and counterparts in affected countries to assess the suitability of potential sites, and establish the infrastructure, staffing and systems for the clinical trials platform.

Capacity built in Liberia for a clinical trial on onchocerciasis now used for Ebola

From 2009-2013, TDR supported extensive research capacity building in Liberia, as part of a Phase 3 clinical trial comparing the safety and efficacy of moxidectin to ivermectin in the treatment of onchocerciasis. The project was closed last November before the Ebola outbreak started in Foya, only 22 miles from Bolahun where the study was coordinated.

Jennifer Kealy, who was the senior monitor for this project, says that many of the colleagues trained by TDR are now working on the front lines in the Ebola efforts -- the principal investigator for the trial, Dr Hayford Howard; nurse Martha Gonway; and lab technician Mark Sessay are in Foya at the Ebola centre, with the parasitologist on his way. Others are in Monrovia.

The Liberian research team
WHO/TDR/Jennifer Kealy

Although no one from the Liberian research team has died, there have been 5 Ebola deaths in that community, including a healthcare provider. Dr Tabeh Freeman, former Dean of the Medical School in Liberia, managed to survive 14 years of civil war. Now he is trying to contend with the Ebola outbreak under the most difficult conditions.

Controlling this outbreak will take many different people with different types of expertise, not only for clinical management but also in research to identify and implement new diagnostic tools and treatment strategies. If you have a story to share about your involvement in research on Ebola, please contact TDR and feel free to share your experiences on our LinkedIn group, TDR.

For more information, please contact

Jamie Guth
TDR Communications Manager
Telephone: +41 79 441 2289
E-mail:guthj@who.int