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A lesion specific to Ebola virus disease showed an anatomical distribution suggesting neuronal transmission., We conducted a case–control study in Freetown, Sierra Leone, to investigate ocular signs in Ebola virus disease (EVD) survivors. A total of 82 EVD survivors with ocular symptoms and 105 controls from asymptomatic civilian and military personnel and symptomatic eye clinic attendees underwent ophthalmic examination, including widefield retinal imaging. Snellen visual acuity was

Objective: This paper examines maternal knowledge regarding perinatal and infant mental health amongst mothers in Alexandra township, Johannesburg. The applicability and utility of these Westernderived concepts in a low socio-economic South African setting is examined. Method: A concurrent mixed methods approach was used. Descriptive statistical analysis was conducted on the responses of 255 mothers on a structured questionnaire, designed to elicit levels of knowledge about the relational needs and awareness of infants and the psychosocial needs of mothers, to determine trends in mothers’ knowledge. A thematic content analysis was also conducted on the responses to determine themes and understandings within the mothers’ responses. Results: Maternal knowledge in Alexandra regarding perinatal and infant mental health correlates with maternal education levels. Cultural, contextual and psychological factors appear to influence maternal understandings of infant sentience and maternal ambivalence. Conclusions: Further research is required to determine possible contributions of the denial of negative maternal affect post-birth to elevated levels of post-natal depression found amongst South African mothers parenting in adverse circumstances. There is a need for education regarding key messages from the neuroscience of development, to give these parents opportunities to raise their children in a way that supports healthy cognitive and emotional development.

Summary Background In survivors of Ebola virus disease, clinical sequelae including uveitis, arthralgia, and fatigue are common and necessitate systematic follow-up. However, the infection risk to health-care providers is poorly defined. Here we report Ebola virus RT-PCR data for body site and fluid samples from a large cohort of Ebola virus survivors at clinic follow-up. Methods In this cross-sectional cohort study, consecutive survivors of Ebola virus disease attending Kerry Town survivor clinic (Freetown, Sierra Leone), who had been discharged from the Kerry Town Ebola treatment unit, were invited to participate. We collected and tested axillary, blood, conjunctival, forehead, mouth, rectal, semen, urine, and vaginal specimens for presence of Ebola virus using RT-PCR. We regarded samples to be positive for Ebola virus disease if the cycle threshold was 40 or lower. We collected demographic data from survivors of their age, sex, time since discharge from the treatment unit, and length of acute admission in the Ebola treatment unit using anonymised standard forms. Findings Between April 2, and June 16, 2015, of 151 survivors of Ebola virus disease invited to participate, 112 (74%) provided consent. The median age of participants was 21·5 years (IQR 14–31·5) with 34 (30%) participants younger than 16 years. 50 (45%) of 112 participants were male. We tested a total of 555 specimens: 103 from the axilla, 93 from blood, 92 from conjunctiva, 54 from forehead, 105 from mouth, 17 from the rectum, one from semen, 69 from urine, and 21 from the vagina. The median time from Ebola treatment unit discharge to specimen collection was 142 days (IQR 127–159). 15 participants had a total of 74 swabs taken less than 100 days from discharge. The semen sample from one participant tested positive for Ebola virus at 114 days after discharge from the treatment unit; specimens taken from the axilla, blood, conjunctiva, forehead, mouth, rectum, and urine of the same participant tested negative. All specimens from the other 111 participants tested negative. Interpretation Patients recovering from Ebola virus disease who do not meet the case definition for acute disease pose a low infection risk to health-care providers 6 weeks after clearance of viraemia. Personal protective equipment after this time might be limited to standard barrier precautions, unless contact with fluids from sanctuary sites is envisaged. Funding Save the Children International, Public Health England.

