High doses of favipiravir in two men survivors of Ebola virus disease carrying Ebola virus in semen in Guinea

BACKGROUND: Persistence of Ebola virus (EBOV) in semen remains of deep concern, as sexual transmission of EBOV seems plausible up to 6 months after acute phase of Ebola virus disease (EVD). Favipiravir, a broad spectrum antiviral product, has been evaluated in reducing EVD mortality in Guinea in 2014-2015 in the JIKI trial, the pharmacokinetic results of which suggest that an increase of dose might be necessary to achieve a therapeutically relevant exposure. In FORCE trial, we aimed at evaluating the tolerance and activity of high doses of favipiravir in male EVD survivors with EBOV RNA detection in semen in Guinea. CASE: In 2016, we launched a phase IIa open-labeled multicenter dose escalation study. Male survivors of EVD with EBOV RT-PCR positive on semen received a loading dose of 2400 mg BID of favipiravir on day 1 then a maintenance dose of 1800 mg BID from day 2-14. The primary outcome was the tolerance, assessed daily during period treatment and up to day 90. Unfortunately only two participants were included and the trial was stopped for lack of recruitment. No clinical adverse event of grade 3/4 was reported for both patients. One patient experienced a grade 3 hypocalcemia at day 10 and 14. CONCLUSIONS: High doses of favipiravir were well tolerated in these two participants. Better characterized tolerance and pharmacokinetics of high doses of favipiravir are of utmost importance considering that favipiravir is a candidate treatment for a variety of emerging severe viral diseases with poor prognosis

Trends of and factors associated with cesarean section related surgical site infections in Guinea

Since the adoption of free obstetric care policy in Guinea in 2011, no study has examined the surgical site infections in maternity facilities. The objective of this study was to assess the trends of and factors associated with surgical site infection following cesarean section in Guinean maternity facilities from 2013 to 2015. This was a retrospective cohort study using routine medical data from ten facilities. Overall, the incidence of surgical site infections following cesarean section showed a declining trend across the three periods (10% in 2013, 7% in 2014 and 5% in 2015, P<0.001). Women who underwent cesarean section in 2014 (AOR: 0.70; 95%CI: 0.57-0.84) and 2015 (AOR: 0.43; 95%CI: 0.34-0.55) were less likely to develop surgical site infections during hospital stay than women operated in 2013. In the contrary, women with comorbidities were more likely to experience surgical site infection (AOR: 1.54; 95% CI: 1.25-1.90) than those who did not have comorbidities. The reductions achieved in 2014 and 2015 (during the Ebola outbreak) should be sustained in the post-Ebola context

Maternal and Child Health Services in the Context of the Ebola Virus Disease: Health Care Workers’ Knowledge, Attitudes and Practices in Rural Guinea

The objective of this study was to document maternal and child health care workers‘ knowledge, attitudes and practices on service delivery before, during and after the 2014 EVD outbreak in rural Guinea. We conducted a descriptive cross-sectional study in ten health districts between October and December 2015, using a standardized self-administered questionnaire. Overall 299 CHWs (94% response rate) participated in the study, including nurses/health technicians (49%), midwives (23%), managers (16%) and physicians (12%). Prior to the EVD outbreak, 87% of CHWs directly engaged in managing febrile cases within the facility, while the majority (89% and 63%) referred such cases to another facility and/or EVD treatment centre during and after the EVD outbreak, respectively. Compared to the period before the EVD outbreak when approximately half of CHWs (49%) reported systematically measuring body temperature prior to providing any care to patients, most CHWs reported doing so during (98%) and after the EVD outbreak (88%). The main challenges encountered were the lack of capacity to screen for EVD cases within the facility (39%) and the lack of relevant equipment (10%). The majority (91%) of HCWs reported a decrease in the use of services during the EVD outbreak while an increase was reported by 72% of respondents in the period following the EVD outbreak. Infection prevention and control measures established during the EVD outbreak have substantially improved self-reported provider practices for maternal and child health services in rural Guinea. However, more efforts are needed to maintain and sustain the gain achieved.Key words: Maternal and child health, practices, Ebola, Guine

Enrolling study personnel in Ebola vaccine trials: from guidelines to practice in a non-epidemic context.

