Deploying RDTs in the DRC Ebola outbreak

During the early stages of the 2013–16 west African Ebola epidemic, we thought we had a grip on transmission only to discover that unknown transmission chains were spreading unchecked, ultimately enabling the epidemic to spiral out of control. The GeneXpert, an automated PCR device with >99% sens...

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Bibliographic Details
Published inThe Lancet (British edition) Vol. 391; no. 10139; pp. 2499 - 2500
Main Authors Dhillon, Ranu S, Srikrishna, Devabhaktuni, Kelly, J Daniel
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 23.06.2018
Elsevier Limited
Subjects
Community involvement
Democratic Republic of the Congo - epidemiology
Disease Outbreaks
Early Diagnosis
Ebola virus
Ebolavirus
Epidemics
Hemorrhagic Fever, Ebola - diagnosis
Hemorrhagic Fever, Ebola - epidemiology
Hemorrhagic Fever, Ebola - prevention & control
Hemorrhagic Fever, Ebola - transmission
Humans
Immunoassays
Malaria
Medical personnel
Outbreaks
Point-of-Care Systems
Public health
Reagent Kits, Diagnostic
Technicians
Vector-borne diseases
Viral diseases
Congo River
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Summary:During the early stages of the 2013–16 west African Ebola epidemic, we thought we had a grip on transmission only to discover that unknown transmission chains were spreading unchecked, ultimately enabling the epidemic to spiral out of control. The GeneXpert, an automated PCR device with >99% sensitivity and >95% specificity, can be carried in a backpack and run off battery for several hours, but requires trained technicians and recurrent inputs that limit its use in the field.4,5 The other two RDTs—the ReEBOV and OraQuick—are dipstick immunoassays that, like widely used malaria and HIV RDTs, require pinprick blood samples and can be used by field workers with only training in biosafety. In a field study during the west African epidemic, the ReEBOV demonstrated 100% sensitivity and 92% specificity.6 The OraQuick achieved 84% sensitivity and 98% specificity and was used safely and effectively by community and primary health workers on over 2500 patients in a field pilot at the end of the epidemic.7 The exact strategy or combinations used should ultimately be determined by teams on the ground who have granular understanding of the communities and settings involved.
Bibliography:SourceType-Other Sources-1
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ObjectType-Correspondence-1
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(18)31315-1