The Ebola virus was discovered in 1976, but it took close to four decades for the world to encounter the magnitude of a full outbreak. Between 2014 and 2016, there was an Ebola outbreak in West Africa that caused more fatalities than the previous six outbreaks combined. The outbreak started in Guinea and spread to Sierra Leone, Liberia, and Nigeria and later spread to Spain, the United Kingdom, and the US. In total, there were over 28,600 infections and over 11,325 deaths by June 2016 when the outbreak was finally declared over by the World Health Organization (WHO). So when new Ebola cases were announced in Uganda in 2022, the world had every reason to be afraid.
In September 2022, there was a new outbreak of the Ebola virus- Sudan variant- that occurred in the Western and Central Regions of Uganda. This time, the world was quick to respond and initiate swift testing, isolation, and treatment for those affected. Consequently, the outbreak was contained and did not spread to any other countries beyond Sudan and Uganda. In total, about 160 people got infected and 77 died and by January 10, 2023, the ebola break had been conquered.
The Ebola virus causes hemorrhagic fevers and kills up to 90% of those infected within one to two weeks. The virus is contagious and can be easily spread from one person to another through contact. Just like the SARS-CoV-2 virus, early screening, testing, and isolation is an effective way of preventing a major Ebola virus outbreak. This blog analyzes the impact of the 2022 Ebola outbreak on laboratories and gives recommendations for better preparedness in the future.
Testing Ebola Virus
Early symptoms of the Ebola virus include severe fever, headaches, muscle pain, and fatigue. Apart from the symptoms, possible exposure to the virus is needed to necessitate a confirmatory test. Exposure can be in the form of contact with:
Blood or body fluids from an infected person
Objects or surfaces that have been contaminated with blood or body fluids from an infected person
Infected primates (apes or monkeys)
Semen from an infected male
Persons exhibiting symptoms of the Ebola virus but who do not have any possible exposure should be isolated, and the responsible health authorities should be notified of such cases.
The Ebola virus can be detected in blood one to three days after a person becomes symptomatic. A Polymerase Chain Reaction (PCR) is often used to detect the Ebola virus because of its ability to detect low levels of the virus. When the virus is in very small amounts, a test that can detect Ebola antibodies may be required. Once the test has been carried out and the results are positive, the patient is started on immediate treatment for the Ebola virus. This whole process needs to be swift to prevent the spread of the infection to other persons and most importantly, to save the patient’s life.
Inadequate Testing Kits for Sudan Ebola Virus (SUDV)
The BioFire FilmArray NGDS Warrior Panel is the only test approved for detecting the SUDV. This test uses a two-stage nested multiplex PCR process. Unfortunately, most commercial and academic laboratories are not able to offer this test. In case of a major outbreak, the few laboratories performing this test would easily get overwhelmed and be unable to keep up with the demands.
Laboratory Biosafety Considerations
Given that most laboratories lack Ebola virus testing kits, there’s an increased need to have biosafety measures in place when handling suspected SUDV biospecimens. First, laboratories should adhere to strict infection control, OSHA, and bloodborne pathogens protocols to prevent or reduce employee exposure. Laboratories should also have appropriate measures in place to contain accidental staff exposure should this happen. Lastly, there is a need to have laboratory staff trained and sensitized about possible Ebola outbreaks and how to respond to them in case they occur.
Learning Points for Diagnostic Testing Laboratories
Laboratories played an important role in containing the 2022 Ebola outbreak, working hand in hand with international, national, and local agencies. Without this collaboration, there would have been more infections and definitely more lives would have been lost. However, there are some key lessons that will improve response in the future should another outbreak occur:
Need to identify and have appropriate personal protective equipment (PPE) in readiness for an outbreak of such a nature. Staff should also be trained on how to use PPEs.
Need to increase access to SUDV test kits and ensure that laboratory staff is appropriately trained.
Need to train laboratory staff on handling and processing such specimens which should include having drills and competency examinations.
Need to create a designated area for handling Ebola suspected specimens where chances of contamination are close to nil.
Need to have protocols in place for the transfer of Ebola suspected specimens when appropriate test kits are not available in a laboratory.
How Does a Diagnostics LIMS Support Infectious Disease Testing?
As laboratories scale up their capacity to manage outbreaks such as that of the Ebola virus, they will need to rely more on efficient Laboratory Information Management Systems (LIMS). With a diagnostics LIMS in place, laboratories can easily manage data and track samples from the point at which they are received to the point where they are disposed of. A clinical diagnostics LIMS also automates workflows to reduce turnaround time which is necessary to initiate early treatment. A diagnostics LIMS also enables laboratories to meet various national and international regulatory requirements. Furthermore, it enables instant delivery of test reports to patients and providers as soon as the test is complete through a secure patient and provider portal respectively, enabling speedy isolation. A cloud-based diagnostics LIMS solution facilitates remote access and collaboration among various stakeholders, factors that played a big role in managing the 2022 Ebola outbreak.
The success that was observed in the 2022 Ebola outbreak provides several learning points for governments, health institutions, and the public in general. The lessons learned can be applied to other similar outbreaks beyond the Ebola virus.