The role of rapid diagnostics in managing Ebola epidemics
File(s)
Author(s)
Type
Journal Article
Abstract
Ebola emerged in West Africa around December 2013 and swept through Guinea, Sierra Leone and Liberia, giving rise to 27,748 confirmed, probable and suspected cases reported by 29 July 2015. Case diagnoses during the epidemic have relied on polymerase chain reaction-based tests. Owing to limited laboratory capacity and local transport infrastructure, the delays from sample collection to test results being available have often been 2 days or more. Point-of-care rapid diagnostic tests offer the potential to substantially reduce these delays. We review Ebola rapid diagnostic tests approved by the World Health Organization and those currently in development. Such rapid diagnostic tests could allow early triaging of patients, thereby reducing the potential for nosocomial transmission. In addition, despite the lower test accuracy, rapid diagnostic test-based diagnosis may be beneficial in some contexts because of the reduced time spent by uninfected individuals in health-care settings where they may be at increased risk of infection; this also frees up hospital beds. We use mathematical modelling to explore the potential benefits of diagnostic testing strategies involving rapid diagnostic tests alone and in combination with polymerase chain reaction testing. Our analysis indicates that the use of rapid diagnostic tests with sensitivity and specificity comparable with those currently under development always enhances control, whether evaluated at a health-care-unit or population level. If such tests had been available throughout the recent epidemic, we estimate, for Sierra Leone, that their use in combination with confirmatory polymerase chain-reaction testing might have reduced the scale of the epidemic by over a third.
Date Issued
2015-12-02
Date Acceptance
2015-12-02
Citation
Nature, 2015, 528 (7580), pp.S109-S116
ISSN
0028-0836
Publisher
Nature Publishing Group
Start Page
S109
End Page
S116
Journal / Book Title
Nature
Volume
528
Issue
7580
Copyright Statement
This work is licensed under the Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0
License URL
Sponsor
Medical Research Council (MRC)
Medical Research Council (MRC)
National Institute for Health Research
National Institutes of Health
Grant Number
G0600719B
MR/K010174/1B
HPRU-2012-10080
1U01GM110721-01
Subjects
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
VIRUS DISEASE
INFECTION
EMERGENCY
Africa, Western
Diagnostic Tests, Routine
Hemorrhagic Fever, Ebola
Humans
Time Factors
Triage
General Science & Technology
MD Multidisciplinary
Publication Status
Published