A VP35 Mutant #Ebola Virus Lacks Virulence but Can Elicit Protective #Immunity to Wild-Type Virus Challenge (Cell Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Cell Rep. 2019 Sep 17;28(12):3032-3046.e6. doi: 10.1016/j.celrep.2019.08.047.

A VP35 Mutant Ebola Virus Lacks Virulence but Can Elicit Protective Immunity to Wild-Type Virus Challenge.

Woolsey C1, Menicucci AR2, Cross RW1, Luthra P3, Agans KN1, Borisevich V1, Geisbert JB1, Mire CE1, Fenton KA1, Jankeel A2, Anand S2, Ebihara H4, Geisbert TW5, Messaoudi I6, Basler CF7.

Author information: 1 Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA. 2 Department of Molecular Biology and Biochemistry, College of Biological Sciences, University of California, Irvine, Irvine, CA 92697, USA. 3 Center for Microbial Pathogenesis, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA. 4 Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55905, USA. 5 Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA. Electronic address: twgeisbe@utmb.edu. 6 Department of Molecular Biology and Biochemistry, College of Biological Sciences, University of California, Irvine, Irvine, CA 92697, USA. Electronic address: imessaou@uci.edu. 7 Center for Microbial Pathogenesis, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA. Electronic address: cbasler@gsu.edu.

 

Abstract

Zaire ebolavirus (EBOV) VP35 protein is a suppressor of type I interferon (IFN) production, an inhibitor of dendritic cell maturation, and a putative virulence determinant. Here, a recombinant EBOV encoding a mutant VP35 virus (VP35m) is demonstrated to activate RIG-I-like receptor signaling and innate antiviral pathways. When inoculated into cynomolgus macaques, VP35m exhibits dramatic attenuation as compared to wild-type EBOV (wtEBOV), with 20 or 300 times the standard 100% lethal challenge dose not causing EBOV disease (EVD). Further, VP35m infection, despite limited replication in vivo, activates antigen presentation and innate immunity pathways and elicits increased frequencies of proliferating memory T cells and B cells and production of anti-EBOV antibodies. Upon wtEBOV challenge, VP35m-immunized animals survive, exhibiting host responses consistent with an orderly immune response and the absence of excessive inflammation. These data demonstrate that VP35 is a critical EBOV immune evasion factor and provide insights into immune mechanisms of EBOV control.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Ebola; RIG-I; RLR signaling; VP35; filovirus; innate immunity; interferon; pathogenesis; primate

PMID: 31533029 DOI: 10.1016/j.celrep.2019.08.047

Keywords: Ebola; Viral pathogenesis.

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Learning from the #Epidemiological #Response to the 2014/15 #Ebola Virus Disease #Outbreak (J Epidemiol Globa Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Epidemiol Glob Health. 2019 Sep;9(3):169-175. doi: 10.2991/jegh.k.190808.002.

Learning from the Epidemiological Response to the 2014/15 Ebola Virus Disease Outbreak.

Holding M1,2,3, Ihekweazu C4,5, Stuart JM1,6, Oliver I1,2.

Author information: 1 NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, Bristol, UK. 2 Field Service, National Infection Service, Public Health England, Bristol, UK. 3 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. 4 Nigeria Centre for Disease Control, Abuja, Nigeria. 5 ECOWAS Regional Centre for Surveillance and Disease Control, Abuja, Nigeria. 6 School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

 

Abstract

A large international response was needed to bring the 2014/15 West African Ebola virus disease outbreak under control. This study sought to learn lessons from this epidemic to strengthen the response to future outbreaks of international significance by identifying priorities for future epidemiology training and response. Epidemiologists who were deployed to West Africa were recruited through a snowball sampling method and surveyed using an online anonymous questionnaire. Associations between demographics, training, qualifications, and role while in-country were explored alongside respondents’ experience during deployment. Of 128 responses, 105 met the inclusion criteria. Respondents originated from 25 countries worldwide, for many (62%), this was their first deployment abroad. The most common tasks carried out while deployed were surveillance, training, contact tracing, and cluster investigation. Epidemiologists would value more detailed predeployment briefings including organizational aspects of the response. Gaps in technical skills reported were mostly about geographical information systems; however, epidemiologists identified the need for those deployed in future to have greater knowledge about roles and responsibilities of organizations involved in the response, better cultural awareness, and leadership and management skills. Respondents felt that the public health community must improve the timeliness of the response in future outbreaks and strengthen collaboration and coordination between organizations.

© 2019 Atlantis Press International B.V.

