Ebola detection and testing rapidly expands in Uganda and US

A presentation slide showing the location of the 2022 Sudan ebolavirus outbreak. The speaker is shown to the right.

Ebola detection and testing rapidly expands in Uganda and US

By Melanie Padgett Powers, writer

A partnership between Uganda and US public health professionals was instrumental in responding to the 2022 Ebola outbreak in Africa. Furthermore, lessons learned from that response helped update guidance on how the US would respond to suspected Ebola cases arriving on US shores.

Ebola is a highly transmissible disease with a mortality rate of 50 to 90 percent without treatment. When people hear “Ebola,” it’s usually referring to the Zaire ebolavirus, explained Trevor Shoemaker, PhD, MPH, at the 2023 APHL Annual Conference May 23 session, “Preparedness and Response Domestically and Abroad—the 2022 Ebola Outbreak” in Sacramento, CA. Shoemaker is team lead, epidemiology, surveillance, clinical and health education, Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC).

The Zaire virus has been responsible for the majority of Ebola outbreaks in recent years and is one of four ebolaviruses known to cause human infection. However, when Ebola broke out in Uganda in September 2022, it was the Sudan ebolavirus.

For the past 12 years, the CDC has been supporting Uganda’s Viral Hemorrhagic Fever (VHF) Surveillance System. “But we’ve been engaged in Uganda ever since the first Sudan virus outbreak detected in the year 2000,” Shoemaker said. For the VHF program, the CDC assisted Uganda’s Ministry of Health, through the Uganda Virus Research Institute, to establish a laboratory to perform in-country diagnostics and enhance the epidemiological and clinical surveillance in the country.

“Most of the things we helped implement were to improve reporting capability, improve the laboratory capacity, detect incident cases very rapidly and report those to the national level so they could take action,” Shoemaker said. “We improved the capability to respond, so this would be quick outbreak investigation and containment.”

They also trained Ugandan health workers on how to properly don personal protective equipment, take a blood specimen for testing, fill out the case report form and safely ship samples to the national laboratory.

The program, which has tested over 20,000 clinical samples, has greatly increased the detection of VHF outbreaks in Uganda and the region, Shoemaker said. Since the program began, it has detected more outbreaks than in the previous 10 years. “It has also reduced the time between initial report of suspected outbreaks and laboratory confirmation by quite a number of days,” he said. The laboratory can provide results within six to 12 hours of receiving the sample and can do confirmatory testing within 24 hours.

In the 2022 Ebola outbreak, there were 164 total cases in nine Ugandan districts, with 77 deaths, which is a 47 percent case fatality rate.

Ebola preparation in the US

Although the risk of Ebola being imported to the US last year was considered low, Shoemaker said, the CDC activated its emergency response structure. CDC Ebola Response Teams were ready to travel to states if needed. CDC updated its guidance for health care workers in the US for suspected Ebola cases. The APHL Biosafety and Biosecurity Committee also updated its Ebola guidance, which was from 2015.

In the US, the CDC oversees the Laboratory Response Network (LRN), a system of approximately 120 US laboratories—including all 50 state public health laboratories—that detect and respond to biological threats.

Before the 2022 Uganda Ebola outbreak, only eight LRN laboratories had the capability to test for the Sudan ebolavirus. Within a month, that was expanded to 27 LRN laboratories, as well as 10 regional emerging special pathogen treatment centers, Shoemaker said. Now, there are 34 laboratories able to test for Sudan virus (as well as the Marburg virus, another severe viral hemorrhagic fever).

To test for the Sudan ebolavirus, the LRN laboratories use the commercial product BioFire FilmArray and the Warrior Panel, which was approved by the US Food and Drug Administration in 2017. CDC uses a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay, similar to what many LRN laboratories already have to test for the Zaire virus. The CDC’s Sudan test is currently undergoing approval to send out to LRN laboratories.

In 2022 in the US, the CDC had clinical consultations for 35 ill returning travelers from the outbreak region and performed tests on three people. All were negative. Compare that to January 2017 to December 2021, Shoemaker said, when there were seven Ebola virus outbreaks and the US performed testing on only nine ill travelers.

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

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Laboratory twinning builds strong lab systems and relationships

Laboratory twinning builds strong lab systems and relationships | www.APHLblog.org

By David Mills, PhD, retired director, Scientific Laboratory Division, New Mexico Department of Health

When I first got involved in twinning, I had no idea that Halloween costumes would be part of the process. Let me explain.

During my time as director of the New Mexico public health laboratory, APHL connected my team with an equivalent lab in Paraguay. This entailed sending personnel to train their laboratorians, who later came to Albuquerque to see our work in action. Our “twin” labs developed strong bonds and this “twinning” project left a good taste in everyone’s mouth.

