In Sierra Leone, a chance to learn from Ebola
UW-Madison’s Yoshihiro Kawaoka, Peter Halfmann and Alhaji Njai stand outside of a military hospital with Foday Sahr, a Sierra Leone military official and chair of microbiology at the University of Sierra Leone. Ebola patients are treated at many of the country’s military hospitals like the Joint Medical Unit.
Photos courtesy of the Kawaoka Lab
When Yoshihiro Kawaoka and members of his research team first arrived in Sierra Leone in December 2014, the consistent wail of ambulance sirens was a frightening reminder that the Ebola virus was there, too.
It was what brought Kawaoka to the West African nation in the first place.
Kawaoka, a professor of pathobiological sciences at the University of Wisconsin–Madison School of Veterinary Medicine, started studying Ebola in 1995 after reading a book about the virus, “The Hot Zone.” He was fascinated by its origins and wanted to understand how it spreads, and how it sickens those it infects, so he could be part of the solution.
His studies had always involved common laboratory models, like mice and special cell cultures, and took place in high security laboratories like the National Institutes of Health Rocky Mountain Laboratories in Montana, where researchers gown up in airtight, spacelike suits and look at how these models respond to infection.
Now, he had a chance to study a disease in the very people who were living and dying with it.
“The sirens are going, on and off, and it was very scary — because that means Ebola patients are there — but at the same time we feel very fortunate to be able to do this work,” Kawaoka says. “We’ve never been able to do this with humans because we’ve never had human samples.”
Health workers tend to a patient at one of Sierra Leone’s military hospitals, where many of the country’s 8,000 Ebola patients have received treatment since an outbreak began in West Africa in December 2013.
Ebola virus first emerged in 1976, in Sudan and the Democratic Republic of Congo, in a village near the Ebola River, from which it gets its name. Over the years, the virus would emerge, sicken people and disappear into the forests again. But in December 2013, the outbreak that was to become history’s largest and deadliest was only just beginning.
“The Ebola virus is identified almost every year now, but it has been contained because it has happened in countries where Ebola virus appears consistently,” says Kawaoka. “This outbreak is different. This outbreak occurred in an area where we never had Ebola outbreak, so the local people did not know how to contain it. Developed countries did not recognize that until last June, when numbers of cases increased dramatically.”
By fall, the outbreak had reached a fever pitch, spreading to health care workers in Spain and the U.S., killing an African traveler in a Dallas suburb. Many of those infected came down with symptoms that ranged from fever and headache to bloody diarrhea and vomiting. Today, more than 10,000 people have died of Ebola in the current outbreak, including almost 4,000 in Sierra Leone, on Africa’s west coast. Nearly 26,000 have become sick.
But amidst the fear and tragedy, Kawaoka (who also holds an appointment at the University of Tokyo) saw opportunity. Almost a decade ago, he began working on an Ebola vaccine, designed using a form of the virus his research group created that could only grow in special cells contained in a high security lab. Before the current outbreak, funding for the project had dwindled as people had stopped thinking about the virus.
Kawaoka meets with Ekundayo Thompson, vice chancellor of the University of Sierra Leone, while in the African nation to establish a partnership to study and fight Ebola while improving the research capacity and infrastructure of the university.
Now, reinvigorated by the crisis, the Japanese government granted Kawaoka the money he needed to continue, and in March 2015, he published a study in the journal Science describing a vaccine shown to be both safe and effective in mice, guinea pigs, and nonhuman primates. That vaccine could be produced for clinical trials in the next couple of years, Kawaoka said at a public hearing at the Wisconsin State Capitol on April 21.
Throughout his career, first at St. Jude Children’s Research Hospital in Tennessee, and for the last 18 years at UW–Madison, Kawaoka has been interested in how influenza viruses and others, like Ebola, infect their hosts and make them sick. Ultimately, one of his goals is to create a universal flu vaccine that keeps people safe from that virus from year to year, and he also hopes to contribute to understanding how and why some influenza viruses become pandemic.