BACKGROUND: Enrolling participants in clinical trials can be challenging, especially with respect to prophylactic vaccine trials. The vaccination of study personnel in Ebola vaccine trials during the 2014-2016 epidemic played a crucial role in inspiring trust and facilitating volunteer enrollment. We evaluated the ethical and methodological considerations as they applied to an ongoing phase 2 randomized prophylactic Ebola vaccine trial that enrolled healthy volunteers in Guinea, Liberia, Sierra Leone, and Mali in a non-epidemic context. METHODS: On the assumption that the personnel on site involved in executing the protocol, as well as community mobilizers (not involved in the on-site procedures), might also volunteer to enter the trial, we considered both ethical and methodological considerations to set clear rules that can be shared a priori with these persons. We reviewed the scientific and gray literature to identify relevant references and then conducted an analysis of the ethical and methodological considerations. RESULTS: There are currently no regulations preventing a clinical investigator or site staff from participating in a trial. However, the enrollment of personnel raises the risk of undue influence and challenges the basic ethical principle of voluntary participation. The confidentiality of personal medical information, such as HIV test results, may also be difficult to ensure among personnel. There is a risk of disruption of trial operations due to the potential absence of the personnel for their commitment as trial participants, and there is also a potential for introducing differential behavior of on-site staff as they obtain access to accumulating information during the trial (e.g., the incidence of adverse events). Blinding could be jeopardized, given knowledge of product-specific adverse event profiles and the proximity to unblinded site staff. These aspects were considered more relevant for on-site staff than for community mobilizers, who have limited contact with site staff. CONCLUSION: In a non-epidemic context, ethical and methodological considerations limit the collective benefit of enrolling site staff in a vaccine trial. These considerations do not apply to community mobilizers, whose potential enrollment should be considered as long as they meet the inclusion criteria and they are not exposed to any form of coercion

Correction to: Partnership for Research on Ebola VACcination (PREVAC): protocol of a randomized, double-blind, placebo-controlled phase 2 clinical trial evaluating three vaccine strategies against Ebola in healthy volunteers in four West African countries.

Following the publication of the original article [1], we were notified of an error in the affiliation of 3 authors of the article: Celine Roy, Laura Richert and Genevieve Chene. Their affiliation was initially mentioned as: “Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia” However, their correct affiliation is: Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, F-33000, Bordeaux, France.tp

Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in infants: a phase 2, randomised, double-blind, active-controlled trial in Guinea and Sierra Leone.

BACKGROUND: This study assessed the safety and immunogenicity of the Ad26.ZEBOV and MVA-BN-Filo Ebola virus (EBOV) vaccine regimen in infants aged 4-11 months in Guinea and Sierra Leone. METHODS: In this phase 2, randomised, double-blind, active-controlled trial, we randomly assigned healthy infants (1:1 in a sentinel cohort, 5:2 for the remaining infants via an interactive web response system) to receive Ad26.ZEBOV followed by MVA-BN-Filo (Ebola vaccine group) or two doses of meningococcal quadrivalent conjugate vaccine (control group) administered 56 days apart. Infants were recruited at two sites in west Africa: Conakry, Guinea, and Kambia, Sierra Leone. All infants received the meningococcal vaccine 8 months after being randomly assigned. The primary objective was safety. The secondary objective was immunogenicity, measured as EBOV glycoprotein-binding antibody concentration 21 days post-dose 2, using the Filovirus Animal Non-Clinical Group ELISA. This study is registered with ClinicalTrials.gov (NCT03929757) and the Pan African Clinical Trials Registry (PACTR201905827924069). FINDINGS: From Aug 20 to Nov 29, 2019, 142 infants were screened and 108 were randomly assigned (Ebola vaccine n=75; control n=33). The most common solicited local adverse event was injection-site pain (Ebola vaccine 15 [20%] of 75; control four [12%] of 33). The most common solicited systemic adverse events with the Ebola vaccine were irritability (26 [35%] of 75), decreased appetite (18 [24%] of 75), pyrexia (16 [21%] of 75), and decreased activity (15 [20%] of 75). In the control group, ten (30%) of 33 had irritability, seven (21%) of 33 had decreased appetite, three (9%) of 33 had pyrexia, and five (15%) of 33 had decreased activity. The frequency of unsolicited adverse events was 83% (62 of 75 infants) in the Ebola vaccine group and 85% (28 of 33 infants) in the control group. No serious adverse events were vaccine-related. In the Ebola vaccine group, EBOV glycoprotein-binding antibody geometric mean concentrations (GMCs) at 21 days post-dose 2 were 27 700 ELISA units (EU)/mL (95% CI 20 477-37 470) in infants aged 4-8 months and 20 481 EU/mL (15 325-27 372) in infants aged 9-11 months. The responder rate was 100% (74 of 74 responded). In the control group, GMCs for both age groups were less than the lower limit of quantification and the responder rate was 3% (one of 33 responded). INTERPRETATION: Ad26.ZEBOV and MVA-BN-Filo was well tolerated and induced strong humoral responses in infants younger than 1 year. There were no safety concerns related to vaccination. FUNDING: Janssen Vaccines & Prevention and Innovative Medicines Initiative 2 Joint Undertaking. TRANSLATION: For the French translation of the abstract see Supplementary Materials section

