The role of rapid diagnostics in managing Ebola epidemics

Pierre Nouvellet, Tini Garske, Harriet L. Mills, Gemma Nedjati-Gilani, Wes Hinsley, Isobel M. Blake, Maria D. Van Kerkhove, Anne Cori, Ilaria Dorigatti, Thibaut Jombart, Steven Riley, Christophe Fraser, Christl A. Donnelly and Neil M. Ferguson ()
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Pierre Nouvellet: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Tini Garske: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Harriet L. Mills: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Gemma Nedjati-Gilani: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Wes Hinsley: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Isobel M. Blake: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Maria D. Van Kerkhove: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Anne Cori: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Ilaria Dorigatti: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Thibaut Jombart: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Steven Riley: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Christophe Fraser: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Christl A. Donnelly: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Neil M. Ferguson: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London

Nature, 2015, vol. 528, issue 7580, S109-S116

Abstract: 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. This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Date: 2015
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DOI: 10.1038/nature16041

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