In 2012, he published a controversial study of the H5N1 virus, in which he showed just how few mutations it could take for the highly pathogenic avian influenza virus to become infectious in humans. That virus is now present in wild bird populations throughout the world, including the U.S., and virus strains harboring these potentially dangerous mutations have recently been found in Cambodia, he says.
In July 2014, Kawaoka’s team showed that a 1918-like pandemic influenza virus (Spanish flu) could be recreated once again in nature through the recombination of just eight viral genes already circulating in waterfowl.
But Ebola had eluded him. Until now.
A vial is labeled and prepared to hold blood from an Ebola patient in Sierra Leone. Researchers will compare blood from those who died of the virus to those who survived and those who never got sick to try to develop treatment.
After hearing of the current outbreak, Kawaoka asked if he could have some blood samples from Ebola patients. He heard nothing in response. Then in November 2014, he heard an interview on the UW–Madison campus with Alhaji Njai, a research fellow at the School of Veterinary Medicine and the Global Health Institute, and a native of Sierra Leone. Njai had begun a twice-weekly radio program to help educate his home countrymen on how to protect themselves from Ebola, and he was soon headed back for the holidays.
“We happened to be in the same department, but I had never met him. I contacted him and he immediately responded,” says Kawaoka. “We met to discuss whether we could do something in Sierra Leone and that was the beginning.”
It was just days before Christmas when Kawaoka and one of his most qualified researchers, Peter Halfmann, packed their bags and headed with Njai into the heart of Ebola territory, which was on mandatory lockdown.
“Usually there are people dancing in the streets,” he says, noting the somber tone that had settled on the colorful city of Freetown, Sierra Leone’s capital and its largest city.
Freetown is also home to the University of Sierra Leone, where Njai is affiliated, and the team toured the city, visiting military hospitals and holding facilities where patients were quarantined. They encountered police stops along the way.
Kawaoka speaks to legislators, legislative staff and media representatives in the North Hearing Room of the Wisconsin State Capitol about his lab’s work to develop a whole virus vaccine.
At the Madison hearing before reporters and policymakers, Kawaoka described how Sierra Leone is caring for its Ebola patients, isolating the sickest in bright rooms, providing the healing with fresh air. Health workers wear head-to-toe protective gear and masks. They incinerate materials from patient rooms and undergo a strict decontamination procedure after exiting patient areas, sprayed down with chlorine, standing in chlorine-filled buckets for five minutes, the process timed by other workers.
Sierra Leone has hired some of its Ebola survivors to work at these facilities. Many, tainted by the virus that has killed so many others, have been shunned by their families and communities, Kawaoka says.
Yet the death rate from the virus among people who receive proper care early in the course of infection — in Sierra Leone, this has involved treatment with malarial drugs, antibiotics and IV fluids — is now fewer than 2 in 10, he says. This is one of the things that surprised him most visiting the country.
“They save 80 percent of the patients and that is dramatic,” he says.
What they’re also saving in Sierra Leone is blood, the priceless material that Kawaoka hopes will unlock some of Ebola’s secrets.
“Now, we have samples to examine exactly what’s happening with humans infected with the Ebola virus and, by doing this, we should be able to find a way to control host responses and save patients.”
Kawaoka, who never entered patient areas himself, gave health workers in the military-run treatment facilities cameras encased in plastic and asked them to take photographs inside. The workers are also taking blood — a couple drops from each patient — packed in a tube inside a tube, wrapped in a bag.
These samples go to the researchers, who inactivate the virus and work in specialized biosafety tents in Sierra Leone, dressed head-to-toe in the same protective gear they use in the U.S. and Japan. They will spin down the blood in high-speed centrifuges, separating the plasma and the white blood cells, involved in immunity, from the oxygen-carrying red blood cells.
The researchers will look at the genetic and molecular signatures within these samples, comparing blood from patients who survived Ebola to blood from those who did not, and to those who never got sick at all.
“We have been working with influenza virus for many years, doing experiments in animals … to identify host proteins or genes that control the infections,” Kawaoka says. “We have tried to do the same thing with Ebola. Now, we have samples to examine exactly what’s happening with humans infected with the Ebola virus and, by doing this, we should be able to find a way to control host responses and save patients.”