Rôle de l’apoptose dans la transmission de Plasmodium falciparum

Plasmodium species use programmed cell death for the survival of their offspring as some prokaryotic parasites. This study was designed to - assess the gametocytes carrier and their genotypes before/ after treatment and studying their infectivity; - express the catalytic domain (PfMCA1-cd-Sc) of Plasmodium falciparum metacaspase (PfMCA1) in yeast; - Test the “in vitro” anti-plasmodial activity of pyrano and ferro- quinolines derived new synthetic molecules on 3D7 and Dd2 Chloroquine laboratory clones. The 28-day “in vivo” WHO test, molecular markers of resistance and direct feeding; yeast culture, protein expression of P. falciparum metacaspase 1, Western blot, proliferation and survival test, and cell death markers were used to achieve the first two objectives while parasite culture and in vitro tests by the method of fluorimetry in SYBR Green I was used to evaluate the anti-plasmodial activity of new molecules. Results show that post-treatment gametocytes were carriers of point mutations and the most infective in the Chloroquine group. The heterologous expression of PfMCA1 catalytic domain in Saccharomyces cerevisiae resulted in apoptotic clonal death and growth retardation activity-dependent Protease-VAD, showing the involvement of PfMCA1 in the process of cell death. The aromatic substitutes with pyrimidine or benzyldimethylamine ferrocene residues showed satisfactory activity against the methoxyethylidene on 3D7 and Dd2. The data suggest that the structural optimization of these compounds based on pyrimidine and ferrocene is more interesting from the standpoint anti-plasmodial activity for candidate molecules in the near future.Ce travail avait pour objectif : 1) évaluer le portage de gamétocytes et leur génotype avant et après le traitement d’une part, et d’étudier leur infectivité ; 2) exprimer le domaine catalytique (PfMCA1-cd-Sc) de la métacaspase de Plasmodium falciparum (PfMCA1) chez la levure et 3) tester in vitro l’activité antiplasmodiale de nouvelles molécules synthétiques dérivées des pyrano et ferro-quinoléines sur des clones de laboratoire 3D7 et Dd2. Pour cela, le test in vivo de 28 jours de l’OMS, les marqueurs moléculaires de résistance et le « direct feeding » ont été utilisés pour le premier objectif. La culture des levures, l’expression des protéines de la métacaspase 1 de Plasmodium falciparum, le western blot, le test de prolifération et de survie, et les marqueurs de mort cellulaire ont servi pour le second objectif et enfin, la culture parasitaire et tests in vitro par la méthode de fluorimétrie au Sybr Green I ont permis l’évaluation de l’activité antiplasmodiale de nouvelles molécules. Nous avons démontré que les gamétocytes post-traitement étaient porteurs de mutations ponctuelles et plus infectants dans le groupe chloroquine ; que l’expression hétérologue du domaine catalytique de la métacaspase de Plasmodium falciparum (PfMCA1) dans la levure Saccharomyces cerevisiae entraînait une mort clonale de type apoptotique et un retard de croissance dépendant de l’activité VAD-Protéase et enfin, que les substitues aromatiques à base de pyrimidine ou de benzylméthylamine ferrocène révèlent une activité satisfaisante par rapport à la méthoxyéthylidene sur les clones 3D7 et Dd2

Role of apoptosis in the transmission of Plasmodium falciaprum

Ce travail avait pour objectif : 1) évaluer le portage de gamétocytes et leur génotype avant et après le traitement d’une part, et d’étudier leur infectivité ; 2) exprimer le domaine catalytique (PfMCA1-cd-Sc) de la métacaspase de Plasmodium falciparum (PfMCA1) chez la levure et 3) tester in vitro l’activité antiplasmodiale de nouvelles molécules synthétiques dérivées des pyrano et ferro-quinoléines sur des clones de laboratoire 3D7 et Dd2. Pour cela, le test in vivo de 28 jours de l’OMS, les marqueurs moléculaires de résistance et le « direct feeding » ont été utilisés pour le premier objectif. La culture des levures, l’expression des protéines de la métacaspase 1 de Plasmodium falciparum, le western blot, le test de prolifération et de survie, et les marqueurs de mort cellulaire ont servi pour le second objectif et enfin, la culture parasitaire et tests in vitro par la méthode de fluorimétrie au Sybr Green I ont permis l’évaluation de l’activité antiplasmodiale de nouvelles molécules. Nous avons démontré que les gamétocytes post-traitement étaient porteurs de mutations ponctuelles et plus infectants dans le groupe chloroquine ; que l’expression hétérologue du domaine catalytique de la métacaspase de Plasmodium falciparum (PfMCA1) dans la levure Saccharomyces cerevisiae entraînait une mort clonale de type apoptotique et un retard de croissance dépendant de l’activité VAD-Protéase et enfin, que les substitues aromatiques à base de pyrimidine ou de benzylméthylamine ferrocène révèlent une activité satisfaisante par rapport à la méthoxyéthylidene sur les clones 3D7 et Dd2.Plasmodium species use programmed cell death for the survival of their offspring as some prokaryotic parasites. This study was designed to - assess the gametocytes carrier and their genotypes before/ after treatment and studying their infectivity; - express the catalytic domain (PfMCA1-cd-Sc) of Plasmodium falciparum metacaspase (PfMCA1) in yeast; - Test the “in vitro” anti-plasmodial activity of pyrano and ferro- quinolines derived new synthetic molecules on 3D7 and Dd2 Chloroquine laboratory clones. The 28-day “in vivo” WHO test, molecular markers of resistance and direct feeding; yeast culture, protein expression of P. falciparum metacaspase 1, Western blot, proliferation and survival test, and cell death markers were used to achieve the first two objectives while parasite culture and in vitro tests by the method of fluorimetry in SYBR Green I was used to evaluate the anti-plasmodial activity of new molecules. Results show that post-treatment gametocytes were carriers of point mutations and the most infective in the Chloroquine group. The heterologous expression of PfMCA1 catalytic domain in Saccharomyces cerevisiae resulted in apoptotic clonal death and growth retardation activity-dependent Protease-VAD, showing the involvement of PfMCA1 in the process of cell death. The aromatic substitutes with pyrimidine or benzyldimethylamine ferrocene residues showed satisfactory activity against the methoxyethylidene on 3D7 and Dd2. The data suggest that the structural optimization of these compounds based on pyrimidine and ferrocene is more interesting from the standpoint anti-plasmodial activity for candidate molecules in the near future