KEYWORDS: Ebola virus; West Africa; FETP; epidemiologist; international deployment; outbreak response

PMID: 31529934 DOI: 10.2991/jegh.k.190808.002

Keywords: Ebola; West Africa; Public Health.

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Pan- #Filovirus #Serum Neutralizing #Antibodies in a Subset of #Congolese #Ebolavirus Infection #Survivors (J Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pan-Filovirus Serum Neutralizing Antibodies in a Subset of Congolese Ebolavirus Infection Survivors.

Bramble MS1,2, Hoff N1, Gilchuk P3, Mukadi P4, Lu K5, Doshi RH1, Steffen I5, Nicholson BP6, Lipson A1, Vashist N2, Sinai C1, Spencer D1, Olinger G7, Wemakoy EO8, Illunga BK9, Pettitt J10, Logue J10, Marchand J10, Varughese J10, Bennett RS10, Jahrling P10, Cavet G11, Serafini T11, Ollmann Saphire E12,13, Vilain E2, Muyembe-Tamfum JJ4, Hensely LE10,14, Simmons G5, Crowe JE Jr3,15, Rimoin AW1.

Author information: 1 Department of Epidemiology, School of Public Health, University of California, Los Angeles. 2 Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia. 3 Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee. 4 Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo. 5 Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco. 6 Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina. 7 Boston University, School of Medicine, Department of Medicine, Massachusetts. 8 Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. 9 Direction de la Lutte Contre les Maladies, Ministère de la Sante, Kinshasa, Democratic Republic of the Congo. 10 Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland. 11 Atreca, Inc, Redwood City. 12 Skaggs Institute for Chemical Biology, La Jolla, California. 13 Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, California. 14 Emerging Viral Pathogens Section, NIAID, NIH, Frederick, Maryland. 15 Departments of Pediatrics and Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.

 

Abstract

One year after a Zaire ebolavirus (EBOV) outbreak occurred in the Boende Health Zone of the Democratic Republic of the Congo during 2014, we sought to determine the breadth of immune response against diverse filoviruses including EBOV, Bundibugyo (BDBV), Sudan (SUDV), and Marburg (MARV) viruses. After assessing the 15 survivors, 5 individuals demonstrated some degree of reactivity to multiple ebolavirus species and, in some instances, Marburg virus. All 5 of these survivors had immunoreactivity to EBOV glycoprotein (GP) and EBOV VP40, and 4 had reactivity to EBOV nucleoprotein (NP). Three of these survivors showed serologic responses to the 3 species of ebolavirus GPs tested (EBOV, BDBV, SUDV). All 5 samples also exhibited ability to neutralize EBOV using live virus, in a plaque reduction neutralization test. Remarkably, 3 of these EBOV survivors had plasma antibody responses to MARV GP. In pseudovirus neutralization assays, serum antibodies from a subset of these survivors also neutralized EBOV, BDBV, SUDV, and Taï Forest virus as well as MARV. Collectively, these findings suggest that some survivors of naturally acquired ebolavirus infection mount not only a pan-ebolavirus response, but also in less frequent cases, a pan-filovirus neutralizing response.

PMID: 30107445 PMCID: PMC6217721 DOI: 10.1093/infdis/jiy453 [Indexed for MEDLINE]  Free PMC Article

Keywords: Ebola; Filovirus; Marburg; Serology.

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Impact of #intensive #care unit supportive care on the #physiology of #Ebola virus disease in a universally lethal #NHP #model (Intensive Care Med Exp., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Intensive Care Med Exp. 2019 Sep 13;7(1):54. doi: 10.1186/s40635-019-0268-8.

Impact of intensive care unit supportive care on the physiology of Ebola virus disease in a universally lethal non-human primate model.

Poliquin G1,2,3, Funk D4, Jones S1, Tran K1, Ranadheera C1, Hagan M1,3, Tierney K1, Grolla A1, Dhaliwal A5, Bello A1, Leung A1, Nakamura C6, Kobasa D1,3, Falzarano D7, Garnett L1, Bovendo HF8, Feldmann H9, Kesselman M2, Hansen G10, Gren J1, Risi G11, Biondi M12,13, Mortimer T13, Racine T3,8, Deschambault Y1, Aminian S1, Edmonds J1, Sourette R1, Allan M1, Rondeau L1, Hadder S1, Press C1, DeGraff C1, Kucas S1, Cook BWM14, Hancock BJ2,15, Kumar A3, Soni R2, Schantz D2, McKitrick J16, Warner B1, Griffin BD1, Qiu X1,3, Kobinger GP3,8, Safronetz D1, Stein D1,3, Cutts T1, Kenny J1, Soule G1, Kozak R17, Theriault S14, Menec L1, Vendramelli R1, Higgins S1, Liu G1, Rahim NM1, Kasloff S1, Sloan A1, He S1, Tailor N1, Gray M1, Strong JE18,19,20.