Kawaoka and his team have now returned to Sierra Leone on multiple occasions and met with the country’s government officials and military and public health leaders, representatives from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and with representatives from the University of Sierra Leone.
Today, Kawaoka and Njai have embarked on a partnership, uniting their two institutions in the fight against Ebola. Kawaoka is trying to help the African nation develop the research infrastructure to continue to detect, study and prevent infectious diseases like Ebola. He is trying to raise the funds to bring this plan to bear.
In return, he will continue to study how Ebola impacts humans and how he might be able to help change future outcomes. While the current outbreak is subsiding, Kawaoka says this will not be the last.
“We have a choice: either not to do any work and see what happens — what happens in nature, whether we see outbreaks — or we study it and be prepared,” Kawaoka says. “It’s fortunate for us to have this opportunity and we very much appreciate it. It is important for people like us who are working on infectious disease to keep working during these outbreaks and continue to do this type of work.”
Katika Sierra Leone, Yoshihiro Kawakami, Peter Halffman na Alhaji Njai, wanaofundisha katika Chuo Kikuu cha Madison, wamesimama nje ya hospitali ya kijeshi na Foday Sahr, afisa wa kijeshi wa Sierra Leone na mwenyekiti wa microbiology katika Chuo Kikuu cha Sierra Leone. Wagonjwa wa Ebola wanatibiwa katika hospitali nyingi za kijeshi nchini humo kama vile Kitengo cha Matibabu cha Pamoja. "Wakati Yoshihiro Kawasaki na timu yake ya utafiti walipofika Sierra Leone mnamo Desemba 2014, sauti ya ""Siren"" ya ambulansi ilikuwa ni ukumbusho wa kutisha kwamba virusi vya Ebola vilikuwapo pia." Ni nini kilicholeta Kawaoka katika taifa la Afrika Magharibi kwanza. Kawakata, profesa wa sayansi ya pathobiolojia katika Chuo Kikuu cha Wisconsin, Madison, alianza kusoma Ebola mnamo 1995 baada ya kusoma kitabu kuhusu virusi hivyo, The Hot Zone, na alitaka kuelewa jinsi inavyoenea na jinsi inavyowaumiza wale wanaowasumbua. Majaribio hayo yalihusisha maabara ya kawaida kama panya na mimea maalum ya seli, na yalifanyika katika maabara ya usalama wa juu kama vile National Institutes of Health Rocky Mountain Laboratories huko Montana, ambapo watafiti walivaa suti za hewa na kuangalia jinsi mifano hii inavyoitikia maambukizo. Sasa alikuwa na nafasi ya kuchunguza ugonjwa huo katika watu waliokuwa wakiishi na kufa nao. "Siren zinazunguka, zinawaka na kuzima, na ilikuwa ya kuogopesha sana kwa sababu hiyo inamaanisha wagonjwa wa Ebola wako huko, lakini wakati huo huo tunahisi bahati nzuri sana kuweza kufanya kazi hii,"" Kawaoka anasema." "Hatujawahi kuweza kufanya hivyo kwa wanadamu kwa sababu hatujawahi kuwa na sampuli za binadamu. "" Wafanyakazi wa afya wanamtunza mgonjwa katika moja ya hospitali za kijeshi za Sierra Leone, ambapo wengi wa wagonjwa wa Ebola 8,000 nchini wamepokea matibabu tangu kuzuka kwa ugonjwa huo kuanza Afrika Magharibi mnamo Desemba 2013." Virusi vya Ebola vilianza kuenea nchini Sudan na Jamhuri ya Kidemokrasia ya