Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease

Placide Mbala-Kingebeni; Catherine Pratt; Mbusa Mutafali-Ruffin; Matthias G Pauthner; Faustin Bile; Antoine Nkuba-Ndaye; Allison Black; Eddy Kinganda-Lusamaki; Martin Faye; Amuri Aziza; Moussa M Diagne; Daniel Mukadi; Bailey White; James Hadfield; Karthik Gangavarapu; Nella Bisento; Donatien Kazadi; Bibiche Nsunda; Marceline Akonga; Olivier Tshiani; John Misasi; Aurelie Ploquin; Victor Epaso; Emilia Sana-Paka; Yannick Tutu Tshia N'kasar; Fabrice Mambu; Francois Edidi; Meris Matondo; Junior Bula Bula; Boubacar Diallo; Mory Keita; Marie R D Belizaire; Ibrahima S Fall; Abdoulaye Yam; Sabue Mulangu; Anne W Rimoin; Elias Salfati; Ali Torkamani; Marc A Suchard; Ian Crozier; Lisa Hensley; Andrew Rambaut; Ousmane Faye; Amadou Sall; Nancy J Sullivan; Trevor Bedford; Kristian G Andersen; Michael R Wiley; Steve Ahuka-Mundeke; Jean-Jacques Muyembe Tamfum

doi:10.1056/NEJMoa2024670

Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease

N Engl J Med. 2021 Apr 1;384(13):1240-1247. doi: 10.1056/NEJMoa2024670.

Authors

Placide Mbala-Kingebeni¹, Catherine Pratt¹, Mbusa Mutafali-Ruffin¹, Matthias G Pauthner¹, Faustin Bile¹, Antoine Nkuba-Ndaye¹, Allison Black¹, Eddy Kinganda-Lusamaki¹, Martin Faye¹, Amuri Aziza¹, Moussa M Diagne¹, Daniel Mukadi¹, Bailey White¹, James Hadfield¹, Karthik Gangavarapu¹, Nella Bisento¹, Donatien Kazadi¹, Bibiche Nsunda¹, Marceline Akonga¹, Olivier Tshiani¹, John Misasi¹, Aurelie Ploquin¹, Victor Epaso¹, Emilia Sana-Paka¹, Yannick Tutu Tshia N'kasar¹, Fabrice Mambu¹, Francois Edidi¹, Meris Matondo¹, Junior Bula Bula¹, Boubacar Diallo¹, Mory Keita¹, Marie R D Belizaire¹, Ibrahima S Fall¹, Abdoulaye Yam¹, Sabue Mulangu¹, Anne W Rimoin¹, Elias Salfati¹, Ali Torkamani¹, Marc A Suchard¹, Ian Crozier¹, Lisa Hensley¹, Andrew Rambaut¹, Ousmane Faye¹, Amadou Sall¹, Nancy J Sullivan¹, Trevor Bedford¹, Kristian G Andersen¹, Michael R Wiley¹, Steve Ahuka-Mundeke¹, Jean-Jacques Muyembe Tamfum¹

Affiliation

¹ From the Institut National de Recherche Biomédicale (P.M.-K., A.N.-N., E.K.-L., A.A., D.M., N.B., D.K., B.N., M.A., O.T., S.M, S.A.-M., J.-J.M.T.), the University of Kinshasa (P.M.-K., A.N.-N., F.M., F.E., M.M., J.B.B., S.A.-M., J.-J.M.T.), and Ministère de la Santé (F.B., V.E., E.S.-P., Y.T.T.N.) - all in Kinshasa, Democratic Republic of Congo; the University of Nebraska Medical Center, Omaha (C.P., B.W., M.R.W.); International Medical Corps (M.M.-R.) and the University of California, Los Angeles (A.W.R., M.A.S.), Los Angeles, and the Scripps Research Institute, La Jolla (M.G.P., K.G., E.S., A.T., K.G.A.) - all in California; the Fred Hutchinson Cancer Research Center, Seattle (A.B., J.H., T.B.); the Institut Pasteur de Dakar, Dakar, Senegal (M.F., M.M.D., O.F., A.S.); the Vaccine Research Center, National Institutes of Health, Bethesda (J.M., A.P., N.J.S.), and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research (I.C.), and the Integrated Research Facility at Fort Detrick, National Institutes of Health (L.H.), Frederick - all in Maryland; the World Health Organization, Geneva (B.D., M.K., M.R.D.B., I.S.F., A.Y.); and the University of Edinburgh, Edinburgh, United Kingdom (A.R.).

Abstract

During the 2018-2020 Ebola virus disease (EVD) outbreak in North Kivu province in the Democratic Republic of Congo, EVD was diagnosed in a patient who had received the recombinant vesicular stomatitis virus-based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) (Merck). His treatment included an Ebola virus (EBOV)-specific monoclonal antibody (mAb114), and he recovered within 14 days. However, 6 months later, he presented again with severe EVD-like illness and EBOV viremia, and he died. We initiated epidemiologic and genomic investigations that showed that the patient had had a relapse of acute EVD that led to a transmission chain resulting in 91 cases across six health zones over 4 months. (Funded by the Bill and Melinda Gates Foundation and others.).

Publication types

Case Reports
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bayes Theorem
Democratic Republic of the Congo / epidemiology
Ebola Vaccines / immunology
Ebolavirus / genetics*
Ebolavirus / isolation & purification
Fatal Outcome
Genome, Viral
Hemorrhagic Fever, Ebola / diagnosis
Hemorrhagic Fever, Ebola / epidemiology
Hemorrhagic Fever, Ebola / therapy
Hemorrhagic Fever, Ebola / transmission*
Humans
Male
Mutation
Phylogeny
RNA, Viral / blood
Recurrence

Substances

Ebola Vaccines
RNA, Viral

Abstract

Publication types

MeSH terms

Substances

Grants and funding