Author information: 1 National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada. 2 Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 3 Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 4 Department of Anaesthesia and Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 5 Medtronic Canada, Winnipeg, Manitoba, Canada. 6 National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, Manitoba, Canada. 7 Vaccine and Infectious Disease Organization-International Vaccine Centre, University of Saskatchewan, Saskatoon, Canada. 8 Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada. 9 Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, USA. 10 Faculty of Critical Care, Royal University Hospital, Saskatoon, Saskatchewan, Canada. 11 Infectious Disease Specialists, P.C., Missoula, MT, USA. 12 Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada. 13 Child & Women’s Health Programme, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada. 14 Cytophage Technologies, Inc., St. Boniface Hospital, Albrechtsen Research Centre, Winnipeg, Manitoba, Canada. 15 Department of Surgery, Division of Pediatric Surgery, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 16 Regional Pharmacy, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada. 17 Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada. 18 National Microbiology Laboratory, Public Health Agency of Canada, 1015 rue Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada. jim.strong@canada.ca. 19 Department of Pediatrics & Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. jim.strong@canada.ca. 20 Department of Infectious Diseases and Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. jim.strong@canada.ca.

 

Abstract

BACKGROUND:

There are currently limited data for the use of specific antiviral therapies for the treatment of Ebola virus disease (EVD). While there is anecdotal evidence that supportive care may be effective, there is a paucity of direct experimental data to demonstrate a role for supportive care in EVD. We studied the impact of ICU-level supportive care interventions including fluid resuscitation, vasoactive medications, blood transfusion, hydrocortisone, and ventilator support on the pathophysiology of EVD in rhesus macaques infected with a universally lethal dose of Ebola virus strain Makona C07.

METHODS:

Four NHPs were infected with a universally lethal dose Ebola virus strain Makona, in accordance with the gold standard lethal Ebola NHP challenge model. Following infection, the following therapeutic interventions were employed: continuous bedside supportive care, ventilator support, judicious fluid resuscitation, vasoactive medications, blood transfusion, and hydrocortisone as needed to treat cardiovascular compromise. A range of physiological parameters were continuously monitored to gage any response to the interventions.

RESULTS:

All four NHPs developed EVD and demonstrated a similar clinical course. All animals reached a terminal endpoint, which occurred at an average time of 166.5 ± 14.8 h post-infection. Fluid administration may have temporarily blunted a rise in lactate, but the effect was short lived. Vasoactive medications resulted in short-lived improvements in mean arterial pressure. Blood transfusion and hydrocortisone did not appear to have a significant positive impact on the course of the disease.

CONCLUSIONS:

The model employed for this study is reflective of an intramuscular infection in humans (e.g., needle stick) and is highly lethal to NHPs. Using this model, we found that the animals developed progressive severe organ dysfunction and profound shock preceding death. While the overall impact of supportive care on the observed pathophysiology was limited, we did observe some time-dependent positive responses. Since this model is highly lethal, it does not reflect the full spectrum of human EVD. Our findings support the need for continued development of animal models that replicate the spectrum of human disease as well as ongoing development of anti-Ebola therapies to complement supportive care.

KEYWORDS: Ebola; Fluid; Hydrocortisone; NHP; Pathophysiology; Supportive care; Vasoactives; Ventilatory support

PMID: 31520194 DOI: 10.1186/s40635-019-0268-8

Keywords: Ebola; Ebola-Makona; Intensive care; Animal models.

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#Immunogenicity, Lot #Consistency, and Extended #Safety of rVSVΔG-Z #Ebola -GP #Vaccine: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Study in Healthy Adults (J Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Dis. 2019 Aug 30;220(7):1127-1135. doi: 10.1093/infdis/jiz241.

Immunogenicity, Lot Consistency, and Extended Safety of rVSVΔG-ZEBOV-GP Vaccine: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Study in Healthy Adults.

Halperin SA1, Das R2, Onorato MT2, Liu K2, Martin J2, Grant-Klein RJ2, Nichols R3, Coller BA2, Helmond FA2, Simon JK2; V920-012 Study Team.

Author information: 1 Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, Canada. 2 Merck & Co., Inc., Kenilworth, New Jersey. 3 NewLink Genetics, Inc., BioProtection Systems, Ames, Iowa.

