Académie royale de Médecine de Belgique

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Jean-Luc Gala (UCL et Défense) - Vidéo + Résumé

The Belgian Lab "B-LiFE/B-FAST" in Forest Guinea: Impact on analytical and therapeutic dogmas applied in Ebola Viral Disease containment?

 

Prof MedCol colonel JL Gala, MD, PhD
Head of B-LiFE/B-FAST mission
20th February 2015

The B-LiFE / B-FAST mission (Biological Light fieldable laboratory / Belgian First Aid and Support Team) has been deployed N’Zerekore, Forest Guinea since the 20th of December. This mission aims to actively contribute to the international fight against the spread of the Ebola virus disease (EVD) in West Africa. The Belgian B-LiFE / B-FAST team consists of a logistical support cell with 4 people (a decontamination expert from civil protection, an officer in charge of security and safety aspects, a military expert in satellite communication and a military nurse) and four researchers from the Applied Molecular Technology Center (CTMA / IREC / UCL). This mission is led by Prof JL Gala, director of CMTA and head of the mission B-LiFE / B-FAST, ensuring supervision of forthcoming rotations until the end of mission in Guinea.
 
The laboratory part of this project is financially supported by two international projects coordinated by CTMA: the B-LiFE project funded by the European Space Agency and the project FP7 MIRACLE (Mobile Laboratory Capacity for the Rapid Assessment of CBRN Threats Located within and outside the EU Infrastructure) funded by the European commission. The mission has been supported by B-FAST during the first two months and then jointly by the Belgian Technical Cooperation and European Commission (DG ECHO) afterwards.

As part this mission, a light laboratory is deployed under a tent backing on the Ebola Treatment Centre (ETC) run by the medical NGO ALIMA (The Alliance for International Medical Action) in the outskirts of N’Zerekore. The main goal of this laboratory is to conduct a rapid DNA-based identification (~3 hours) of Ebola virus in samples from suspected patients originating from Forest Guinea (i.e., mainly swab samples from community death and blood samples from patients admitted in the CTE for suspicion of EVD). Meanwhile, several scientific projects are carried out concomitantly (e.g., favipiravir study under INSERM lead, validation of new rapid diagnostic tests with Biomérieux, cartography of Ebola contamination in patients’ surroundings, viral excretion in Ebola patients ….).

The B-LiFE project and the "Emergency.lu" service provided by the Luxembourg Government enables the laboratory to have an outstanding satellite communication capability allowing secure communications at very high speed to Belgian and international operational centers. This capacity benefits from a close collaboration with the European Space Agency, the European Commission (DG ECHO and ERCC) and COPERNICUS, which enables the laboratory to integrate advanced technology developed by small and medium-sized Belgian enterprises (Nazka MAPPS, Aurea IMAGING and UCL spin off Eonix) and satellite operator SES TechCom Luxembourg. Through these extensive technological collaborations, an epidemiological mapping of Ebola disease in the N'zerekore region is currently being developed based on the identification of infected patients and their living or working place. The generated results are stored into a central database that can be consulted by World Health Organization (WHO) and European Centre for Disease Control (ECDC) experts and help them to monitor patients infected contacts.

While the threshold of 23.400 cases and 9.400 deaths of Ebola has now been reached, Guinea is the third most affected by Ebola countries with 3.100 cases and 2.000 deaths recorded on February 18, 2015 according to the WHO. In the absence of specific Ebola treatment, a clinical trial testing the Favipiravir began on December 26 CTE Nzerekore, thanks to the rapid deployment of the Belgian laboratory. This trial began a week before in the center run by Doctors Without Borders in Gueckedou. CTE’s of N’Zerekore and Gueckedou are currently the only two centers involved in this promising therapeutic clinical research.

The Favipiravir, manufactured by the Japanese company Toyama Chemical Co, is an antiviral drug approved in Japan in March 2014 for the treatment of influenza virus. Its mode of action is to block the replication of RNA viruses. This antiviral drug has demonstrated efficacy against Ebola virus in vitro and when tested in a mouse model (immunocompromised mice exposed to Ebola virus). The Favipiravir has already been administered to compassionate in almost all patients with Ebola in Europe. However, this is the first time that the subject of a controlled clinical study in a cohort of patients with EVD. This test, supervised by the National Institute of Health French Medical Research (INSERM) and the Guinean authorities, was initiated within the framework defined by the WHO. It aims to assess the efficacy of antiviral Favipiravir measured in terms of reduction of mortality.

To date, more than 100 patients have been included in this study coming from both CTE’s centers. This study prompted regular biochemical monitoring of patients under treatment. All laboratory tests (including analysis of blood electrolytes and renal function) required as part of the study were conducted by the Belgian laboratory. This type of work has undoubtedly had a substantial impact on analytical and therapeutic dogmas applied so far in Ebola Viral Disease containment. In a press release dated February 5, 2015, INSERM confirms that the favipiravir study has produced promising therapeutic results on the cohort of patients treated in both CTEs.

Whereas lesser known aspects of the disease are also investigated (virus shedding in urine during the remission phase; viral shedding in breast milk and sweat from highly infected patients), the Belgian lab is sometimes confronted with more unexpected requests, like this recently made by the WHO. The Belgian team was indeed asked to collect samples from dead dogs suspected to have died from Ebola and to have transmitted it to villagers who have eaten them! A negative result following sampling by the team and rapid analysis in the laboratory enabled to quickly calm down rumors while ensuring the laboratory a reputation of flexibility, rapidity and efficiency.

The laboratory is also actively involved in the training of Guinean technical staff (more than 35 candidates presented spontaneously to offer their contribution to the laboratory!). The hope is to enable the Guinean laboratory to gain practical sufficient laboratory to become less dependent on international aid.

The continuation of this mission is currently justified by the strategic position of N'Zerekore, a city at the crossroads of three African countries (Ivory Coast, Sierra Leone and Liberia) the last two being still confronted with cases of Ebola. It is also prompted by the fact that the N'Zerekore region is exposed to some communities which remain so far highly resistant to the actions taken by humanitarian organisations. As seen in recent weeks, this resistance hinders an efficient control of disease chain of transmission, and fuels the occurrence of new local outbreaks, which in turns, increases EVD geographical spread in Guinea. Accordingly, the work is now pursued. After the end of the first rotation on January 22, a second shift took over on January 20, 2015 followed by a third shift on February 19, 2015. This highlights the value of the work carried out by the Belgian team in N’zerekore.