9 Dec 2015

Update: Ebola convalescent plasma study in Sierra Leone

Dr Calum Semple is a Senior Lecturer & Consultant Respiratory Paediatrician at the Institute of Translational Medicine, University of Liverpool, and is a member of the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections.

Around the country Ebola Medals are being received by British Volunteers, Armed Services staff and Research Teams who contributed to the Ebola Response in West Africa. Ebola is no longer in the daily news. But Ebola has not left West Africa. There is a cluster of at least three cases in Liberia, which was previously declared free of Ebola transmission on 3 September 2015. In Liberia in October a sixteen year old girl presented to health services after being unwell for several days in the Bombali district of Sierra Leone. She deteriorated rapidly and died overnight. This in an area that had been free of Ebola for 160 days. Guinea had continued to have cases at least through to 18th November.

Plasma donor

There have been only a few trials of therapeutic interventions for Ebola Virus Disease. The challenges of conducting trials in this context meant some research groups chose designs that relied upon historic controls, were not blinded or used a predefined outcome.  These decisions have been criticised in various editorials but I doubt these critics could do better.  I observed the best and worst of behaviour by researchers. There were a few good examples of co-operation between research groups, sharing protocols, outcome measures and even data. Yet the presence of one particular drug study in Sierra Leone caused a inexplicable perturbation in the usual pathway of admissions of ebola patients away from their closest Ebola Treatment Unit (ETU) to the ETU running that drug study, starving two other trails of patients. Some research teams worked on a basis of training and mentoring local investigators and left a legacy of improved capacity and facilities. Others just collect data, samples and left without a care.

I am optimistic that the Ebola crisis is nearly over. The studies of Convalescent Plasma that I am involved in (Ebola_Tx in Guinea and Ebola_CP in Sierra Leone) are winding up. Our study in Guinea is closed and we hope the first results will be published soon. For that study we have been careful to disclose the result to the local authorities and policy makers in advance of publication to avoid any surprises and manage expectations. In Sierra Leone we remain open to recruit in the event of resurgence and have capacity to mobilise the plasma under trial conditions to any willing ETU. Our trial team including transfusion technicians took part in a dry run of the Rapid Deployment Isolation Facility in partnership with the UK MoD. We brought frozen saline up from Freetown to Benguela Hastings in cold chain and mocked up the administration of plasma.

In Guinea and Liberia, convalescent plasma was produced using a specially converted bus that contained the aphoresis machines and a small laboratory. In Sierra Leone we chose instead to refurbish the existing blood bank at the Connaught Hospital Freetown, install apheresis and UV transillumination and provide a plasma freezer. All this equipment was required anyway. It made no sense to bring this kit in for the study and not install it for ongoing use. The refurbishment of the blood bank was extensive. Wooden bench tops with cracked formica tops were torn out and replaced with stainless steel. Air conditioning with redundancy to allow for breakdown and serving was installed. The steps leading up the blood bank were retiled with non-slip surfaces, and a lick of paint was added. Finally we rewired the building and installed a massive lead acid battery uninterrupted power supply. 

The investment at the blood bank has already proved worthwhile. Freetown suffered a devastating flash flood in September. 1,000 houses were damaged, 3,000 people were displaced and unofficial reports claim about 40 bodies were recovered from the water. The Connaught Hospital was caught directly hit by the torrent. The operating theatres were flooded and mains and generator power was lost. The Blood Bank fridges and freezers remained under power preserving the precious blood, frozen plasma and our research samples.

We don’t expect the trial in Sierra Leone to recruit to power, but we will complete the characterisation of the donors and continue to support the Safe Blood Service Sierra Leone.

I’d like to express my gratitude to the Clinical Team at The 34th Regiment Military Hospital Freetown, The Transfusion team at the Blood Bank Freetown, the Project Managers Gerry McCann and Lewis Matthews, and Clinical Leads Dr Christine Cole and Dr Janet Scott (IGH).

Dr Calum Semple

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1 comment:

  1. Thanks to your team's effort, there's an African solution that's cost-effective, in-country and scalable, to quote a friend. Congratulations on a job VERY well done!


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