TY - JOUR
T1 - Persistence of Ebola virus after the end of widespread transmission in Liberia
T2 - an outbreak report
AU - Dokubo, Emily Kainne
AU - Wendland, Annika
AU - Mate, Suzanne E.
AU - Ladner, Jason T.
AU - Hamblion, Esther L.
AU - Raftery, Philomena
AU - Blackley, David J.
AU - Laney, A. Scott
AU - Mahmoud, Nuha
AU - Wayne-Davies, Gloria
AU - Hensley, Lisa
AU - Stavale, Eric
AU - Fakoli, Lawrence
AU - Gregory, Christopher
AU - Chen, Tai Ho
AU - Koryon, Augustine
AU - Roth Allen, Denise
AU - Mann, Jennifer
AU - Hickey, Andrew
AU - Saindon, John
AU - Badini, Mehboob
AU - Baller, April
AU - Clement, Peter
AU - Bolay, Fatorma
AU - Wapoe, Yatta
AU - Wiley, Michael R.
AU - Logue, James
AU - Dighero-Kemp, Bonnie
AU - Higgs, Elizabeth
AU - Gasasira, Alex
AU - Williams, Desmond E.
AU - Dahn, Bernice
AU - Kateh, Francis
AU - Nyenswah, Tolbert
AU - Palacios, Gustavo
AU - Fallah, Mosoka P.
N1 - Funding Information:
Funding for this work was provided by the US Centers for Disease Control and Prevention (CDC), the Defense Threat Reduction Agency, and WHO. We acknowledge the patients and key informants in this investigation; Montserrado county health team; Liberia Ministry of Health incident management system; CDC-Liberia and WHO-Liberia Ebola response teams; other technical partners; and staff from Illumina for providing filovirus hybrid capture probes. The content of this publication reflects the views of the authors and does not necessarily reflect the views or policies of the CDC, the US Department of Defense, the US Department of the Army, or the institutions and companies affiliated with the authors.
Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/9
Y1 - 2018/9
N2 - Background: Outbreak response efforts for the 2014–15 Ebola virus disease epidemic in west Africa brought widespread transmission to an end. However, subsequent clusters of infection have occurred in the region. An Ebola virus disease cluster in Liberia in November, 2015, that was identified after a 15-year-old boy tested positive for Ebola virus infection in Monrovia, raised the possibility of transmission from a persistently infected individual. Methods: Case investigations were done to ascertain previous contact with cases of Ebola virus disease or infection with Ebola virus. Molecular investigations on blood samples explored a potential linkage between Ebola virus isolated from cases in this November, 2015, cluster and epidemiologically linked cases from the 2014–15 west African outbreak, according to the national case database. Findings: The cluster investigated was the family of the index case (mother, father, three siblings). Ebola virus genomes assembled from two cases in the November, 2015, cluster, and an epidemiologically linked Ebola virus disease case in July, 2014, were phylogenetically related within the LB5 sublineage that circulated in Liberia starting around August, 2014. Partial genomes from two additional individuals, one from each cluster, were also consistent with placement in the LB5 sublineage. Sequencing data indicate infection with a lineage of the virus from a former transmission chain in the country. Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later. Interpretation: Investigation of the source of infection for the November, 2015, cluster provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak. Funding: US Centers for Disease Control and Prevention, Defense Threat Reduction Agency, and WHO.
AB - Background: Outbreak response efforts for the 2014–15 Ebola virus disease epidemic in west Africa brought widespread transmission to an end. However, subsequent clusters of infection have occurred in the region. An Ebola virus disease cluster in Liberia in November, 2015, that was identified after a 15-year-old boy tested positive for Ebola virus infection in Monrovia, raised the possibility of transmission from a persistently infected individual. Methods: Case investigations were done to ascertain previous contact with cases of Ebola virus disease or infection with Ebola virus. Molecular investigations on blood samples explored a potential linkage between Ebola virus isolated from cases in this November, 2015, cluster and epidemiologically linked cases from the 2014–15 west African outbreak, according to the national case database. Findings: The cluster investigated was the family of the index case (mother, father, three siblings). Ebola virus genomes assembled from two cases in the November, 2015, cluster, and an epidemiologically linked Ebola virus disease case in July, 2014, were phylogenetically related within the LB5 sublineage that circulated in Liberia starting around August, 2014. Partial genomes from two additional individuals, one from each cluster, were also consistent with placement in the LB5 sublineage. Sequencing data indicate infection with a lineage of the virus from a former transmission chain in the country. Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later. Interpretation: Investigation of the source of infection for the November, 2015, cluster provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak. Funding: US Centers for Disease Control and Prevention, Defense Threat Reduction Agency, and WHO.
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U2 - 10.1016/S1473-3099(18)30417-1
DO - 10.1016/S1473-3099(18)30417-1
M3 - Article
C2 - 30049622
AN - SCOPUS:85051709332
SN - 1473-3099
VL - 18
SP - 1015
EP - 1024
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 9
ER -