Rôle de l’apoptose dans la transmission de Plasmodium falciparum

Plasmodium species use programmed cell death for the survival of their offspring as some prokaryotic parasites. This study was designed to - assess the gametocytes carrier and their genotypes before/ after treatment and studying their infectivity; - express the catalytic domain (PfMCA1-cd-Sc) of Plasmodium falciparum metacaspase (PfMCA1) in yeast; - Test the “in vitro” anti-plasmodial activity of pyrano and ferro- quinolines derived new synthetic molecules on 3D7 and Dd2 Chloroquine laboratory clones. The 28-day “in vivo” WHO test, molecular markers of resistance and direct feeding; yeast culture, protein expression of P. falciparum metacaspase 1, Western blot, proliferation and survival test, and cell death markers were used to achieve the first two objectives while parasite culture and in vitro tests by the method of fluorimetry in SYBR Green I was used to evaluate the anti-plasmodial activity of new molecules. Results show that post-treatment gametocytes were carriers of point mutations and the most infective in the Chloroquine group. The heterologous expression of PfMCA1 catalytic domain in Saccharomyces cerevisiae resulted in apoptotic clonal death and growth retardation activity-dependent Protease-VAD, showing the involvement of PfMCA1 in the process of cell death. The aromatic substitutes with pyrimidine or benzyldimethylamine ferrocene residues showed satisfactory activity against the methoxyethylidene on 3D7 and Dd2. The data suggest that the structural optimization of these compounds based on pyrimidine and ferrocene is more interesting from the standpoint anti-plasmodial activity for candidate molecules in the near future.Ce travail avait pour objectif : 1) évaluer le portage de gamétocytes et leur génotype avant et après le traitement d’une part, et d’étudier leur infectivité ; 2) exprimer le domaine catalytique (PfMCA1-cd-Sc) de la métacaspase de Plasmodium falciparum (PfMCA1) chez la levure et 3) tester in vitro l’activité antiplasmodiale de nouvelles molécules synthétiques dérivées des pyrano et ferro-quinoléines sur des clones de laboratoire 3D7 et Dd2. Pour cela, le test in vivo de 28 jours de l’OMS, les marqueurs moléculaires de résistance et le « direct feeding » ont été utilisés pour le premier objectif. La culture des levures, l’expression des protéines de la métacaspase 1 de Plasmodium falciparum, le western blot, le test de prolifération et de survie, et les marqueurs de mort cellulaire ont servi pour le second objectif et enfin, la culture parasitaire et tests in vitro par la méthode de fluorimétrie au Sybr Green I ont permis l’évaluation de l’activité antiplasmodiale de nouvelles molécules. Nous avons démontré que les gamétocytes post-traitement étaient porteurs de mutations ponctuelles et plus infectants dans le groupe chloroquine ; que l’expression hétérologue du domaine catalytique de la métacaspase de Plasmodium falciparum (PfMCA1) dans la levure Saccharomyces cerevisiae entraînait une mort clonale de type apoptotique et un retard de croissance dépendant de l’activité VAD-Protéase et enfin, que les substitues aromatiques à base de pyrimidine ou de benzylméthylamine ferrocène révèlent une activité satisfaisante par rapport à la méthoxyéthylidene sur les clones 3D7 et Dd2