CONFERENCE REPORT Journal of Virus Eradication 2015; 1: 282–283 International Congress on Targeting Ebola 28–29 May 2015, Pasteur Institute, Paris Sabine Kinloch-de Loës1* and Colin S Brown2,3 1 Division of Infection and Immunity, Royal Free Hospital, London, UK 2 Hospital for Tropical Diseases, University College Hospital London, UK 3 King‘s Sierra Leone Partnership, King‘s Centre for Global Health, King‘s Health Partners and King‘s College London, UK Introduction messages throughout the meeting. Professor Piot, one of the discoverers of the Ebola virus, described a recent return to The International Congress on Targeting Ebola 2015 was held on Yambuku in the DRC, the site of the first EVD outbreak in 1976. 28–29 May 2015 at the Pasteur Institute in Paris (www.targeting- The current state of the healthcare infrastructure did not reflect ebola.com). The meeting was organised in partnership with the the many promises of future investments made at the time of the COPED of the French Academy of Sciences, the French Task Force outbreak, a poignant reminder that we must not assume that Group for Ebola, the Pasteur Institute and the Task Force for current promises of investment will always materialise. Infectious Diseases. Publication of a summary of the meeting by the organisers is anticipated in an open-access journal. This paper Professor Muyembe-Tamfum, a microbiologist with four decades aims to provide a brief overview of the main discussion points of EVD experience, warned how outbreaks have become more during the meeting. frequent since 2012 in the DRC, both with the Zaire ebolavirus (EBOV) strain now seen in West Africa, and the Bundibuyo ebolavirus This meeting brought together more than 300 experts in the field (BDBV). He stressed that a community approach was fundamental of ebola virus disease (EVD) from Europe, Africa, Asia and the for control measures, with the need for dialogue and negotiation US to discuss advances in combatting the virus. Their expertise with communities paramount. Despite the DRC‘s long-standing encompassed infectious diseases, basic science, epidemiology, expertise and vigilance, developed through managing EVD anthropology, virology, immunology, and included representatives outbreaks, early recognition remains challenging with a wide from industry (both diagnostics and therapeutics), non- differential diagnosis including malaria and typhoid fever, and governmental organisations (NGOs) such as Médecins Sans outbreaks in remote areas with poor laboratory diagnostics. Frontières (MSF), funding agencies such as the Gates Foundation and Fondation Mérieux, and the World Health Organization Dr Sylvie Briand, the Director of Pandemic and Epidemic Diseases (WHO). The meeting aimed to cover diverse topics including viral for the WHO, highlighted that it was fundamental to strengthen pathogenesis, virus–host interactions, epidemiology, cultural the local capacities of countries to respond to future outbreaks to aspects of the disease, diagnostic tools, treatment protocols, ensure that the International Health Regulations could be delivered. vaccines and operational research. WHO interventions have included technical support and coordination with experts in high-transmission countries, pre-deployment training of over 1500 people, with 732 staff deployed in 77 field sites by Conference discussion April 2015.This significant experience will be of great future benefit The index case was thought to arise on 6 December 2013. The if harnessed appropriately. She warned that we must not be WHO was notified on 23 March 2014 of an EVD outbreak in Guinea, complacent and must heed lessons from the pandemic H1N1 with rapid spread to Liberia and Sierra Leone by May 2014. On 8 influenza, which spread to every continent within 9 weeks [4]. August 2014 it was declared a Public Health Emergency of Combined, these reflections framed the intense discussion over International Concern (PHEIC). Peak transmission occurred during the two days of the meeting, which included oral and poster August and September 2014, with a reported case fatality rate of presentations by an array of experts in the field. The key messages up to 70% [1]. By the end of May 2015 over 27,000 cases and from this collective experience can be thematically grouped into more than 12,000 deaths had been reported in Sierra Leone, Liberia the following points. and Guinea. Following the conference close, by the end of August 2015, Liberia and Sierra Leone had no reported cases in the The delay in global response was unacceptable preceding weeks, with limited onwards transmission in Guinea [2]. However, there has subsequently been an unprecedented international At the time of the conference the countries affected by the West response that has