Guinea Research Perspectives on Ebola Outbreak

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE

22nd Canadian Conference on Global Health Capacity Building for Global Health: Research & Pratice Hotel Bonaventure, Montreal, 6-7 November 2015 Guinea Research Perspectives on Ebola Outbreak

Mandy Kader KONDE, MD, MPH, PHD Department of Public Health, University of Conakry Chairman Guinea Ebola Research Commission Executive Director Center of Research on Diseases (CEFORPAG)

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Outline

• Background • Main Strategies for Ebola Outbreak Control • R & D Organizational Structure • Research Priorities & Preliminary Findings • Main Lessons learnt • Perspectives

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Background • Ebola Outbreak in West Africa unprecedented magnitude, new Disease for Communities & Entiere Country • High toll of death among frontline workers • Ecosystem of forest region where people are more & more agressive • Intense migrations / movement accross West Africa Vs Central Africa • Most affected countries, are post-conflict (Sierra Leone, Liberia, Guinea), weak health system • lack of confidence in Public service delivery, poverty • Perception/Acceptance of the Disease & • Negative Impact of Mass media and communication (No drug, No Vaccine, CFR high)

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Update on Guinea Ebola Epidemic location 30 Dec 2013 – 03 Nov 2015

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE

Main Strategies for Outbreak Control • Case Management (MoH/MSF/WHO) – starting with 2 isolation Centers (Gueckedou, Conakry) to > 8 ETU • Surveillance (MoH/WHO/CDC, PLAN-Guinea, Save the Children) • Contact tracing (MoH/WHO/CDC) • Lab support (Institut Pasteur, UE Mobile Lab, Kaplan, Canadian Mobile Lab, ) • Safe Burial intervention (Croix Rouge) • Communication (MoH/Unicef) • Prevention & Infection Control (MoH/WHO)

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Guinea Ebola Epidemic Curve & Clinical Trial 30 Dec 2013- 06 Nov 2015

180 Favipiravir Study confirmés (n=3351) 160 probables (n=453) Ring Vaccination Trial 140 23 March 2015 suspects (n=1)

120 Interferon Study

100 Convalescent Plasma

80 Nombre deNombrecas 60 LAB+ 40 21 March

1_14 3_14 5_14 7_14 9_14 1_15 3_15 5_15 7_15 9_15

29_14 47_14 13_15 31_15 11_14 13_14 15_14 17_14 19_14 21_14 23_14 25_14 27_14 31_14 33_14 35_14 37_14 39_14 41_14 43_14 45_14 49_14 51_14 11_15 15_15 17_15 19_15 21_15 23_15 25_15 27_15 29_15 33_15 35_15 37_15 39_15 41_15 43_15 45_15 Semaine de début des signes Epidemic Curve with 6 Waves COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE

HCW Infection during Ebola Outbreak 90 Guinea, 30/12/2013 – 09/06/2015 79 80

Nb Confirmés = 187 40 36 Nb Probable = 15 Décès Confirmés=94 30 Décès Probable= 15 19 20 18 13 14 11 12 12 11 9 9 10 7 8 4 4 5 5 2 2 2 3 3 2 2 3 3 2 2 1 1 1 1 0 0 1 1 1 1 1 0

confirmes_probables deces

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Update as of 06 November 2015 Total Cases Total Death % Total Confirmed cases 3 351 2 083 62% Total Probables cases 453 453 Total cas suspected 02 0

All Total cases (confirmed, 3 806 2 536 67% probables et suspected ) Survivors (estimated) 1 270

Health Care Workers 211 115 55%

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE R & D Organizational Structure • Ebola Research Commission (CRE) (April 14) – Coordination of research activities – Research capacity building • Ethical committee (CNERS) – Assessment of compliance of the research to international ethical standard • National Regulatory Authority (NRA) – Lot authorization importation – Pharmaco vigilance • NIH Collaboration Committee – Established June 2015 COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Research Priorities – Therapies, Vaccines, Diagnostics & others trial – Social aspects (Perception & community engagement, behavioral changes) – Research training for local investigators (GCP, virology, clinical research, anthropology and social science…) – Post-epidemic management (survivors, health system recovery…) – Environmental & Ecological study