 

Abstract

BACKGROUND:

This double-blind study assessed immunogenicity, lot consistency, and safety of recombinant vesicular stomatitis virus-Zaire Ebola virus envelope glycoprotein vaccine (rVSVΔG-ZEBOV-GP).

METHODS:

Healthy adults (N = 1197) were randomized 2:2:2:2:1 to receive 1 of 3 consistency lots of rVSVΔG-ZEBOV-GP (2 × 107 plaque-forming units [pfu]), high-dose 1 × 108 pfu, or placebo. Antibody responses pre-/postvaccination (28 days, 6 months; in a subset [n = 566], months 12, 18, and 24) were measured. post hoc analysis of risk factors associated with arthritis following vaccination was performed.

RESULTS:

ZEBOV-GP enzyme-linked immunosorbent assay (ELISA) geometric mean titers (GMTs) increased postvaccination in all rVSVΔG-ZEBOV-GP groups by 28 days (>58-fold) and persisted through 24 months. The 3 manufacturing lots demonstrated equivalent immunogenicity at 28 days. Neutralizing antibody GMTs increased by 28 days in all rVSVΔG-ZEBOV-GP groups, peaking at 18 months with no decrease through 24 months. At 28 days, ≥94% of vaccine recipients seroresponded (ZEBOV-GP ELISA, ≥2-fold increase, titer ≥200 EU/mL), with responses persisting at 24 months in ≥91%. Female sex and a history of arthritis were identified as potential risk factors for the development of arthritis postvaccination.

CONCLUSIONS:

Immune responses to rVSVΔG-ZEBOV-GP persisted to 24 months. Immunogenicity and safety results support continued rVSVΔG-ZEBOV-GP development.

CLINICAL TRIALS REGISTRATION: NCT02503202.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

KEYWORDS: Ebola; clinical trial; immunogenicity; rVSVΔG-ZEBOV-GP; vaccine

PMID: 31505665 DOI: 10.1093/infdis/jiz241

Keywords: Ebola; Vaccines.

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A qualitative study to understand how #Ebola Virus Disease affected #nutrition in #SierraLeone—A #food value-chain #framework for improving future response #strategies (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

A qualitative study to understand how Ebola Virus Disease affected nutrition in Sierra Leone—A food value-chain framework for improving future response strategies

Stephen R. Kodish , Frank Bio, Rachel Oemcke, James Conteh, Jean Max Beauliere, Solade Pyne-Bailey, Fabian Rohner, Ismael Ngnie-Teta, Mohammad B. Jalloh, James P. Wirth

Published: September 10, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007645

 

Abstract

Background

This study sought understand how the 2014–2016 EVD Virus Disease (EVD) outbreak impacted the nutrition sector in Sierra Leone and use findings for improving nutrition responses during future outbreaks of this magnitude.

Methodology

This qualitative study was iterative and emergent. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations (UN) agencies and non-governmental organizations (NGO)), as well as community informants (n = 21; EVD survivors, health workers, community leaders) until data saturation. Multiple analysts collaborated in a team-based coding approach to identify key themes using Dedoose software. Findings are presented as both quotations and tables/figures.

Results

The EVD outbreak effects and the related response strategies, especially movement restriction policies including 21-day quarantines, contributed to disruptions across the food value-chain in Sierra Leone. System-wide impacts were similar to those typically seen in large-scale disasters such as earthquakes. Participants described an array of direct and indirect effects on agricultural production and food storage and processing, as well as on distribution, transport, trade, and retailing. Secondary data were triangulated by interviews which described the aggregate negative effect of this outbreak on key pillars of food security, infant and young child feeding practices, and nutrition. During the humanitarian response, nutrition-specific interventions, including food assistance, were highly accepted, although sharing was reported. Despite EVD impacts across the entire food value-chain, nutrition-sensitive interventions were not central to the initial response as EVD containment and survival took priority. Culturally-appropriate social and behavior change communications were a critical response component for improving health, nutrition, and hygiene-related behaviors through community engagement.

Conclusions

Infectious diseases such as EVD have far-reaching effects that impact health and nutrition through interrelated pathways. In Sierra Leone, the entire food value-chain was broken to the extent that the system-wide damage was on par with that typically resulting from large natural disasters. A food value-chain approach, at minimum, offers a foundational framework from which to position nutrition preparedness and response efforts for outbreaks in similar resource constrained settings.