A year later, when APHL asked if we’d help Uganda’s Central Public Health Laboratory evolve into a national reference lab, we jumped at the chance to twin again.

Our first step was to visit Uganda to learn about their priorities and see what was truly achievable. We had an instant rapport with the Ugandan team and their director, Steven Aisu, and our discussion quickly reinforced how well matched our labs were. Our team had just moved from an old, cramped facility to a state of the art facility, just as the Ugandan team needed to do.

Because Aisu’s team was developing a new paradigm without ever seeing the process in action, our task was to help them clearly visualize the goal and then make it a reality through technical assistance, management and leadership training. We were all excited to get started.

The second step was for Sally Liska, retired director of the San Francisco public health lab, and me to hold training sessions in Kampala, the capital of Uganda. I loved doing these interactive courses because, for me, teaching is the best way to learn.

The Ugandan team was eager to know everything about how we ran our biosafety level 3 (BSL-3) lab, so the third step was for the Ugandan team to visit our facility in New Mexico. They met with experts from epidemiology to IT, quality assurance to maintenance, as well as senior officials. They were especially interested in how we worked with agricultural and environmental partners; Aisu described such collaborations as akin to bridging chasms. We shared our hard-won experiences. His team quickly gained proficiency in physical and scientific quality systems.

Just as important, we built strong relationships that will last.

I invited the team to my home for their last night in New Mexico before their return flight to Uganda. It happened to be Halloween, but we had been so busy it hadn’t come up in conversation. When the first trick-or-treaters arrived, I suddenly realized that my friends had never experienced the holiday. They were surprised and enchanted to find witches, ghosts and other costumed children at the door. It’s a good thing they were delighted—150 creatures of the night rang our bell over the next few hours! The following morning, we said farewell, but not goodbye.

I retired in 2015, but my connection to the Uganda team has continued without breaking stride. In June 2016, I went to Kampala for two weeks to help them develop strategic plans for their national health lab system and for oversight and regulation of the country’s entire health system. On my team were APHL consultants Kim Lewis and John Pfister, who has retired from the Wisconsin state lab.

A month later, we three musketeers facilitated a stakeholders’ meeting to review those plans and helped refine the strategic plan for their new facility (built by CDC) as they prepared for the September 2016 grand opening.

The New Mexico team has continued working with the Ugandan team as they transitioned into their new roles, and I have jumped in with both feet as a consultant through APHL. If they can stand my jokes, the least I can do is help them take their next steps. It’s my calling.

A Little Extra Fun…

This story isn’t directly related to my work with the laboratory, but I love telling it! While we were in Uganda, we stayed in a small hotel where the friendly manager would often come and chat. One day, she asked, “Have you ever had an avocado before?” I said, “Yes, I make guacamole with avocados.” She’d never heard of guacamole, so I described it and she grimaced, saying, “That sounds terrible!” I offered to make some anyway.

Laboratory twinning builds strong lab systems and relationships | www.APHLblog.org

Two days later, I had a night off from teaching and was sitting in the lobby when the manager came up to me and said, “We’re ready! Let’s make the guacamole. The whole kitchen staff is waiting!” Sure enough, a chef with a tall white hat and his crew were lined up behind the ingredients: avocados, lemon juice, garlic, onions. I was astonished and eager to get cooking!

Together, we made a huge batch for the hotel staff and served it on fried corn tortillas. Everyone was game to try it. Although first their reactions were uniformly polite yet skeptical, they eventually grew enthusiastic.

My conclusion: Guacamole is an acquired taste.

 

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APHL is a proud partner in the Global Health Security Agenda

Today President Obama announced the United States and 30 other nations have committed to join together to achieve the targets of the Global Health Security Agenda (GHSA).  APHL is proud to be a key partner in the effort to make the world safe from infectious disease threats.

APHL is working closely with US federal agencies as well as domestic agencies within African and Asian partner nations to achieve the following GHSA targets:

  • Countering antimicrobial resistance
  • Preventing the emergence and spread of zoonotic disease
  • Advancing a whole-of-government national biosafety and biosecurity system in every country
  • Establishing a national laboratory system
  • Strengthening real-time biosurveillance
  • Advancing timely and accurate disease reporting
  • Establishing a trained global health security workforce
  • Establishing emergency operations centers

APHL in Africa
Guinea, Kenya, Liberia, Sierra Leone, Tanzania, Uganda

To address the limited laboratory capacity and capability in many African nations, we are currently partnering with the African Society of Laboratory Medicine (ASLM) to provide technical and management assistance for design, development and implementation of the African Public Health Laboratory Network (APHLN).  Working with ASLM, APHL will convene stakeholders to develop the operational rules for the network, support laboratory accreditation and set goals for national public health laboratories. We will leverage existing laboratory models, notably the US Laboratory Response Network (LRN), to design an effective laboratory network for the continent.