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Clinical Trial (CT) - Therapies Product/Spon Trial Description Design Location Enrolled/ Goal sor & Phase Favipiravir Safety & Efficacy Non random, Open- Gueckedou, 126/225 (JIKI) Phase 2 label, Single arm, Nzerekore, Prelimirary INSERM-F Historical Control Macenta, Coyah, data presented Forecariah Seattle, Oct 14 Convalescent Safety & Efficacy Non random, Conakry 102/130 Plasma (CP) Phase 2/3 (based on CP Consortium availability) Open- Ebloa Tx label, 2 arms, Control is SOC Interferon Safety & Efficacy Non random, Open- Coyah 9/30 Beta 1 a (IFN) Phase 1/2 label, Single arm, University of historical Control Toronto Favipiravir – Safety & Efficacy Non random, Open- Coyah, 12/ Zmap (JIKI- Phase 2 label, 2 arms, Forecariah Map) Control is SOC Jiki INSERM & NIH COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE CT - Vaccine & Other Trials Product/ Sponsor Trial Design Location Enrolled/ Description & Goal Phase rVSV-ZEBOV Efficacy & Safety Cluster-randomized, open Basse > 7 651 Consortium (WHO, – Ring label vaccines Guinea Preliminary Norway, MSF, Canada, Vaccination (Vaccination of contacts/ data Welcomme Trust, etc) Phase 3 Contact of contacts) of published confirmed cases, Lancet Immediate Vs Delayed vaccination (21 days) rVSV-ZEBOV Safety & Non-Random, open label, Basse 1 200 Consortium (WHO, Immunogenicity Single arm receiving Guinea Norway, MSF, Canada, – Frontline vaccine Welcome Trust) workers POSTEBOGUI Ebola Survivor 22 months Follow up Conakry, 300 INSERM study cohorte of survivors Macenta (socio-anthropology, biochemical, immuno, virological, Ophtamo, COORDINATION NATIONALE DE LUTTENeuro CONTRE LA MALADIE À VIRUS EBOLA Survivors Study Ebola Survivor Immunology Gueckedou 90 Public Health study Coyah 120 England, CEFORPAG RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE

Lancet. 2015 Aug 3. pii: S0140-6736(15)61117-5. doi: 10.1016/S0140-6736(15)61117-5.

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE

14 COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE All vaccinated adults assigned to immediate vaccination versus all eligible individuals assigned to delayed vaccination

†Four cases were vaccinated and developed symptoms on day 0, 2, 6, 6 15 COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE CT-Diagnostic Products Product Manufacturer/ Technology Platform Location Sponsor Samples BioThreat-E BioFire Defense Multiplex rRT-PCR Film Array Macenta IPP Blood, Urine Xpert Ebola Cepheid rRT-PCR GeneXpert Conakry MSF Venous Blood Oraquick OraSure Ebola Rapid Conakry Technolies Antigen Test (PN CDC-Atlanta 3001-2812) Blood, Swab Ebotest 2 Institut Pasteur Rapid test RPA Macenta Blood EBOV-RT- Institut Pasteur 928 post-mortem TR-RPA Conakry RPA Dakar swabs,

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Case Management & Research

Coyah & Nongo ETU (Favipiravir & Visit Eleanor Fish University Toronto, Nongo Interferon are tested) ETU (Co-PI Interferon Trial )

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Secure Burial Process by Red Cross

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Ring Vaccination Trial with rVSV vaccine

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Sub Regional Ebola Research Partnership

Sierra Guinea Liberia Leone

Research Collaboration: 1+1+1=1

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Main Lessons learnt • Need for long term collaboration on Institutional basis • Real capacity building (strenghten Human ressources & lab infrastructure) rather than just publications or colonial consideration • Influence Politic & Science, Need for better coordination (complementary vs duplication/ competition) • Lack of national leadership & Ownership • Orientation of funds raised by partners • Need for a regional framework for multicenter studies on therapies, vaccines & Diagnostic test with neighboring’s countries • How Research on disease control could better prepare & contribute for any new Ebola outbreak or emergent diseases ? COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Perspectives • Socio-Anthropological studies • Long term Survivors Studies : Psychosocial, neuro sensorial, Clinical, virological, biochemical, Immunological studies • Mapping & Virus variability and sequencies • New infection routes/modes (investigation of cases with no epidemiological links with identified chains) • Persistance of virus on body fluids • Bio-surveillance & Environmental study (Reservoirs and animal transmission) • Sub Regional Collaboration (Extension of Zmapp clinical trial, Liberia/NIH Vaccine trial in Guinea) • Guinea open to any other collaboration

COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA

RÉPUBLIQUE LA GUINÉE Travail-Justice-Solidarité MINISTÈRE DE LA SANTE Coyah Survivors Association

Thank you ! COORDINATION NATIONALE DE LUTTE CONTRE LA MALADIE À VIRUS EBOLA