Marcia Frellick

April 27, 2015

COPENHAGEN, Denmark — A rapid test to screen for Ebola will help workers in West Africa keep up with demand and eliminate the automatic isolation that eats up precious time and separates families.

"It's an urgent situation for the scientific community," said Marta Lado, who works at the Connaught Hospital in Freetown, Sierra Leone, and who is clinical lead of the King's Sierra Leone Partnership.

That shouldn't be lost in the current fight for a vaccine and new treatments. "A rapid test would make a big difference for everyone," she told Medscape Medical News.

Without a rapid test, providers cannot maintain current levels of screening in West Africa, she told the crowd gathered here at the 25th European Congress of Clinical Microbiology and Infectious Diseases.

At the Connaught Hospital, they now screen eight to 10 people a day. Patients are isolated for 24 hours and then tested to see if they can be sent to regular wards.

Dr Lado is part of a team working with Defence Science and Technology Laboratory in the United Kingdom on a rapid test. "What we have to do now is convince the scientists to promote this so we can start using it in healthcare systems," she explained.

 
We really need a rapid test with 100% sensitivity.
 

In February, the World Health Organization (WHO) approved a version called the ReEBOV Antigen Rapid Test Kit, developed by Corgenix, which has 91% sensitivity.

However, that is "probably not enough because you still have 9% of cases that you're missing," Dr Lado said. "We really need a rapid test with 100% sensitivity."

She said rapid tests, which can return results in less than 20 minutes, might also be of use in airports and in the transportation of patients who come from high-risk areas.

Clinical Presentation Is Changing

Delay in diagnosis is just one of the problems encountered by those fighting the deadly virus over the past few years.

Another is the fact that the symptoms are changing.

At the beginning of the outbreak, it was expected that people infected with Ebola would be bleeding heavily from many orifices, but that turned out not to be the case, Dr Lado explained. Then patients with severe weakness who were unable to walk or talk were being diagnosed with Ebola. Then the symptoms were fever, diarrhea, and vomiting.

"We had to adopt all the things we were seeing and create a new case definition," she reported. "Everyone coming to the hospital had to be a suspected case."

Doctors learned that many patients thought they had malaria, but after 5 to 10 days, came to the hospital for Ebola screening. This led to the recognition that people with no movement of their limbs and with red eyes staring straight ahead were likely to die within 48 hours, she said.

"Symptoms are really unspecific," she pointed out. "We have seen fever in 85% of the patients, but there's still 15% who don't have fever or a history of fever."

Originally, people presented with confusion and fever. Now, 68% present with intense fatigue, 50% present with vomiting, 40% present with diarrhea, and 37% present with anorexia, she reported.

It is possible that patients are coming in earlier, and therefore present with different symptoms, or that their viral load is smaller.

And methods of contact have changed. Now that the practice of washing corpses has been banned in Sierra Leone, that large source of contact has been eliminated. But more answers are needed, she said.

"This is going to happen again. It happened in East Africa and we should have learned from East Africa," she pointed out.

It is unclear what will happen to the survivors.

Research has shown that many survivors have severe psychosocial problems, said Hilde De Clerck, MD, from Médecins Sans Frontières. In fact, 20% to 22% show signs of depression and 20% to 30% show signs of post-traumatic stress.

"This seems to be link to long-term fatigue and long-term muscle pain and further investigation is needed," she pointed out.

Médecins Sans Frontières is currently researching trends seen in the Ebola outbreak, such as why very few pregnant women survive, Dr De Clerck reported.

Safe Burials Important

One of the biggest lessons learned from the outbreak was the extent to which unsafe burial practices played a role in the spread of the disease, said Sylvie Briand, MD, from the Pandemic and Epidemic Diseases Department at the WHO in Geneva. In some cases, even if burials were done safely, families were removing remains to complete rituals, she explained.

"Usually, for one patient, you have 10 to 15 contacts. But when you have an unsafe burial, you can have 60 to 100 contacts," she said.

Although the number of new infections is waning, there is still much to be done, she added. "It's really time to finish this and get it to zero."

The focus of the WHO has shifted; it is now training community leaders to learn to detect cases as early as possible, Dr Briand explained. In the past, when the WHO investigated an outbreak, detection was done primarily by epidemiologists and laboratory scientists.

In the future, teams will include clinicians who will identify the signs and symptoms of the disease, and anthropologists, social scientists, and communications specialists who will analyze the effect the changes have on a culture, she said.

Dr Lado, Dr De Clerck, and Dr Briand have disclosed no relevant financial relationships.

25th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). Presented April 25, 2015.

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