Mobile diagnostics in outbreak response, not only for Ebola: a blueprint for a modular and robust field laboratory

Wölfel, Roman; Stoecker, Kilian; Fleischmann, Erna; Gramsamer, Brigitte; Wagner, Mat­thias; Molkenthin, Peter; Di, Antonino; Günther, Stephan; Ibrahim, Sofi; Genzel, Gelimer H.; Ozin-Hofsäss, Amanda J; Formenty, Pierre; Zöller, Lothar

doi:10.2807/1560-7917.es.2015.20.44.30055

Cited by 49 publications

(53 citation statements)

References 21 publications

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“…To meet this requirement, several mobile BSL-4 facilities were used during the recent West Africa outbreak (1,2). However, extensive safety precautions and training of medical and technical staff are needed to ensure personal safety (2-6).…”

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confidence: 99%

Rapid Bedside Inactivation of Ebola Virus for Safe Nucleic Acid Tests

et al. 2016

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Rapid bedside inactivation of Ebola virus would be a solution for the safety of medical and technical staff, risk containment, sample transport, and high-throughput or rapid diagnostic testing during an outbreak. We show that the commercially available Magna Pure lysis/binding buffer used for nucleic acid extraction inactivates Ebola virus. A rapid bedside inactivation method for nucleic acid tests is obtained by simply adding Magna Pure lysis/binding buffer directly into vacuum blood collection EDTA tubes using a thin needle and syringe prior to sampling. The ready-to-use inactivation vacuum tubes are stable for more than 4 months, and Ebola virus RNA is preserved in the Magna Pure lysis/binding buffer for at least 5 weeks independent of the storage temperature. We also show that Ebola virus RNA can be manually extracted from Magna Pure lysis/binding buffer-inactivated samples using the QIAamp viral RNA minikit. We present an easy and convenient method for bedside inactivation using available blood collection vacuum tubes and reagents. We propose to use this simple method for fast, safe, and easy bedside inactivation of Ebola virus for safe transport and routine nucleic acid detection. The most recent Ebola virus disease (EVD) outbreak began in West Africa in December 2013. As of March 2016, the number of confirmed, probable, and suspected EVD cases reported worldwide was 28,646. Guinea, Liberia, and Sierra Leone were the most affected countries with 3,804, 10,666 and 14,122 cases, respectively (1).Ebola virus (EBOV) is classified as a risk group 4 pathogen that requires handling under biosafety level 4 (BSL-4) conditions. To meet this requirement, several mobile BSL-4 facilities were used during the recent West Africa outbreak (1, 2). However, extensive safety precautions and training of medical and technical staff are needed to ensure personal safety (2-6). As of August 2015, 880 health care workers had been diagnosed with EVD, and 512 had died from the disease (7). Rapid bedside inactivation of EBOV would be a solution for the safety of medical and technical staff, risk containment, and easier transport of samples without requiring expensive category A shipping. Additionally, this process removes the need for sample handling under high-containment environments and facilitates high-throughput and rapid testing under nonbiosafety laboratory conditions and, thus, a rapid diagnosis of the disease.There is a need for a simple, efficient, and safe bedside inactivation method for EBOV. Presently, laboratory EBOV inactivation is accomplished by gamma irradiation (8), UV radiation (9), nanoemulsion (10), and photoinducible alkylating agents (11), but these methods are not applicable in outbreak situations or as bedside inactivation methods. Other EBOV inactivation methods, such as acetic acid (12), heat (12), AVL buffer (13), TRIzol (13) or the combination of heat and Triton X-100 (14), are more applicable in outbreak situations and are currently used in field laboratories. Unfortunately, all of these methods require...

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confidence: 99%

Rapid Bedside Inactivation of Ebola Virus for Safe Nucleic Acid Tests

et al. 2016

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“…Design, biosafety and biocontainment equipment used by international field-deployed laboratories in Africa differ from laboratory to laboratory [29–31, 36–37]. Currently there is no approved or recommended international standard for a mobile laboratory for the diagnosis of filovirus infections.…”

Section: Discussionmentioning

confidence: 99%

South African Ebola diagnostic response in Sierra Leone: A modular high biosafety field laboratory

et al. 2017

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BackgroundIn August 2014, the National Institute for Communicable Diseases (NICD) in South Africa established a modular high-biosafety field Ebola diagnostic laboratory (SA FEDL) near Freetown, Sierra Leone in response to the rapidly increasing number of Ebola virus disease (EVD) cases.Methods and findingsThe SA FEDL operated in the Western Area of Sierra Leone, which remained a “hotspot” of the EVD epidemic for months. The FEDL was the only diagnostic capacity available to respond to the overwhelming demand for rapid EVD laboratory diagnosis for several weeks in the initial stages of the EVD crisis in the capital of Sierra Leone. Furthermore, the NICD set out to establish local capacity amongst Sierra Leonean nationals in all aspects of the FEDL functions from the outset. This led to the successful hand-over of the FEDL to the Sierra Leone Ministry of Health and Sanitation in March 2015. Between 25 August 2014 and 22 June 2016, the laboratory tested 11,250 specimens mostly from the Western Urban and Western Rural regions of Sierra Leone, of which 2,379 (21.14%) tested positive for Ebola virus RNA.ConclusionsThe bio-safety standards and the portability of the SA FEDL, offered a cost-effective and practical alternative for the rapid deployment of a field-operated high biocontainment facility. The SA FEDL teams demonstrated that it is highly beneficial to train the national staff in the course of formidable disease outbreak and accomplished their full integration into all operational and diagnostic aspects of the laboratory. This initiative contributed to the international efforts in bringing the EVD outbreak under control in Sierra Leone, as well as capacitating local African scientists and technologists to respond to diagnostic needs that might be required in future outbreaks of highly contagious pathogens.

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“…Organizations such as the Centers for Disease Control and Prevention, USA, the National Institutes for Health, USA, the World Health Organization and the European Committee for Standardization should revise international recommendations accordingly. Technical advances arising from the successful deployment of mobile BSL-3 laboratories in the West African outbreak of Ebola disease (Chen et al, 2015;Faye et al, 2015;Inglis, 2015;Wölfel et al, 2015) should be exploited to derive cost-effective improvements to diagnostic laboratories in the CCHF endemic countries. In particular, the use of flexible-walled or hard plastic glove boxes for extraction of nucleic acids and inactivation of sera would greatly improve laboratory safety.…”

Section: Discussionmentioning

confidence: 99%