Ebola PREP-TBOX

The challenge

Ebolavirus and other filovirus infections are much feared across the globe and in sub-Saharan Africa in particular, where major outbreaks have claimed thousands of lives. Seen across a swathe of central Africa, outbreaks arise when viruses spill over from animals to people. The virus can then be spread by contact with an infected person. Fatality rates can be very high, so early detection and a rapid response to prevent the spread of infection are critical to an effective public health response.

Multiple strains of ebolavirus circulate. The most common human infections are of Zaire ebolavirus, which was responsible for the 2013–2016 West African ebolavirus outbreak. Vaccines are now available to prevent Zaire ebolavirus infections.However, a related strain, the Sudan ebolavirus, can also infect humans, and no treatment or vaccine has yet been licensed for this species.

Effective control of ebolavirus requires a combination of approaches, including surveillance to rapidly identify new cases, vaccines and treatments, and public health measures to prevent transmission. The latter depend on support from local communities to ensure adherence to disease control measures.

The project

The Ebola PREP-TBOX project is developing a toolbox of interventions to improve preparedness and response to ebolavirus outbreaks, particularly of Sudan ebolavirus. It is targeting several key aspects of disease control:

• Detection: The project is collating information on previous outbreaks, and integrating multiple other sources of environmental, climate, demographic, socioeconomic and zoological data, to develop spatiotemporal models that identify hotspots where infections are most likely to occur. This will help countries target more intensive surveillance activities.
• Surveillance: An enhanced approach to surveillance will be developed, involving communities in case reporting, closer monitoring of the human–animal interface, and social listening – automated analysis of communications materials to detect mentions suggestive of ebolavirus infections.
• Diagnostics: Currently used diagnostics lack sensitivity, leading to false negatives and undetected cases. Improved diagnostics will be developed, incorporating a pathogen enrichment step based on nanomagnetic beads to enhance test sensitivity.
• Treatments: Polyvalent antibodies, generated by inoculation of horses, are a practical and affordable way to generate therapeutics with a wide spectrum of activity. A formulation covering Sudan ebolavirus will be developed. A ‘mosaic’ antigen will also be developed, incorporating parts of multiple proteins, to determine whether antibodies protective across different ebolaviruses (and related viruses such as Marburg virus) can be generated.
• Community engagement: An interdisciplinary approach is being adopted, including community studies to better understand current knowledge, attitudes, practices and social dynamics, to raise awareness, and to inform more community-oriented responses. 

The project has a strong emphasis on trans disciplinarity, incorporating experts from many different fields, including social science and One Health.

Impact

The Ebola PREP-TBOX project will provide tools to support countries in their preparation for ebolavirus outbreaks. It will:

• Generate risk maps where outbreaks are most likely, and highlight factors associated with human infection, to support prevention and early identification of cases.
• Provide more sensitive diagnostics and new treatment options for Sudan ebolavirus infections.
• Ensure that communities are more aware and supportive of the public health measures needed to control ebolavirus outbreaks.
• Strengthen health systems so they are better prepared to manage cases of ebolavirus infections.

This combination of advances will lead to earlier detection of ebolavirus outbreaks and help to ensure that they do not flare up into major epidemics that are harder to control.