Kongo mwaka 1976 katika kijiji kimoja karibu na Mto Ebola, ambapo viliitwa Ebola. Baada ya miaka kadhaa, virusi hivyo vilianza kuenea, na watu wakawa wagonjwa na kutoweka tena msituni. Lakini mnamo Desemba 2013, mlipuko ambao ulikuwa mkubwa zaidi na wenye kuua zaidi katika historia ulikuwa unaanza tu. "Virus ya Ebola hutambuliwa karibu kila mwaka sasa, lakini imehifadhiwa kwa sababu imetokea katika nchi ambazo virusi vya Ebola huonekana mara kwa mara", Kawaoka anasema. <unk>Mlipuko huu ni tofauti. Mlipuko huo ulitokea katika eneo ambalo halikuwa na ugonjwa wa Ebola, kwa hivyo watu wa eneo hilo hawakujua jinsi ya kuuzuia. "Nchi zilizoendelea hazikufahamu hilo hadi Juni mwaka jana, wakati idadi ya visa ilipoongezeka kwa kasi. ""Kufikia majira ya kupukutika kwa virusi vya corona, ugonjwa huo ulikuwa umefikia kilele, ukienea kwa wafanyakazi wa afya nchini Hispania na Marekani, na kumuua msafiri mmoja wa Afrika katika kitongoji cha Dallas." Wengi wa wale walioambukizwa walipata dalili ambazo zilitofautiana kutoka homa na maumivu ya kichwa hadi kuhara kwa damu na kutapika. Watu zaidi ya 10,000 wamefariki kutokana na ugonjwa wa Ebola, ikiwa ni pamoja na karibu 4,000 nchini Sierra Leone, pwani ya magharibi mwa Afrika. Karibu watu 26,000 wameugua. Lakini katikati ya hofu na msiba, Kawaoka (ambaye pia ana uteuzi katika Chuo Kikuu cha Tokyo) aliona fursa. "Kama ilivyoelezwa, ""Mwanamume huyo alianza kufanya kazi kwenye chanjo ya Ebola, iliyoundwa kwa kutumia aina ya virusi vilivyotengenezwa na kikundi chake cha utafiti ambavyo vinaweza kukua tu katika chembe maalum zilizomo katika maabara ya usalama wa juu.""" Kabla ya mlipuko wa sasa, fedha kwa ajili ya mradi huo zilikuwa zimepungua kwa kuwa watu walikuwa wameacha kufikiria kuhusu virusi. Kawasaki alikutana na Ekundayo Thompson, makamu wa kansela wa Chuo Kikuu cha Sierra Leone, wakati akiwa nchini Afrika kuanzisha ushirikiano wa kusoma na kupambana na Ebola wakati wa kuboresha uwezo wa utafiti na miundombinu ya chuo kikuu. Serikali ya Japan ilimpa Kawakami pesa alizohitaji ili kuendelea na utafiti wake, na mnamo Machi 2015, Kawakami alichapisha utafiti katika jarida la Sayansi, unaoelezea chanjo iliyoonyesha kuwa salama na yenye ufanisi kwa panya, nguruwe wa Guinea na primates. "Kama ni kweli, chanjo hiyo inaweza kutengenezwa kwa majaribio ya kliniki katika miaka michache ijayo, ""Kawakata alisema katika usikilizaji wa umma katika Wisconsin State Capitol Aprili 21." Katika kazi yake, kwanza katika Hospitali ya Utafiti ya Watoto ya St. Jude huko Tennessee, na kwa miaka 18 iliyopita katika Chuo Kikuu cha Madison, Kawasaki amekuwa akipendezwa na jinsi virusi vya mafua na vingine, kama Ebola, vinavyoambukiza majeshi yao na kuwafanya wagonjwa. "Mmoja wa malengo yake ni kuunda chanjo ya virusi vya mafua ambayo itawaweka watu salama kutoka kwa virusi hivyo kila mwaka, na pia anatarajia kuchangia kuelewa jinsi na kwa nini virusi vya mafua vinavyokuwa na janga.""" Katika mwaka wa 2012, alichapisha utafiti wa madai kuhusu virusi vya H5N1 ambapo alionyesha ni mabadiliko machache tu yanayoweza kutokea ili virusi vya mafua ya ndege kuwa na athari kwa binadamu. Virusi hivyo vimeenea