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The Sudan ebolavirus (SUDV)-caused Ebola outbreak in the Republic of Uganda was declared on September 20, 2022, following the confirmation of a case in a community in Madudu Sub-County, Mubende District, Uganda, on September 19. A total of 115 confirmed and 21 probable patient cases, including 32 confirmed and 21 probable deaths, have been reported as of October 26, 2022. 1
From 2014 to 2016, gaps in the ability to test and mount a timely response allowed an outbreak of Ebola to become an epidemic that spread from Guinea to seven other countries, including Italy and the United States. Over 11,000 people perished, and the costs to the global economy were staggering. Better information management and a quick global response to the 2022 outbreak portend a better outcome. Still, the previous epidemic serves as a stark reminder that Ebola may originate primarily in Africa but poses a substantial risk for global spread.
There are no quick test kits available to detect infections with SUDV, unlike Zaire ebolavirus (EBOV). Medical professionals must take blood samples from people thought to have the virus and forward them to laboratories that can test for the strain. The complicated nature of sampling systems used to detect these viruses means that there are only a few labs in the entire region capable of testing for infection.
Sudan ebolavirus strain
There are sporadic outbreaks of deadly Ebola, which is primarily found in Africa. Ebola mainly affects nonhuman primates (such as monkeys, gorillas, and chimpanzees) and people. SUDV is one of a number of viruses belonging to the genus Ebolavirus that infect people.
In Uganda, the SUDV strain is spreading, which is negligibly less prevalent than the EBOV strain that has been associated with recent outbreaks in the Democratic Republic of the Congo. The Sudan strain does not have a vaccine that has been scientifically confirmed, making it incredibly treacherous, with the potential for the rapid spread of the disease, especially in population centers.
Compounding the problem is that this virus cannot be tested on a large preventative scale because there are currently only a select few laboratories equipped to do the testing.
Ebola testing in 2022
Humans are susceptible to the severe, frequently fatal SUDV. Since its discovery in southern Sudan in June 1976, SUDV has periodically reemerged. Currently, seven SUDV outbreaks have been documented: four in Uganda and three in Sudan. In previous epidemics, the estimated case fatality percentages for SUVD ranged from 41 percent to 100 percent.2
The Administration for Strategic Preparedness and Response revealed earlier this month that it would fund efforts to hasten the FDA’s approval of BioFire’s analytical test (discussed later), enabling more labs to employ the technology. The test is currently manufactured for use by the US Department of Defense (DoD) laboratories and other laboratories designated by the DoD.
As the world is only starting to regain a sense of normalcy after the turmoil and chaos brought on by the COVID-19 pandemic, it is threatening to hear that only a select few laboratories can test for this variation of the Ebola virus. The greatest threat is that the spread of the disease could become uncontrollable without adequate testing. The ability to test for this virus allows for prevention and safety measures to prevent the spread of such a deadly disease.
Laboratory and biosafety considerations
The only test for SUDV detection is the Biofire FilmArray NGDS Warrior Panel (which can also detect EBOV, Taï Forest ebolavirus, Bundibugyo ebolavirus, and Reston ebolavirus).3 Neither commercial nor academic laboratories offer this test.
The lack of these detection tests in the US poses a significant concern for a potential outbreak. The present geographic extent of this outbreak in Uganda is limited, and there are currently no confirmed cases of Ebola associated with this outbreak reported in the US or other nations outside Uganda. However, this could change if transmission of the virus is not controlled and mitigated.
To minimize infection and transmission among laboratory staff, all individuals handling samples from patients with suspected Ebola—particularly those with a travel history to Uganda three weeks prior to symptom onset— should follow advised infection control methods.
Laboratories handling blood and bodily fluids are required to have an exposure control behavior plan in place as part of the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard to prevent or reduce employee exposure to pathogens.4
Laboratory risk assessments
Labs should conduct thorough risk assessments to detect and reduce risks related to handling Ebola specimens. Laboratories handling potential biosafety hazards mitigate the danger of accidental transmissions by following industry-standard safety protocols in their daily operations. General considerations include:
- Identifying the right personal protective equipment (PPE), ensuring it is on-hand, and providing staff members with training on how to put it on and take it off correctly;
- Receiving, handling, and processing these specimens properly, which requires staff members having specialized training, passing competency exams, and participating in drills;
- Ensuring a laboratory has a designated test area, specialized tools for handling and analyzing patient specimens, and strategies for minimizing specimen manipulation; and
- Ensuring a waste management plan is in place for lab reagents and Category A waste, including PPE and sample material.
The specimen should be sent to another facility if the one receiving it lacks the necessary risk mitigation tools to prevent the potential spread of the virus.
There should be a provocation for more laboratories to be able to perform this needed test safely to stop the spread of Ebola, which has the potential to have a significant impact on many. As part of the United States’ actions to manage this outbreak with the international community, the Centers for Disease Control and Prevention (CDC) and the US Agency for International Aid and Development (USAID) are cooperating closely with local, national, and international partners. The coordinated response efforts to the outbreak in Uganda are designed to guarantee integration and alignment to better address and control the outbreak, while recognizing that limiting the spread of the disease in one geographical region keeps the US safer from potential outbreaks on its own soil.5
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