created opportunities to collectively improve how African outbreak included the Democratic Republic of Congo we deal with global infectious disease crises. We must engage with (DRC), Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Spain, these discussions to ensure lessons are learned. Political commitment, the United Kingdom and the United States. The outbreak was national coordination, appropriate financing, global governance and unprecedented in terms of its scale, severity and complexity [3]. support from international partners are needed. We must be poised A strong emphasis throughout the meeting was placed on the need to deliver a rapid response effectively next time. to develop strategies to ensure that any future outbreak did not escalate to this level, through both scientific and community Future outbreaks are almost inevitable engagement. The need for better diagnostics, therapeutics and This was highlighted by the seventh DRC outbreak in the Boende vaccines for all highly pathogenic viruses, together with regular district, where the index case was a pregnant woman and the source international monitoring, was repeatedly mentioned. Reflections of infection a dead monkey found in the forest by her husband. were made on previous outbreaks. How to prevent animal-to-human transmission in rural areas where Two of the ‘founding fathers’ of EVD care, Professors Peter Piot consumption of bush meat and hunting activities are common is a and Jean-Jacques Muyembe-Tamfum, highlighted key, recurrent challenging reality for disease control. Mapping of the zoonotic niche is greatly needed to identify current and new at-risk regions, *Corresponding author: Sabine Kinloch, Division of Infection and particularly given rapidly changing population growth, and urban Immunity, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK and non-urban increases in mobility. Emphasis was placed on the Email: [email protected] intense urban transmission including in all three affected capital cities. © 2015 The Authors. Journal of Virus Eradication published by Mediscript Ltd 282 This is an open access article published under the terms of a Creative Commons License. Journal of Virus Eradication 2015; 1: 282–283 CONFERENCE REPORT Rapid diagnostic tests are key, along with back-up and operational research. There are presently several vaccine laboratory support candidates for the prevention of EVD but at the time of the meeting Novel ways of providing rapid, highly sensitive and specific diagnosis none had proven efficacy – recently a novel cluster-randomised such as point-of-care diagnostic tests (antigen-based lateral flow ring vaccination trial has demonstrated Phase III efficacy of the assays and RT-LAMP)to EVD-prone areas in resource-limited countries rVSV-ZEBOV vaccine [5]. Available potential drugs for EVD treatment are urgently needed. Alternative methods of sample collection such include favipiravir and brincidofovir, monoclonal antibody as capillary blood, oral swabs and urine collection should be utilised, combinations such as ZMapp on its own or in combination, novel alongside new platforms such as cards and microtubes. Mobile compounds such as TKM-Ebola, and convalescent plasma. The laboratories for confirmatory testing and supportive pathology services, relative benefit of each of these remains unclear.There is an ongoing and deep sequencing to identify reintroductions of virus and mapping debate regarding the ethics of randomisation in clinical trials during of viral evolution for assessing chains of transmission are also key the peak of an escalating epidemic with high mortality. The priorities. Innovative, combined research in this area can also help coordination of such trials in the face of decreasing numbers of address future investments in outbreak control. new patients highlights the complexities of any field research, and how advanced discussions must happen before any future outbreak. Multidisciplinary approaches to outbreak control are vital The use of non-controlled trials and other strategies needs to be EVD outbreaks threaten both society and the individual.They generate addressed and codified. Organisations such as MSF have now fear through its spread by practices normally associated with acts developed considerable experience in clinical trials, but involvement of love and care, with significant family and nosocomial transmission. of the NGO community in future research needs to be strengthened. This outbreak arose in a region with inadequate health systems An emphasis was put on the need to develop local biotechnologies following years of civil war, with ongoing issues of mistrust. EVD and research capacity, for example to conduct plasmapheresis and reinforces existing stereotypes and prejudices