Deployment of the French Military Field Laboratory Dedicated to Ebola Virus Infected Patients in Guinea, January–July 2015

Biosafety level 3 containment laboratory within the French Military Field Laboratory, Guinea, 2015. Depressurized modular structure (Iso-Ark) with 2 glove boxes (Eurobioconcept). Right, Glove box 1, with a coagulation analyzer (Hemochron, Gamida, France) and 2 biochemistry analyzers. Left, Glove box 2, with a hematology analyzer (Poch-I100, Sysmex, Switzerland), centrifuge, and rapid diagnostic tests for malaria and human immunodeficiency virus. Bottom, The depressurized airlock, allowing transfer of inactivated specimens and doffing. Each laboratory team consisted of 2 medical biologists and 4 scientists, deployed for 2 months. All had received prior training in a similar laboratory set up for the occasion in a French military hospital. To avoid mistaken identities, kits with labeled collection tubes and prescriptions with unique laboratory identifiers were distributed to nurses. After collecting samples, a unique patient identification number was attached to a prescription container in the patient's room to link laboratory and patient identifiers. Disinfected collection tubes were transferred in a triple-packaged container to the adjacent laboratory from 8:00 am to 8:00 pm. Packages were opened in glove box 1. Citrate and heparin tubes remained inside for biochemistry and coagulation tests, while ethylenediaminetetraacetic acid (EDTA)–containing tubes were transferred to glove box 2 via a rapid transfer port container. There, the second scientist performed a hemogram, rapid diagnostic tests, and viral inactivation with AVL buffer (Qiagen). All results were printed inside the glove box, photographed through its wall, and sent via Bluetooth to a second camera outside the Iso-ark. Biological results were entered into a database by a third scientist. Then, screw-cap tubes containing inactivated plasma were decontaminated by soaking in a peracetic acid and quaternary ammonium solution (Oxy'Floor, Anios, France) before being removed from the glove box and then from the Iso-ark for further RNA extraction. Molecular biology facilities were organized in 4 areas with unidirectional work flow, to prevent carry-over of RNA or amplicons. Extraction from inactivated specimens was performed using the QIAamp Viral RNA Mini Kit (Qiagen) in an initial area. Reagents were stored and aliquoted in a preparation clean room delimited by a plastic wall. RNA was added to master mix in a third area. Amplification was performed in the last area, using the RealStar Filovirus Screen RT-PCR Kit 1.0 (Altona Diagnostics) and Lightmix Modular Ebola Virus Zaire assay (Roche) on a Smart Cycler device (Cepheid). RT-PCR results, systematically evaluated with attention paid to internal extraction and negative controls and the date of onset of symptoms [5], were obtained within 6 hours. The last steps of the work flow were glove box disinfection with peracetic acid gas, Iso-ark cleaning with chlorine, and waste elimination. Biohazard containers were deposited in the ETC high-risk zone through secure access and transported via the waste stream to the incinerators. We have described an alternative organization and processes for an EBOV field laboratory. To our knowledge, this laboratory was unique in West Africa in 2015, both for the large panel of analyses available and for the choices made for biosafety. As a supplement to laboratories dedicated to high-throughput RT-PCR screening for case classification, we assume that this type of laboratory is of interest. It appeared essential for good biological and clinical disease description and, above all, for helping in management of care [5–7]. Acknowledgments. We thank all laboratory technologists who were deployed in the French Military Field laboratory in Conakry, Guinea; and all laboratory technologists who contributed to the training of the teams before deployment. Financial support. This work was supported by the Service de Santé des Armées (France). Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.