Background Throughout the Ebola virus disease (EVD) epidemic in West Africa, field laboratory testing for EVD has relied on complex, multi-step real-time reverse transcription PCR (RT-PCR) assays; an accurate sample-to-answer RT-PCR test would reduce time to results and potentially increase access to testing. We evaluated the performance of the Cepheid GeneXpert Ebola assay on clinical venipuncture whole blood (WB) and buccal swab (BS) specimens submitted to a field biocontainment laboratory in Sierra Leone for routine EVD testing by RT-PCR (“Trombley assay”). Methods and Findings This study was conducted in the Public Health England EVD diagnostic laboratory in Port Loko, Sierra Leone, using residual diagnostic specimens remaining after clinical testing. EDTA-WB specimens (n = 218) were collected from suspected or confirmed EVD patients between April 1 and July 20, 2015. BS specimens (n = 71) were collected as part of a national postmortem screening program between March 7 and July 20, 2015. EDTA-WB and BS specimens were tested with Xpert (targets: glycoprotein [GP] and nucleoprotein [NP] genes) and Trombley (target: NP gene) assays in parallel. All WB specimens were fresh; 84/218 were tested in duplicate on Xpert to compare WB sampling methods (pipette versus swab); 43/71 BS specimens had been previously frozen. In all, 7/218 (3.2%) WB and 7/71 (9.9%) BS samples had Xpert results that were reported as “invalid” or “error” and were excluded, leaving 211 WB and 64 BS samples with valid Trombley and Xpert results. For WB, 22/22 Trombley-positive samples were Xpert-positive (sensitivity 100%, 95% CI 84.6%–100%), and 181/189 Trombley-negative samples were Xpert-negative (specificity 95.8%, 95% confidence interval (CI) 91.8%–98.2%). Seven of the eight Trombley-negative, Xpert-positive (Xpert cycle threshold [Ct] range 37.7–43.4) WB samples were confirmed to be follow-up submissions from previously Trombley-positive EVD patients, suggesting a revised Xpert specificity of 99.5% (95% CI 97.0%–100%). For Xpert-positive WB samples (n = 22), Xpert NP Ct values were consistently lower than GP Ct values (mean difference −4.06, 95% limits of agreement −6.09, −2.03); Trombley (NP) Ct values closely matched Xpert NP Ct values (mean difference −0.04, 95% limits of agreement −2.93, 2.84). Xpert results (positive/negative) for WB sampled by pipette versus swab were concordant for 78/79 (98.7%) WB samples, with comparable Ct values for positive results. For BS specimens, 20/20 Trombley-positive samples were Xpert-positive (sensitivity 100%, 95% CI 83.2%–100%), and 44/44 Trombley-negative samples were Xpert-negative (specificity 100%, 95% CI 92.0%–100%). This study was limited to testing residual diagnostic samples, some of which had been frozen before use; it was not possible to test the performance of the Xpert Ebola assay at point of care. Conclusions The Xpert Ebola assay had excellent performance compared to an established RT-PCR benchmark on WB and BS samples in a field laboratory setting. Future studies should evaluate feasibility and performance outside of a biocontainment laboratory setting to facilitate expanded access to testing., Nira Pollock and colleagues evaluate the performance of the GeneXpert Ebola assay for diagnosis of clinical and post-mortem specimens submitted to a field laboratory in Sierra Leone., Editors' Summary Background During the recent Ebola virus disease (EVD) outbreak in West Africa, there were more than 28,000 confirmed, probable, and suspected cases of EVD and more than 11,000 deaths from EVD. Ebola virus is transmitted to people from wild animals and spreads in human populations through contact with the bodily fluids (including blood, saliva, and urine) or organs of infected people and through contact with bedding and other materials contaminated with bodily fluids. The symptoms of EVD, which start 2–21 days after infection, include fever, headache, vomiting, diarrhea, and internal and external bleeding. Infected individuals are not infectious until they develop symptoms, but they remain infectious as long as their bodily fluids contain virus, which can be several weeks. There is no proven treatment for EVD, but supportive care—given under strict isolation conditions to prevent the spread of the disease—improves survival. Currently, there are no licensed Ebola vaccines, but two candidate vaccines are being evaluated. Why Was This Study Done? EVD diagnosis during the recent epidemic relied on multi-step reverse transcription polymerase chain reaction (RT-PCR) assays (for example, the Trombley assay) performed in field biocontainment laboratories on blood obtained from a vein using a needle (venipuncture) or on samples of cells and saliva collected from the mouth lining using a swab (buccal swab); buccal swabs are mainly used for surveillance, particularly postmortem screening. Prior to RT-PCR, the sample must be inactivated and nucleic acid extracted. An accurate, fully automated “sample-to-answer” assay that is capable of testing both whole blood and buccal swabs and that minimizes the potential exposure of laboratory personnel to the Ebola virus could greatly improve EVD diagnosis. Here, the researchers evaluate the performance of the Cepheid GeneXpert Ebola assay on whole blood samples and buccal swabs sent to a field laboratory in Sierra Leone for routine testing using the Trombley assay. The Xpert assay is an automated RT-PCR system that integrates all the steps needed to determine the presence of Ebola virus; once the test sample has been inactivated and added to a proprietary cartridge, no further operator action is necessary to generate the result. What Did the Researchers Do and Find? The researchers tested 218 whole blood specimens collected from patients with suspected or confirmed EVD using both the Trombley and the Xpert assay. After excluding a few samples that gave Xpert results that were reported as “invalid” or “error,” 22 out of 22 Trombley-positive samples were Xpert-positive, and 181 out of 189 Trombley-negative samples were Xpert-negative. That is, the Xpert assay had a sensitivity (true positive rate) of 100% and a specificity (true negative rate) of 95.8% compared to the benchmark assay. Notably, seven of the eight Trombley-negative but Xpert-positive blood samples were follow-up samples obtained from previously Trombley-positive patients, which suggests that the specificity of the Xpert test was actually 99.5%. When the Xpert assay was used to test 71 buccal swabs, the sensitivity and specificity of the Xpert assay were both 100%. Finally, Xpert results obtained using a pipette versus a swab to pick up a portion of blood for testing were concordant in 78 out of 79 samples; this test was done in part to get an indication of whether the Xpert Ebola assay will work on fingerstick samples—blood samples obtained by using a sterile lancet to pierce the fingertip and then collecting the blood with a swab; this collection method is more easily done in the field at point of care than venipuncture. What Do These Findings Mean? These findings show that, compared to an established RT-PCR Ebola virus assay, the Xpert Ebola assay performed well on both whole blood samples and buccal swabs in a field laboratory setting. Although sampling of blood with a swab partly simulated the performance of the Xpert assay on fingerstick samples collected at point of care, fingerstick sample collection will need to be tested directly before the Xpert assay can be used to test individuals for Ebola virus by this method at point of care. Further studies are also needed to evaluate the feasibility and performance of the Xpert assay in a range of clinical settings to determine where and when this assay can be deployed; the need for an uninterrupted power supply and, in some settings, for refrigeration of reagents may prevent its deployment in some resource-limited settings. Ultimately though, these findings suggest that the use of the Xpert Ebola assay could facilitate expanded access to Ebola virus testing. Additional Information This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at http://dx.doi.org/10.1371/journal.pmed.1001980. The World Health Organization (WHO) provides information about EVD, information about potential EVD vaccines and therapies, and regular updates on the West African EVD epidemic; the WHO website also provides information about efforts to control Ebola in the field and personal stories from people who have survived EVD The UK National Health Service Choices website provides detailed information on EVD The US Centers for Disease Control and Prevention also provides information about EVD More information on the Xpert Ebola test and authorization for its emergency use is available from the US Food and Drug Administration and from WHO

