DZIF Researchers fight against Ebola
Professor Stephan Becker, Director of Marburg Virology and Coordinator of the DZIF Thematic Translational Unit “Emerging Infections”, is experienced in dealing with highly contagious viruses. At the high security laboratory of the University of Marburg—one of three in Germany that meets the requirements for the highest security level BSL4—intensive research on Ebola viruses and preparations for a vaccine trial are underway. Stephan Becker answers questions about the Ebola epidemic and explains what the DZIF has accomplished in the fight against Ebola.
Media is reporting that Ebola “has gotten out of control”. What does this mean?
Prof Stephan Becker: This is actually misleading because Ebola has never been under control. What is more probably meant with this statement is that for an Ebola outbreak, the number of cases are getting so staggeringly high. This is something we are simply not used to from other outbreaks.
Why is it so devastating this time and how can it be contained?
Prof Stephan Becker: Outbreaks can be contained as long as the case numbers are low. With every newly infected patient, the number of contacts increases exponentially, so you suddenly have to follow up hundreds or thousands of contacts to contain the outbreak. This means: Isolating the patient on the one hand, and then monitoring his/her contacts on the other, to see if they also develop the disease. You have to visit these contacts daily and check whether they have fever or have developed other Ebola symptoms. If they have, we ask them to go into isolation. Not following this procedure results in losing track of many people who in turn become a source of new infections.
Does this mean that you are currently “losing track” of very many patients?
Prof Stephan Becker: This is precisely the huge problem at the moment: That many people do not accept or understand that they have to go into quarantine. We will keep seeing new infections, even in many months to come, if this does not change.
What measures do you think are currently necessary for this situation?
Prof Stephan Becker: Implementing the described quarantine measures are the first, and currently also the only, thing that we can do, as there are no drugs and no vaccines available to help. Also, looking after patients has to happen in a way that ensures doctors and other helpers do not get infected themselves. Another important issue is burial practices: These need to be modified to make them safe for the relatives. However, the cultural customs of the West African people need to be taken into consideration for this. They should be able to bury their loved ones according to their wishes. There are some promising approaches as to how this can successfully be done.
Are the right people on site and does sending entire clinics to West Africa make sense?
Prof Stephan Becker: Sending clinics is certainly the right thing to do, but this is not far reaching enough. Of course, you also need the staff to run it, and this is what is especially lacking. There is a need for materials, infrastructure and logistics, but you also need the medical staff to accompany this. And they need to be trained for these tasks.
How is the DZIF currently active in the fight against Ebola?
Prof Stephan Becker: Different DZIF members have sent their staff to Guinea and Liberia, to help with diagnostics on the ground. They review patients who have been admitted to the treatment centres that have been set up—to see if they really have been infected with Ebola or whether they are suffering from another disease with similar symptoms, such as severe malaria or typhoid fever. With this, the DZIF is currently making a very significant contribution. The diagnostic procedures play a decisive role for quarantine decisions.
How are doctors on site equipped for diagnostic testing?
Prof Stephan Becker: The basis for testing is the European Mobile Laboratory, an EU initiative led by Prof Stephan Günther from the Bernhard Nocht Institute for Tropical Medicine (BNI) in Hamburg. The mobile laboratory was specifically developed and constructed by the Microbiology Institute of the German Federal Armed Forces to allow researchers to take it along with them in their normal baggage. This happened back in April, when the outbreak became known. Since then, researchers from Europe have consistently been on the ground and have been conducting diagnostic testing for Ebola. Incidentally, the BNI and the Microbiology Institute of the German Federal Armed Forces are both members of the DZIF.
Is the DZIF planning anything beyond this?
Prof Stephan Becker: At the DZIF Thematic Translational Unit “Emerging Infections”, we have taken on the challenge of developing strategies for containing virus outbreaks rapidly and effectively. The concept is based on different pillars: The first is to characterise the virus quickly by means of PCR testing. The second pillar is to develop new vaccines, so-called emergency vaccines. The third pillar would be to test antiviral drugs. This concept was tested for the first time during the MERS coronavirus outbreak in Saudi Arabia, where it proved to be very useful. Now, initial preparations for a clinical trial of a MERS coronavirus vaccine are under way. Then the Ebola outbreak came…
Is there a candidate vaccine against Ebola?
