Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations

Abstract

Introduction Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.

Health Systems and Services During COVID-19: Lessons and Evidence From Previous Crises: A Rapid Scoping Review to Inform the United Nations Research Roadmap for the COVID-19 Recovery

“…A pilot assessment of feasibility in using short message services to report daily Ebola cases in Guinea-Bissau shows high compliance and may be a rapid way to strengthen surveillance in a low-resource setting 104 (#334, Level II). Recruitment and training of staff, as well as the establishment of an EVD laboratory facility in Liberia with specific diagnostic platforms, led to an 8-fold increase in testing and a quick turnaround time, resulting in a better surveillance system that detected and contained two EVD clusters subsequently 105 (#1072, Level IV). Enhanced surveillance and better laboratory capacity are integral in pandemic response to ensure fast, affordable sequencing of pathogen genomes and rapid diagnostic capacity, for example.…”

Improving dog bite victim survey and estimation of annual human deaths due to suspected rabies cases in three selected Liberian cities and environs, 2008–2017

“…It was notable that shortly after Ebola virus disease epidemic ended in 2017, the number of hospitals included in the integrated disease surveillance system had remarkably increased from three hospitals only (one each from the three selected counties, of Grand Bassa, Bong and Lofa, respectively) as obtained during 2008 to 2014, to a minimum of ten hospitals/clinics per county in each of the 15 counties of Liberia by 2017 [ 14 ]. This transformation was facilitation by the WHO following Ebola virus disease outbreak that attracted global attention and support to Liberia [ 14 , 20 , 21 ].…”

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Analyses of the performance of the Ebola virus disease alert management system in South Sudan: August 2018 to November 2019

“…Not much improvement in the TAT of the GeneXpert testing was observed during the study perhaps due to the lead time required to transmit the result from the laboratory to the EVD taskforces especially at the state level, inadequate proficiency and quality assurance in the PLOS NEGLECTED TROPICAL DISEASES laboratory. Improving this performance indicator would require decentralization of GeneXpert testing to the sub-national level which was shown to work well in Liberia [29] and instituting a quality assurance system at the NPHL. However, the operational feasibility and added value of decentralizing testing during the EVD preparedness phase in a complex humanitarian setting like South Sudan would have to be demonstrated.…”