Background. Throughout the Ebola virus disease (EVD) epidemic in West Africa, field laboratory testing for EVD has relied on complex, multi-step RT-PCR assays; an accurate, sample-to-answer RT-PCR test would reduce time to results and potentially increase access to testing. We evaluated the performance of the Cepheid GeneXpert Ebola assay on clinical venipuncture whole blood (WB) and buccal swab (BS) specimens submitted to a field biocontainment laboratory in Sierra Leone for routine EVD testing by RT-PCR (“Trombley assay”). Methods. EDTA-WB (n = 218) and BS (n = 71) specimens were tested with Xpert (targets: GP and NP genes) and Trombley (target: NP gene) assays in parallel. All WB specimens were fresh; 84 of 218 were tested in duplicate on Xpert to compare WB sampling methods (pipette versus swab). Forty-three of 71 BS specimens had been previously frozen. Results. Seven of 218 (3.2%) WB and 7 of 71 (9.9%) BS samples had invalid Xpert results and were excluded, leaving 211 WB and 64 BS samples with valid Trombley and Xpert results. For WB, 22 of 22 Trombley-positive samples were Xpert-positive [sensitivity 100% (95% CI 84.6–100)] and 181 of 189 Trombley-negative samples were Xpert-negative [specificity 95.8% (91.8–98.2)]. Seven of 8 Trombley-negative, Xpert-positive (Xpert Ct range 37.7–43.3) WB samples were confirmed to be follow-up submissions for previously Trombley-positive EVD patients, suggesting a revised Xpert specificity of 99.5% (97.1–100). For Xpert-positive WB (n = 22), Xpert NP Ct values were consistently lower than GP Ct values (mean difference 4.12, SD = 1.00); Trombley (NP) Ct values closely matched Xpert NP Ct values (mean difference 0.09, SD 1.56). Xpert results (pos/neg) for WB sampled by pipette versus swab were concordant for 78 of 79 (98.7%) WB samples, with comparable Ct values for positives. For BS, 20 of 20 Trombley-positive samples were Xpert-positive [sensitivity 100% (83.2–100)] and 44 of 44 Trombley-negative samples were Xpert-negative [specificity 100% (92.0–100)]. Conclusions. The Xpert Ebola test had excellent performance on WB and BS samples in a field laboratory setting as compared to an established RT-PCR benchmark. Future studies should evaluate feasibility and performance outside of a biocontainment laboratory setting to facilitate expanded access to testing. Disclosures. All authors: No reported disclosures.

Rapid Ebola virus (EBOV) detection is crucial for appropriate patient management and care. The performance of the FilmArray BioThreat-E test (v2.5) using whole-blood samples was evaluated in Sierra Leone and the United Kingdom and was compared with results generated by a real-time Ebola Zaire PCR reference method. Samples were tested in diagnostic laboratories upon availability, included successive samples from individual patients, and were heat treated to facilitate EBOV inactivation prior to PCR. The BioThreat-E test had a sensitivity of 84% (confidence interval [CI], 64% to 95%) and a specificity of 89% (CI, 73% to 97%) in Sierra Leone ( n = 60; 44 patients) and a sensitivity of 75% (CI, 19% to 99%) and a specificity of 100% (CI, 97% to 100%) in the United Kingdom ( n = 108; 70 patients) compared to the reference real-time PCR. Statistical analysis (Fisher's exact test) indicated there was no significant difference between the methods at the 99% confidence level in either country. In 9 discrepant results (5 real-time PCR positives and BioThreat-E test negatives and 4 real-time PCR negatives and BioThreat-E test positives), the majority ( n = 8) were obtained from samples with an observed or probable low viral load. The FilmArray BioThreat-E test (v2.5) therefore provides an attractive option for laboratories (either in austere field settings or in countries with an advanced technological infrastructure) which do not routinely offer an EBOV diagnostic capability.