Prof Stephan Becker: There are currently two very promising vaccines against the Ebola virus. One of them is an adenovirus-based vaccine, which was primarily developed at the NIH and is currently being tested in the USA. The other is the vesicular stomatitis virus-based vaccine (VSV-EBOV). It was developed here in Marburg by Heinz Feldmann before he moved to Canada. In my opinion, this vaccine is ideal for outbreak scenarios like this. A big advantage is that the vaccination can even be administered a day after infection—so the vaccine has a therapeutic effect as well. A second advantage is that only a single dose is required. The vaccine is already being produced in Canada and so our next step is getting it to Germany for a clinical trial. We have paved the way for this with the MERS coronavirus, we have the necessary contacts in Canada and to the Paul-Ehrlich-Institut, which is very interested in testing the vaccine as quickly as possible. We are very optimistic that we will be able to start with the trial in the next weeks.
How will the trial be conducted?
Prof Stephan Becker: The vaccine will be tested at the University Medical Center Hamburg-Eppendorf. With Marylyn Addo, we have an experienced clinician at the DZIF who has already conducted such studies. We are going to recruit 20 study participants who will be vaccinated consecutively. It is a phase-I-trial, testing both safety and immunogenicity at the same time. We have two scenarios for recruiting participants. We could recruit people who want to go to Africa, but if this proves to be unviable for practical reasons, we will include healthy adults in the trial. The vaccine has already been tested in non-human primates, so there is a good base of evidence.
Who is participating in the trial?
Prof Stephan Becker: The DZIF together with Marburg Virology, the University Medical Center Hamburg-Eppendorf and the Bernhard Nocht Institute. Some tests will be performed at the BNI, others at Marburg Virology. We will plan the trial in collaboration with the Paul-Ehrlich-Institut which, as a higher federal authority, is responsible for its approval and safety. We will also collaborate with a small company that has the rights to the vaccine, as we need to document the manufacturing process to plan the trial.
Should the results be positive, when could the vaccine be implemented on a larger scale?
Prof Stephan Becker: Our planned trial is part of a WHO coordinated consortium, which is planning to conduct simultaneous trials with the same vaccine in Switzerland, Gabon and Kenya. We expect to have collected all the data we need to assess whether the trial can be expanded to include subjects for vaccination in the epidemic areas about 3 months after the start of the trial.
Could mutations develop which make the virus more infectious and could hence further accelerate its spread?
Prof Stephan Becker: Generally, these viruses actually do change quickly, and mutations can occur repeatedly. However, I currently do not see that the virus is under evolutionary pressure to change into becoming air transmissible. The virus is already being transmitted effectively in its current form.
So is there still the danger of a global threat?
Prof Stephan Becker: This Ebola epidemic is definitely a very big risk. If it is not contained very soon, it may have huge impacts on the economy and stability of the affected countries. The neighbouring countries have to continuously monitor their borders to ensure that the epidemic does not spread further. This will further distinctly aggravate the already unstable political situation. The Ebola virus outbreak is not only a concrete infectious disease problem, it is a humanitarian problem.
Would Germany be able to cater for more patients?
Prof Stephan Becker: There are special isolation units in Germany with a total of about 50 beds. If the need outgrows this number, we will have adjustment problems. However, I am convinced that we can also care for Ebola patients and treat them in isolation wards in normal hospitals, if doctors are trained accordingly. Nevertheless, it will give rise to a certain unrest and fear. So we should do everything we can to prevent such an event from occurring. We urgently need to help in West Africa.
Why have trained medical staff become infected relatively often?
Prof Stephan Becker: I see two reasons for this. One is that doctors and nurses are completely overburdened, which leads to them no longer taking sufficient precautions to protect themselves against infection. There is also a great danger for doctors when they encounter patients who have not been diagnosed with Ebola in normal wards.
How long could this Ebola epidemic still be of concern to us?
Prof Stephan Becker: Several months… When looking at it from an economic perspective, the more we invest now, the faster and the cheaper it will be overall. The Ebola outbreak is severe and has dramatic consequences. We also should not forget that these parts of Africa have other high disease burdens as well, like malaria and other infectious diseases. These also require our help and attention.
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