GloPID-R’s response to outbreaks

In this summary, our Research and Policy team outline GloPID-R’s response to recent outbreaks.

March 31: Public health Scotland reports increased cases of severe acute hepatitis of unknown origin in children. Shortly after, cases are being detected worldwide.
April 27: GloPID-R writes its first written briefing for members providing up to date key information on severe acute hepatitis of unknown origin.
May 14: UK reporting monkeypox cases with no link to international travel to previously endemic countries.
May 25: Cases reported across 13 European countries, Australia, and North America. Increasing presentation among MSM community. No deaths.
June 9: GloPID-R searched ICTRP and World Report databases to identify existing active clinical trials related to monkeypox and shared these findings within a brief sent to GloPID-R members prior to the members meeting.
June 16: In response to members meeting, GloPID-R secretariat actively encouraged members to share information related to monkeypox activities. This was shared across membership.
July 20: GloPID-R held a convening call where funders shared ongoing activities. Agreed at call to hold another convening cal as members found it is useful.
July 22-23: Over 16,000 confirmed cases of monkeypox reported to WHO. Five deaths noted in Nigeria (n=3) and Central African Republic (n=2) since January 1st 2022. WHO declares monkeypox a Public Health Emergency of International Concern.
September 9: Another convening call held. Updated information on members activities related to monkeypox shared ahead of this meeting.
September 20: Uganda reports its first confirmed case of SUDV.
October 19: GloPID-R dedicated time to discussion on SUDV during General Assembly. Provided written briefing with findings on existing studies from searching the ICTRP, World RePORT, and EU clinical trial register.
October 19: GloPID-R continues to monitor monkeypox and SUDV. Members have been notified to express interested in a third convening call for monkeypox. An update on SUDV will be provided in December and collate funder activities related to this.

Response to severe acute hepatitis of unknown origin

Provided a written briefing containing a summary of updated situational information, research, and public health response
Monitored the situation and research being undertaken in relation to this outbreak
Shared briefing with GloPID-R members

Response to monkeypox

Regular written briefing to update GloPID-R members on the situation
Searched WHO ICTRP and World RePORT databases for existing active monkeypox studies. Results were incorporated into written briefings
Collated information from members on funding organisations’ activities related to monkeypox. Shared a brief descriptive analysis from this and the raw data collection sheet with the GloPID-R membership
Data collection sheet uploaded onto members-only section of the website
Two convening calls held and a possible third convening call will be held in November 2022

Response to SUDV in Uganda

One written brief circulated to members ahead of General Assembly
Searched the WHO ICTRP, World RePORT, EU Clinical Trial Register, and Pan African Clinical Trial Registry for any research on SUDV with no time restrictions placed. Results from this incorporated into the written briefing
Time dedicated to discuss SUDV at General Assembly
Monitoring the situation with likely further written updates throughout the year and more discussions at future meetings

Background information

Monkeypox

On May 14, 2022, the UK reported its first case of monkeypox confirmed in an individual who had recently travelled to Nigeria where the viral disease is endemic. Within a few days, four more monkeypox cases were detected in the UK with no relation to the first case. Cases of monkeypox began being detected all over the world with no relations to endemic countries. As of October 17, 2022, there have been 73,437 laboratory confirmed cases of monkeypox with 29 deaths globally. The largest number of confirmed cases has been detected in the US with 27,128 cases and 2 deaths. Nigeria has had the largest number of deaths with seven deaths and 530 cases.

Monkeypox treatment includes antiviral therapy, supportive care, and management of secondary complications. Tecovirimat is the main, recently licensed antiviral used to treat monkeypox. Other antivirals such as Cidofovir and Vaccinia immunoglobulin also exist but there is limited data on the effectiveness in humans. People who received a smallpox vaccine may be at a reduced risk of severe illness as the vaccine is shown to provide 85% protection against monkeypox. Jynneos (also known as Imvamune or Imvanex) is the main vaccine used against monkeypox and has been used in multiple countries to combat the 2022 multi-country monkeypox outbreak. However, there is a lack of data on efficacy and safety particularly in pregnant women, immunocompromised individuals, and children.

In response to monkeypox, GloPID-R conducted a rapid search of the WHO International Clinical Trials Registry (ICTRP) and World REPORT to identify existing active research on monkeypox. Only three open interventional clinical trials were found and 28 active non-clinical research projects, illustrating the lack of existing research on monkeypox. This is particularly concerning given this viral disease had been endemic in many African countries for several decades before cases were detected in other countries. On June 9, 2022, GloPID-R provided a written briefing to members with data found from WHO ICTRP and World REPORT findings. By June 16, 2022, in response to the members’ meeting, GloPID-R actively encouraged members to share information on any monkeypox related activities they were carrying out. GloPID-R collated this information from members up until September 9 and has been regularly sharing this with members. Two convening calls have been held with members, the first on July 20 and the second on September 9. Members have expressed that these calls are a useful opportunity to share information on activities and funding organisations’ response to monkeypox. GloPID-R will announce by November 7 if a third convening call on monkeypox is to take place. If members continue to express interest, the third convening call will be held at the end of November 2022.

Sudan Virus Disease

On September 20, 2022, Uganda declared its first confirmed case of Sudan Virus disease (SUDV). SUDV is the new classification, since May 2019, for Ebola caused by the Sudan virus disease. Currently, there are six known Ebola viruses: Bundibugyo, Sudan, Tai Forest, Zaire. Ebola outbreaks have been predominantly caused by Zaire and Sudan ebolaviruses. Uganda has had six Ebola outbreaks, four of which were SUDV outbreaks and the most severe being in 2000 with 425 cases and 224 deaths. As of October 14, 2022, there have been 58 laboratory confirmed cases and 21 deaths.

The risk of spread and increase in SUDV cases is of concern to public health professionals. SUDV has affected the highly mobile population of gold miners in Uganda, and cases have spread to five districts including one district that borders the Democratic Republic of Congo. It is likely that SUDV was circulating up to three weeks prior to the first case being detected. A death was recently reported in the capital, Kampala, in an individual who travelled there to seek help in an affected district after being identified as a close contact and asked to isolate. Uganda has faced Ebola outbreaks in the past and has good capacity to deal with this. However, it is currently facing multiple infectious disease outbreaks including COVID-19, anthrax, and yellow fever in addition to flooding and food insecurity.

There are no licenced vaccines or therapeutics for SUDV and research on SUDV is limited due to sporadic outbreaks. There are some vaccines being considered for clinical trials for SUDV in Uganda. These include cAd3-EBO S (VRC-EBOADC086-00-VP) vaccine developed by the Sabine Vaccine Institute, ChAdOx1 biEBOV developed by the University of Oxford, and Ad26.ZEBOV, and rVSV based vaccine developed by Merck (the organisation that produced the licenced ERVEBO vaccine against Zaire ebolavirus).

In response to this outbreak, GloPID-R conducted a rapid search of the WHO ICTRP, World RePORT, and the EU Clinical Trials Register to identify any existing studies on SUDV. Nineteen studies were identified (eight on therapeutics, eight on vaccines, one on social sciences, one on One Health, and one on diagnostics). GloPID-R dedicated time at their General Assembly to discuss SUDV in Uganda and a presentation on this was delivered by Dr Ana Maria Henao-Restrepo on behalf of the WHO R&D Blueprint team. GloPID-R will be monitoring the situation in Uganda and providing updates as required to its members and at future meetings.

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