As our GHSA work moves forward, APHL is also planning to initiate laboratory assessments, inventory and review of laboratory policies, training and mentoring of laboratory staff, support for development of biosafety facilities, and review of specimen referral systems, quality management system programs and capacity for detecting anti-microbial resistance.

APHL in Asia
India, Indonesia, Vietnam

In Asia, APHL is working directly with ministries of health and other national health officials to develop laboratory systems capable of safely and accurately detecting and characterizing pathogens causing epidemic disease. Lucy Maryogo-Robinson, APHL’s global health director, is traveling to partner countries in southeast and central Asia to plan activities under GHSA. In November she traveled with an APHL team to Vietnam to discuss projects to expand APHL’s longstanding relationship with that country.  Ongoing development of informatics systems and strengthening of capacity to respond to infectious diseases will be priorities.

The African Science Truck Experience

The African Science Truck Experience (TASTE) is an amazing charity I first found our about when founder Amy Buchanan-Hughes spoke at a science unconference I co-organised a few years ago.

TASTE is a project to provide school kids in Uganda with appropriate science lab tools that they need to study science in middle and high school. It’s difficult and expensive to set up science labs in individual schools in Uganda, but TASTE solves the problem with wheels: They have a mobile lab (the “science truck”) which can travel from school to school. Kids use the equipment when the truck is in town, and then it leaves after their labs are done, onto the next location!

TASTE1

In 2013, they reached 1400 students this way, and now TASTE are planning their next trip to Uganda. They are raising money throughout 2015 to be able to return in 2016 with the mobile lab and teacher training.

They’ve just started their fundraising, which involves a weekly focus on a specific item that they need sponsors for. This week’s item is…. a box of cockroaches, to help students learn anatomical drawing, which is a part of their curriculum.

TASTE2

You can follow TASTE on Facebook and Twitter to keep track of the weekly items, or their fundraising page to donate. (Note that the donation amounts listed are in British pounds. £10 is approximately $15 US)

Images from TASTE site and Facebook page.


Filed under: Have Science Will Travel Tagged: Africa, Education, outreach, Science Education, TASTE, The African Science Truck Experience, Uganda

Bee researcher in the Congo blames “injustice, segregation and colonialism” for retractions, Science correction

A bee researcher based in Congo has had two papers retracted, and a paper in Science corrected, for various reasons including unreliable data. The researcher, however, blames colonialism. M. B. Théodore Munyuli is at the National Center for Research in Natural Sciences, CRSN-Lwiro, D.S. Bukavu, Kivu, and studies the distribution and diversity of bees. Here’s the notice from […]

Paper on anti-HIV efforts in Uganda pulled for plagiarism

ijhpmA public health journal has retracted a 2010 paper by a CDC AIDS researcher in Uganda who appears to have lifted much of the work from a Canadian scientist.

The article, “Determinants of project success among HIV/AIDS NGOs in Rakai, Uganda,” appeared in the International Journal of Health Planning and Management, a Wiley title. The author was Stevens Bechange, who was listed as being with the Uganda Virus Research Institute, in Entebbe. Bechange’s Linkedin page says he is a doctoral student at the University of East Anglia, in Norwich, UK, studying “Health, Wellness and Fitness.” His contact information on the article was an email with a CDC address (we’ve put in a call to the agency to find out more about his status but haven’t heard back yet).

As the abstract stated:

The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross-sectional study using face-to-face interviews in a mixed-methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision-making processes, organizational vision, mission and strategies, gender allocation in staffing, and beneficiary involvement.

According to the retraction notice:

The following article from The International Journal of Health Planning and Management, Determinants of Project Success among HIV/AIDS NGOs in Rakai, Uganda by Stevens Bechange published online in Wiley Online Library (http://onlinelibrary.wiley.com/doi/10.1002/hpm.1025/abstract) on 11 January 2010 and in volume 25, issue 3, pp. 215–230 (Bechange, 2010), has been retracted by agreement between the author, the journal Editor in Chief, Calum Paton, and Blackwell Publishing Ltd. The retraction has been agreed because of substantial unattributed overlap with previously published qualitative research methodology, findings, and ideas by Susan Walker (Walker, 2004).

The paper has yet to be cited, according to Thomson Scientific’s Web of Knowledge.

Walker used to be with the anthropology department at McMaster University in Ontario, but she’s no longer there, according to the school. And we’re not sure what the 2004 paper is, since the notice doesn’t specify and we haven’t heard back from the editor of the journal.

Bechange does, however, cite a 2004 work by Walker, “Strong voices, hopeful futures : enhancing leadership capacities for determining and sustaining health initiatives with young people in Uganda; final report,” which may have been a dissertation — it seems to have been funded with an “IDRC doctoral research award.” (The actual reference in the paper is incorrect; it says the work was published in 2006.)

Hat tip: Victoria Fan