Ebola Laboratory Response at the Eternal Love Winning Africa Campus, Monrovia, Liberia, 2014–2015

Abstract

West Africa experienced the first epidemic of Ebola virus infection, with by far the greatest number of cases in Guinea, Sierra Leone, and Liberia. The unprecedented epidemic triggered an unparalleled response, including the deployment of multiple Ebola treatment units and mobile/field diagnostic laboratories. The National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention deployed a joint laboratory to Monrovia, Liberia, in August 2014 to support the newly founded Ebola treatment unit at the Eternal Love Winning Africa (ELWA) campus. The laboratory operated initially out of a tent structure but quickly moved into a fixed-wall building owing to severe weather conditions, the need for increased security, and the high sample volume. Until May 2015, when the laboratory closed, the site handled close to 6000 clinical specimens for Ebola virus diagnosis and supported the medical staff in case patient management. Laboratory operation and safety, as well as Ebola virus diagnostic assays, are described and discussed; in addition, lessons learned for future deployments are reviewed.

Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening

“…This unique model describes a mobile laboratory structure co-located at an ETU which differed from other laboratories deployed during the response in a number of ways [ 9 , 19 – 21 , 39 ]. The laboratory was equipped with a rapid molecular diagnostic test, Xpert Ebola, allowing single specimen testing, staffed by local laboratory technicians as opposed to international teams on short deployments, supported by MoH and a collaboration of international partners, and provided EVD testing for both surveillance and ETU admissions towards the end of the outbreak when sustained diagnostic to detect new clusters was essential.…”

“…The assay has been shown to have a highly accurate performance and is comparable to other commercial assays for EVD [ 26 , 27 , 46 ]. Running on an automated cartridge-based platform means the assay has many benefits over conventional PCR platforms including reduced technical expertise and training requirements, minimal biosafety constraints outside of the glovebox, less sample processing and a faster turn-around time to results [ 5 , 26 , 27 , 39 ]. In Liberia, the assay resulted in shorter testing time than other EVD testing methodologies including the DOD EZ1 RT-PCR assay and US CDC’s Ebola virus NP/VP40 RT-PCR assays which were used in the other three Liberian EVD testing laboratories and averaged at 5–6 hours/run.…”

“…The model described here, differs from many mobile laboratories deployed during the outbreak as it was staffed by local laboratory technicians as opposed to international experts on short missions, providing more sustainable diagnostic capacity, vital as international partner support declined towards the end of the outbreak [ 5 , 9 , 19 , 39 , 47 ]. Staff feedback further supports the success of the laboratory and the impact of the initiative on laboratory systems strengthening.…”

Building laboratory capacity to detect and characterize pathogens of public and global health security concern in Kenya

“…For DGHP Africa regional Ebola outbreak response activity in 2014, a joint CDC Kenya DLSP staff and US National Institutes of Health team was deployed to Liberia, where the first mobile laboratory during the Ebola outbreak was established that assisted in the real time reverse transcription polymerase chain reaction (rRT-PCR) confirmation of Ebola virus from suspected and probable cases of Ebola virus disease for clinical management. The mobile Ebola laboratory tested6 000 specimens in support of the Ebola response [28]. DLSP has also identified and responded to other outbreaks including a rickettsial outbreak in Rwanda, [29].…”

INMI/Emergency NGO Italian Laboratory Established In Sierra Leone during Ebola Virus Disease Outbreak in West Africa

“…This meeting did not assemble all organisations actively deploying mobile laboratories in the EVD outbreak in West Africa nor did all organisations choose to publish their experiences in this special issue. Additional publications on mobile laboratory deployments have been published in other journals [31][32][33][34][35][36][37][38][39].…”