 

Author summary

The 2014–2016 EVD outbreak has greatly impacted the population health and nutrition of affected countries in West Africa, including that of Sierra Leone. Since this recent outbreak, the humanitarian community acknowledges the need for improved solutions to better prepare for, and respond. Despite the importance of nutrition during outbreaks, there has been little systematic research conducted for understanding lessons learned and improving upon the typical nutrition response options currently available. This study used qualitative interviews to collect in-depth narratives from government officials, front-line health workers, non-government organization management, and community members including local leaders and EVD survivors. Findings reveal the unprecedented magnitude of this outbreak, which had systems-wide impacts not dissimilar to those felt by natural disasters. Interviews with people who lived through this event in Sierra Leone described EVD effects which revealed the importance and fragility of multiple, interconnected systems comprising the food value-chain for optimal nutrition in Sierra Leone. Findings across the food value-chain reveal how this interconnected system was impacted at every level with consequences for population-level nutrition. In preparation for future outbreaks of this magnitude, such a framework may prove useful for policy and planning, including improved guidelines development for employing coordinated nutrition-specific and nutrition–sensitive approaches that address immediate and underlying determinants of nutritional status.

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Citation: Kodish SR, Bio F, Oemcke R, Conteh J, Beauliere JM, Pyne-Bailey S, et al. (2019) A qualitative study to understand how Ebola Virus Disease affected nutrition in Sierra Leone—A food value-chain framework for improving future response strategies. PLoS Negl Trop Dis 13(9): e0007645. https://doi.org/10.1371/journal.pntd.0007645

Editor: Ruth Kutalek, Medizinische Universitat Wien, AUSTRIA

Received: May 15, 2017; Accepted: July 19, 2019; Published: September 10, 2019

Copyright: © 2019 Kodish et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are available from Groundwork. Because the original audio files cannot be anonymized, participant confidentiality is at risk should the files be made publicly available. Therefore, only anonymized transcripts can be shared with interested parties upon request by emailing contact@groundworkhealth.org.

Funding: UNICEF funded this research project. UNICEF supported both Groundwork and FOCUS 1000 research team members during study design, data collection and analysis, decision to publish, and preparation of this manuscript.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JMB and IN-T are employees of UNICEF and SP-B is a Ministry of Health official in Sierra Leone.

Keywords: Ebola; Sierra Leone; Food safety; Society.

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The #impact of Infection Prevention and control (#IPC) bundle implementationon IPC compliance during the #Ebola virus #outbreak in Mbandaka / #DRC: a before and after design (BMJ Open., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMJ Open. 2019 Sep 5;9(9):e029717. doi: 10.1136/bmjopen-2019-029717.

The impact of Infection Prevention and control (IPC) bundle implementationon IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design.

Ousman K1, Kabego L2,3, Talisuna A4, Diaz J5, Mbuyi J6, Houndjo B4, Ngandu JP6, Omba G6, Aruna A6, Mossoko M6, Djingarey MH4, Balde T4, Abok P4, Diallo B4, Dovlo D7, Yao M4, Fortin A5, Formenty P5, Fall IS4.

Author information: 1 World Health Organization Regional Office for Africa, Brazzaville, Congo ousmank@who.int. 2 Infection Control Africa Network, Bukavu, Democratic Republic of the Congo. 3 Microbiology, Universite Catholique de Bukavu Faculte de Medecine, Bukavu, Democratic Republic of the Congo. 4 World Health Organization Regional Office for Africa, Brazzaville, Congo. 5 World Health Organization, Geneva, Switzerland. 6 Ministry of Health, Kinshasa, Democratic Republic of the Congo. 7 International Health System Services Expert, Accra, Ghana.

 

Abstract

OBJECTIVES:

To assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs)

DESIGN:

This was a before and after comparison study

SETTINGS:

This study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).

PARTICIPANTS:

48 HCFs

INTERVENTIONS:

HCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.

PRIMARY OUTCOME MEASURES:

IPC score

RESULTS:

48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centres (p value<0.001). The aggregate mean IPC score at baseline for all HCFs, combined was 4.41% and at follow-up it was 39.51% with a mean difference of 35.08% (p-value<0.001).

CONCLUSIONS:

Implementation of HCW capacity building in IPC, IPC kit donation to HCF and mentoring in IPC improved IPC compliance during the ninth EVD outbreak in the DRC.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS: Democratic Republic of the Congo; Ebola virus disease; infection prevention and control

PMID: 31492782 DOI: 10.1136/bmjopen-2019-029717

Keywords: Ebola; DRC; IPC.

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