katika ndege wa mwituni duniani kote, na hivi karibuni vimepatikana nchini Cambodia. Katika Julai 2014, Kawakami na wenzake walionyesha kwamba virusi vya mafua ya 1918 (mlipuko wa Kihispania) vinaweza kuundwa tena katika asili kwa kuchanganya jeni nane tu za virusi ambavyo tayari vinazunguka katika ndege wa maji. Lakini ugonjwa wa Ebola haukuwa umemkumba. Hadi sasa. Chupa imeandikwa na kutayarishwa ili kubeba damu ya mgonjwa wa Ebola huko Sierra Leone. Watafiti watalinganisha damu ya wale waliokufa kutokana na virusi hivyo na wale waliokoka na wale ambao hawakuugua kamwe, ili kujaribu kuunda matibabu. Baada ya kusikia juu ya mlipuko wa sasa, Kawaoka aliuliza kama angeweza kuwa na sampuli za damu kutoka kwa wagonjwa wa Ebola. Hakusikia jibu lolote. Katika mkutano wa Novemba 2014 katika chuo kikuu cha UW-Madison, Alhaji Njai, mwanachama wa utafiti katika Shule ya Tiba ya Wanyama na Taasisi ya Afya ya Ulimwenguni, na mzaliwa wa Sierra Leone, alielezea jinsi alivyojiandaa. Njai alikuwa ameanza programu ya redio mara mbili kwa wiki kusaidia kuelimisha wananchi wake juu ya jinsi ya kujilinda dhidi ya Ebola, na hivi karibuni alikuwa akirudi kwa ajili ya likizo. <unk>Tulikuwa katika idara ileile, lakini sikuwa nimekutana naye kamwe. Nilimpigia simu na alijibu mara moja, "anasema Kawaoka. "Tuliungana ili kujadili kama tunaweza kufanya kitu huko Sierra Leone na hiyo ilikuwa mwanzo. ""Ilikuwa siku chache tu kabla ya Krismasi wakati Kawakami na mmoja wa watafiti wake wenye sifa zaidi, Peter Halfman, walipunga mifuko yao na kuelekea Njai katikati ya eneo la Ebola, ambalo lilikuwa kwenye kufungwa kwa lazima." "Kwa kawaida kuna watu wanaocheza dansi barabarani", anasema, akitaja sauti yenye kuhuzunisha ambayo ilikuwa imekaa katika jiji lenye rangi nyingi la Freetown, mji mkuu wa Sierra Leone na jiji lake kubwa zaidi. Freetown pia ni makao ya Chuo Kikuu cha Sierra Leone, ambapo Njai ni mshirika, na timu ilizuru mji, ikitembelea hospitali za kijeshi na vituo vya kushikilia ambapo wagonjwa walikuwa quarantined. Walikutana na vituo vya polisi njiani. Kawakata anaongea na wabunge, wafanyakazi wa bunge na wawakilishi wa vyombo vya habari katika chumba cha kusikia kaskazini cha Wisconsin State Capitol kuhusu kazi yake ya maabara ya kutengeneza chanjo kamili ya virusi. Katika mkutano wa waandishi wa habari na watunga sera, Kawakata alielezea jinsi Sierra Leone inavyowatunza wagonjwa wake wa Ebola, kuwaweka wagonjwa katika vyumba vyenye mwangaza, na kuwapa wagonjwa hewa safi. Wafanyakazi wa afya huvaa mavazi ya kinga ya kichwa hadi vidole na vinyago. "Wanawasha vifaa kutoka kwenye vyumba vya wagonjwa na kupitia utaratibu mkali wa kuondoa uchafuzi baada ya kuondoka katika maeneo ya wagonjwa, wakirusha klorini, wakisimama katika ndoo zilizojaa klorini kwa dakika tano, mchakato huo ukifuatwa na wafanyakazi wengine.""" Sierra Leone imewaajiri baadhi ya waokokaji wake wa Ebola kufanya kazi katika vituo hivi. "Wengi, walioharibiwa na virusi ambavyo vimewaua wengine wengi, wamepuuzwa na familia zao na jamii zao, ""Kawakata anasema." "Hata hivyo, kiwango cha vifo kutokana na virusi vya corona miongoni mwa watu wanaopokea huduma sahihi mapema