Diagnostics Take Center Stage in Ebola Response as Rare Bundibugyo Outbreak Expands

The ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) and Uganda is drawing global attention not only because of its growing case count, but also because it is being caused by the rare Bundibugyo strain of Ebola virus, a strain for which no approved vaccines or targeted treatments currently exist.

For Matt Scullion, vice president of business development at BioFire Defense, that reality underscores the critical importance of rapid and accurate diagnostics in outbreak response.

"Because you don't have effective therapeutics or vaccines, the most effective intervention is identifying potential infected individuals or infected individuals, contact tracing, isolating, and treating them appropriately," Scullion said. "But you need an accurate diagnostic to do that."

BioFire Defense, an affiliate of bioMérieux, focuses on public health and defense-related diagnostic work. According to Scullion, the company occupies a unique niche supporting government agencies and public health organizations responding to high-consequence infectious diseases.

"BioFire Defense was established to do this unusual defense and public health work," he explained.

A Rare Strain Creates New Challenges

Unlike the better-known Zaire strain responsible for the devastating 2014-2015 West African outbreak, Bundibugyo has been identified in only a handful of outbreaks.

"This is only the third time we've seen this strain or an outbreak of this strain," Scullion said. "The more common one is Zaire, and that's traditionally what we've seen outbreaks in the past."

That distinction matters because most Ebola therapeutics and vaccines were developed against the Zaire strain.

"The Bundibugyo strain, there are no treatments or at least defined treatments for it or vaccines for it," Scullion said. "So this is where the public health response becomes more challenging."

Without pharmaceutical interventions, early detection becomes the primary defense against further spread.

Why BioFire Planned for the Uncommon

BioFire's Global Fever Special Pathogens Panel can detect multiple Ebola species, including Bundibugyo, despite the strain's rarity.

Scullion said that decision was intentional.

"We thought, while we're doing this, we might as well get both the common and the uncommon, so we have the ability to test for all of them," he said.

The rationale was straightforward. Patients presenting with fever often have diseases such as malaria, dengue, chikungunya, or leptospirosis. Early Ebola symptoms can look remarkably similar.

"Until it differentiates where you're getting specific symptoms that would indicate one infection over another, they all look the same," Scullion said.

Misidentification can have serious consequences.

"You don't want to stick someone who only has malaria with a bunch of people who have Ebola if all they have is malaria," he said. "Because if they only had malaria before, they're going to end up with Ebola."

Lessons From 2014

Scullion believes one of the most important lessons learned from the 2014 Ebola epidemic is that preparedness today is substantially better than it was a decade ago.

"All the open questions we had in 2014 around just everything from decontaminating instruments to properly treating patients and just the whole range, we have the answers for," he said.

He pointed specifically to improvements in diagnostic infrastructure and laboratory readiness.

"Today we don't have to be as reactive or reactive at all because we've been through it," Scullion said. "We have an entire network just ready for this instance and the potential for anyone coming in with an infection."

While public discussions have focused heavily on government preparedness, Scullion expressed confidence in the United States' diagnostic capabilities.

"We have a federally funded lab network between the CDC's Laboratory Response Network and the RESPECT lab network that are quite adept and prepared for dealing with high consequence pathogens in the US," he said.

Rapid Results, Broad Detection

The BioFire panel uses venous whole blood and can provide results in approximately 45 to 60 minutes.

"We get the results back for 16 different pathogens," Scullion said. "We test for five different strains of Ebola. We test for four or five different strains of malaria."

The ability to simultaneously evaluate multiple diseases allows clinicians to rapidly distinguish between common tropical illnesses and potentially catastrophic infections.

"The sooner these diagnostics are made available, the more critical it is to preventing the spread of that infection," Scullion said.

Supporting the Current Response

BioFire Defense is currently working with ministries of health in Rwanda, Uganda, and the DRC to position testing resources where they can have the greatest impact.

"We are currently working with the Ministries of Health in Rwanda, Uganda, and the DRC to try to get these products in and close to where they can do the most good," Scullion said.

For Scullion, the outbreak highlights a reality that often receives less attention than vaccines or therapeutics.

"Diagnostics are critical," he said. "They're critical in identification early on, and they're critical in the response and containing these outbreaks."

As the Bundibugyo outbreak evolves, that capability may prove to be one of the most important tools available to public health officials working to prevent further spread.