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A new laboratory for Ivory Coast

Researchers from the Robert Koch Institute set up a laboratory in Bouaké for the diagnosis of Ebola virus disease

Laboratory head Chantal Akoua-Koffie and Claudia Kohl test the glovebox. Source: Andreas Nitsche/RKI

If Claudia Kohl’s mobile phone lights up with the digits + 225, it is possible that she will have to pack her suitcase immediately. +225 is the country code for Ivory Coast. Claudia and her colleagues from the Robert Koch Institute (RKI) just re­cent­ly built a new laboratory for the diagnosis of Ebola virus disease (EVD) in Bouaké. A mobile laboratory is stored there as well, which can be quickly set up and operated in any region of the country in which EVD cases might occur. That’s why the virologists maintain an unofficial on-call status: “If an actual case of Ebola virus disease (EVD) emerges in the region, we fly there the next day and take over the work.”

Claudia works for the German Partnership Program for Excellence in Biological and Health Security of the German Federal Foreign Office, which is partly housed in the Centre for Biological Threats and Special Pathogens at the RKI. The pro­gram aims for preventing biological vulne­ra­bi­li­ties and setting up the necessary la­bo­ra­to­ry capacities with the help of African partner nations. Ivory Coast is lo­ca­ted in West Africa. It bor­ders on Guinea and Liberia, those countries in which EVD has been raging for more than one and a half years. The virus has often over­come borders in West Africa. There have been cases in Senegal, Mali and Nigeria. So far, Ivory Coast has been spared. All suspected cases have turned out negative. However, experts fear that it might be only a matter of time until the first true infection occurs.

Therefore, the RKI virologists want to expand the diagnostic capabilities in Ivory Coast. The goal is for the country to identify cases of EVD quickly and reliably. This is the only way to prevent further spread of the disease in the case of emer­gency. The German Federal Foreign Office provides 1.8 million euros. Claudia Kohl and Andreas Nitsche, head of the Department for Highly Pathogenic Viruses at the RKI, coordinate the project.

Waiting for the virus

In Ivory Coast, people have prepared for the plague as well as they can. “In the cities, posters explain the symptoms, disinfectant is placed on the tables in res­tau­rants,” Claudia says. Arrivals have their temperature checked at the airport.

The laboratory equipment being delivered. Source: Andreas Nitsche/RKI The laboratory equipment being delivered.

Until now, however, samples from sus­pec­ted cases have been examined at only one location in the entire country: at the Institut Pasteur de Côte d’Ivoire, the national reference laboratory for Ebola virus disease. It is located in Abidjan in the South. The Robert Koch Institute and the German Federal Foreign Office have built an additional laboratory for the diag­no­sis of EVD in Bouaké. The city in the center of Ivory Coast is a trans­por­ta­tion hub. Main roads from the entire country converge here in a star shape. Many travelers from Guinea and Liberia, potential carriers of the Ebola virus, pass through. “The laboratory has been ready for use since December 13, 2014” says Andreas Nitsche.

The laboratory is the result of a strenuous logistical and organizational effort which has taken weeks to accomplish. Since October 2014, ten RKI employees have repeatedly traveled to Ivory Coast in order to advance the project. One of the first was Heinz Ellerbrok from the Department for Highly Pathogenic Viruses. Heinz is fluent in French. He presented the project to the Ivorian Ministry of Health, co­or­di­na­ted with the Institut Pasteur in Abidjan, and explored possible locations with his colleagues.

The virologist had been to Africa only once before. In the summer of 2014, he had been working in the European Mobile Laboratory (EMLab) in Guinea for four weeks, right in the middle of the outbreak in Guéckédou. He examined blood samp­les from suspected EVD cases there, as if on an assembly line. “Guinea is a coun­try with no functioning infrastructure,” he says. The health system had, for all intents and purposes, crumbled to dust.

Guinea and Ivory Coast are worlds apart. Ivory Coast is in good shape, com­pa­ra­ti­ve­ly speaking. The power supply is stable, there are highways with French toll systems. “The organisation of the university hospital in Bouaké is outstanding.” The RKI has worked with Chantal Akoua-Koffi, head of the hospital laboratory, before. There are suitable rooms and highly motivated employees who regularly take part in training courses on Ebola. A temporary isolation ward for suspected cases has been set up. Bouaké, he says, is the perfect partner.

An empty room, nothing more

In No­vem­ber 2014, Claudia Kohl, An­dre­as Nitsche and two other col­leagues from the RKI plan the design of the new laboratory in Bouaké. All have been wor­king with dangerous pathogens for years and are familiar with the requirements the laboratory must meet. “We had an empty room, nothing more,” says Claudia. The scientists have to order everything needed for the detection of Ebola virus: gloveboxes (these are transparent boxes with integrated gloves in which blood samp­les are rendered inactive before being further processed), thermal cyclers, centrifuges, pipettes, reagents, gloves, personal protective equipment.

Claudia Kohl and Andreas Kurth examine the collapsible glovebox for the mobile laboratory. Source: Andreas Nitsche/RKI Claudia Kohl and Andreas Kurth examine the collapsible glovebox for the mobile laboratory.

That’s not all. “In the case of emer­gency, the samp­les must be handled according to a stan­dar­dized procedure so that the risk of in­fec­tion is kept as low as possible for em­plo­yees,” says Andreas Nitsche. Every detail of the laboratory, from the location of the glovebox to the washable paint for the walls, has to be coordinated. The room even has to be remodeled.

The requirements are tight, for example for the acceptance of samples, says Claudia. In Guinea, where she also had been deployed in the EMLab for several weeks, she received throat swabs from patients with EVD in a knotted rubber glove. Something like that will not be allowed to occur in Bouaké: “Blood or saliva samples must be sealed in a bio-bottle.” A bio-bottle is a special container for highly infectious material for which, in turn, there is only one path of entry into the laboratory: a specially created hatch in the wall.

The renovation work in the laboratory is finished quickly, no matter if a wall must be breached or newly constructed. “Ms. Akoua-Koffi reached for the phone and a couple of hours later, everything was completed,” says Andreas. Laboratory benches, cabinets and shelves are custom-built by a local cabinet maker.

However, getting all the equipment into the country to fully furnish the laboratory is significantly more complicated. “Clearing customs in Abidjan and transporting the load to Bouaké took ten days, despite having all the necessary import permits,” says Claudia.

Trainings for the local laboratory staff

Finally, the new labo­ra­to­ry at the Uni­ver­si­ty Hospital in Bouaké is finished mid De­ce­mber 2014. Now, up to 60 sus­pec­ted EVD samples could be ana­lyzed here per day. In another room, the additional mobile laboratory is stored. The equipment for a second mobile la­bo­ra­to­ry is stationed in Berlin. In an emer­gency, it can be sent to Ivory Coast or a neighbouring country quickly.

Thankfully, the director of the university hospital in Bouaké called for his tailor: the RKI staff all received tailor-made Ivorian dresses and shirts. The con­struc­tion of the laboratory in Bouaké was just the beginning. “It is our goal that people there can operate the laboratory alone in the long run, that they will diagnose not only Ebola viruses, but also other highly pathogenic agents like Lassa or Marburg viruses,” says Claudia. The team has trained the local staff in handling the dangerous samples. Seven new employees have been hired by the Robert Koch Institute for that purpose, funded by the German Federal Foreign Office. “The local staff can operate the stationary laboratory at the university hospital by themselves now,” says Andreas Nitsche. Trainings in the mobile laboratory are scheduled for this winter. The on-call status will remain for a while.

Date: 13.08.2015