katika mchakato wa maambukizi, nchini Sierra Leone, ambayo imehusisha matibabu ya dawa za malaria, antibiotics na kioevu, sasa ni chini ya 2 katika 10, ""alisema." Hii ni moja ya mambo ambayo yalimshangaza zaidi kutembelea nchi hiyo. "Wanaokoa asilimia 80 ya wagonjwa na hiyo ni ya kushangaza", anasema. Kile wanachokificha pia nchini Sierra Leone ni damu, nyenzo isiyo na thamani ambayo Kawaoka anatumaini itafunua baadhi ya siri za Ebola. "Sasa tuna sampuli za kuchunguza hasa nini kinachotokea kwa wanadamu walioambukizwa na virusi vya Ebola na, kwa kufanya hivyo, tunapaswa kuwa na uwezo wa kupata njia ya kudhibiti majibu ya mwenyeji na kuokoa wagonjwa. ""Kawaoka, ambaye kamwe aliingia maeneo ya wagonjwa mwenyewe, aliwapa wafanyakazi wa afya katika vituo vya matibabu vya kijeshi kamera zilizofungwa kwa plastiki na kuwaomba kupiga picha ndani." Wafanyakazi pia wanachukua damu - matone machache kutoka kwa kila mgonjwa - iliyofungwa katika bomba ndani ya bomba, iliyofungwa katika mfuko. Kwa mfano, watafiti wa Sierra Leone wanafanya kazi katika mahema ya usalama wa kibiolojia, wakiwa wamevaa mavazi ya kinga kama yale wanayotumia nchini Marekani na Japan. Vifaa hivyo vinaweza kuunganisha damu katika mashine za kutenganisha damu kwa kasi, na kutenganisha plasma na chembe nyeupe za damu, ambazo zinahusika katika mfumo wa kinga, na chembe nyekundu za damu zinazobeba oksijeni. Watafiti hao watatazama alama za maumbile na molekuli katika sampuli hizo, wakilinganisha damu ya wagonjwa waliopona Ebola na damu ya wale ambao hawakuokoka, na wale ambao hawakuugua kabisa. "Tumekuwa tukifanya kazi na virusi vya mafua kwa miaka mingi, tukifanya majaribio kwenye wanyama... kutambua protini au jeni za mwenyeji ambazo zinadhibiti maambukizo", Kawaoka anasema. <unk>Tumejaribu kufanya kitu kimoja na Ebola. "Kama tulivyoona, sasa tuna sampuli za kuchunguza hasa nini kinachotokea kwa wanadamu walioambukizwa na virusi vya Ebola na, kwa kufanya hivyo, tunapaswa kuwa na uwezo wa kupata njia ya kudhibiti majibu ya mwenyeji na kuokoa wagonjwa. ""Kawaoka na timu yake sasa wamerudi Sierra Leone mara nyingi na kukutana na maafisa wa serikali ya nchi na viongozi wa kijeshi na afya ya umma, wawakilishi kutoka Shirika la Afya Ulimwenguni (WHO) na Vituo vya Kudhibiti na Kuzuia Magonjwa (CDC)." Kawasaki na Njai wameanzisha ushirikiano wa kimataifa dhidi ya Ebola Kawakura amekuwa akisaidia nchi hiyo kuendeleza miundombinu ya utafiti ili kuendelea kugundua, kujifunza na kuzuia magonjwa ya kuambukiza kama Ebola. Anajaribu kukusanya fedha za kutekeleza mpango huo. Kwa upande wake, ataendelea kujifunza jinsi Ebola inavyoathiri wanadamu na jinsi anaweza kusaidia kubadilisha matokeo ya baadaye. Ingawa mlipuko wa sasa unapungua, Kawaoka anasema huu hautakuwa wa mwisho. "Tuna chaguo: ama kutofanya kazi yoyote na kuona nini kinatokea - nini kinatokea katika asili, ikiwa tutaona milipuko - au tunaichunguza na kuwa tayari, "Kawaoka anasema". Ni bahati nzuri kwetu kuwa na fursa hii na tunathamini sana. Ni muhimu kwa watu kama sisi ambao tunafanya kazi juu ya magonjwa ya kuambukiza kuendelea kufanya kazi wakati wa milipuko hii na kuendelea kufanya aina hii ya kazi.