The problem: testing takes time, and it can be dangerous
Rapid diagnosis is imperative for controlling Ebola outbreaks. Early symptoms like fever and fatigue are the same for numerous other tropical diseases, so identifying the culprit is not easy without laboratory tests. Usually, samples need to go to specialised containment facilities to run the right tests, but due to weak infrastructure and a lack of sophisticated testing centres in the areas where Ebola outbreaks typically occur, it can take many days and up to a week to get results. There is an obvious need for a reliable, mobile and biosafe testing tool that can return results quickly and thus reduce the chances of the disease expanding further into the population. This would allow patients to be isolated straight away, and to target their close social circle for vaccination.
A test to detect (and deactivate) Ebola
The first hurdle for the EbolaMoDRAD project partners was to come up with a way of handling blood samples without creating any risk for the people who are responsible for taking, working with or transporting the samples. The project partners did this by creating a vacuum collection tube filled with an inactivation liquid that deactivates the virus itself while keeping the genetic material stable for about five weeks. This eliminates the need for a glovebox-equipped lab. Diagnosis is carried out on the spot, using the lateral flow dipstick test, eliminating the need for high-spec equipment or expertise.
The researchers tried out different techniques for detecting the infection in the blood, such as looking out for the virus itself, or looking for immune responses that would point to an infection. Apart from the rapid lateral flow assay, one of the most promising methods is gene detection by isothermal amplification. The project pitted different methods against each other to pick the best performing method. They also developed a pipette tip extraction, a battery-operated extraction method to single out the Ebola material so that the whole process is less dependent on electricity. Using samples gathered during the 2013-2016 outbreak, the researchers were able, with the help of local NGO Emergency, to test out the efficacy of the tools in Sierra Leone.
The legacy: teaching the tools
Once the project partners had achieved their mission of developing an Ebola test that was biosafe, specific, sensitive, rapid and simple to use, they set about the practicalities of making sure the local population would be able to use the technology independently. They organised a number of well-attended workshops in order to teach local groups in west African countries the necessary skills and procedures. Specifically, the workshops covered outbreak management, diagnostics and the use of diagnostic tools and how to interpret the results. They also organised hands-on training in neighbouring but non-epidemic countries.
Access to more (and more varied) expertise
Though the challenge itself was rather broad, the technical issues encountered during the project were very specific and complicated – and as such the mixed bag of expertise from the project partners was considered extremely beneficial. There were 18 partners, who knew they had to bring together whatever research and expertise was already out there, and most importantly, use the combined experience and expertise of a group to fix problems that would be next to impossible with an individual organisation.
The IMI-funded VHFMoDRAD builds on the achievements of EbolaMoDRAD which aims to develop a test capable of detecting a number of diseases related to Ebola. Both projects are part of the IMI Ebola+ programme.