Deploying our Rapid Response Mobile Lab into the heart of disease outbreaks
Image credit: WHO Europe
What is a Rapid Response Mobile Lab?
Rapid Response Mobile Labs (RRMLs) bring critical laboratory resources and diagnostic surge capability to the doorstep of affected and vulnerable communities, often in hard-to reach remote areas during outbreaks. Staffed by expert scientists, RRMLs come in one of five main functional set ups, from a highly compact single case unit to a full-scale self-contained laboratory truck.
They are highly adaptable based on the context they need to be used in - boosting local diagnostic capacity for a National Public Health service disrupted during a crisis, providing surge diagnostics capacity at the epicentre of an outbreak or supporting disease surveillance and research.
Since regular deployments started in the early 2000s, mobile labs providing diagnostics in the field have been a central part of managing outbreaks of diseases such as viral haemorrhagic fever. During the 2014-2016 Ebola outbreak, deployments like European Mobile Laboratory (EMLab) Projectreduced sample-to-result turnaround times from days to hours, increasing the effectiveness of the response to the epidemic.
Using the Rapid Response Mobile Lab for UK-PHRST's research, capacity strengthening and outbreak response activities
The UK-PHRST microbiology team operate a “Type II” RRML set up, consisting of several robust flight cases that can be easily transported by van or aircraft, allowing our experts to respond to outbreaks in remote locations. The RRML adapts its function to each unique situation –from identifying unknown pathogens to tracking the spread of an outbreak following natural disasters or mass migration events.
When no diagnostic capability exists, the RRML can be deployed straight into the centre of the outbreak, substantially reducing test turnaround times. Where some diagnostic capacity exists, such as in hospital labs or National Public Health Institutes, the RRML can provide ‘surge’ testing capacity to bolster this further by increasing the number of tests that be conducted per day, or by increasing the range of tests available. The RRML can also add value during humanitarian crises by supporting and complementing the response capabilities of partner emergency medical teams or non-government organisations (NGOs), by providing disease surveillance and diagnostic testing capabilities.
In non-outbreak ‘peace time’, the RRML facilitates operational research, builds capacity through training local scientists, validates locally sourced test results, and strengthens local biosafety and biosecurity measures.
During the creation and expansion of UK-PHRST's RRML, individual components of the lab and the team’s microbiology expertise have been used to support outbreak response, research and capacity strengthening projects across the world. Excitingly, UK-PHRST's Type II RRML is complete and ready to deploy in its entirety, offering its full range of diagnostic capacity. Here are some real-life examples of where components of the RRML and our microbiology team have been deployed.
In July 2018, Sudan’s Ministry of Health requested UK-PHRST assistance following an upsurge in febrile illnesses of unknown origin in Kassala State. The team deployed both traditional diagnostic methods (RT-PCR and serology) and metagenomic sequencing, which can provide critical insights into the genetic information of the virus.
A total of 142 patients (102 adults, 40 children) with fever (≥37.5°C) and at least three associated symptoms such as headache, arthralgia, vomiting or bleeding were identified for testing at Kassala Teaching Hospital. Blood sample analysis which underwent RNA extraction and RT-PCR testing confirmed Chikungunya virus (CHIKV) in 84.5% of patients, while serological assays for CHIKV and Dengue virus (DENV) differentiated between acute and past infections.
Metagenomic sequencing using the sequence independent single primer amplification (SISPA) method followed by Oxford Nanopore Technologies (ONT) sequencing uncovered the specific strain of CHIKV, its mutations and likely transmission patterns. It also detected DENV co-infections in some patients.
The speed of ONT metagenomic sequencing enabled near-real-time tracking of viral evolution, improving public health decision-making and vector control strategies for preventing future outbreaks. This case demonstrates the value of incorporating metagenomic approaches into routine outbreak investigations,particularly in regions affected by multiple emerging infectious diseases.
UK-PHRST's microbiology team is collaborating on several research projects with our partners, including Rapid virus genomics for outbreak investigation (RaViG)- proof of principle in Coastal Kenya. The project, a collaboration between the KEMRI Wellcome Trust Research Programme (KWTRP) in Kilifi, Kenya, the UK-PHRST, the Kenya Ministry of Health and six coastal counties, will assess whether deploying portable whole genome sequencing in real-time during outbreaks is feasible, and if this provides added value to conventional outbreak response approaches.
To build the evidence base, the project team will co-ordinate with local rapid response teams to trial deploying a portable whole genome sequencing system alongside conventional outbreak responses to diseases of suspected or confirmed viral origin. The team will also engage with local and regional stakeholders to evaluateany added value of deploying portable sequencing resource. Microbiology experts from the UK-PHRST are supporting and advising on setting up portable whole genome sequencing in the field during outbreak response, and UK-PHRST epidemiologists are providing scientific evaluation and interpretation.
The Global Outbreak Alert and Response Network’s (GOARN) strategic group for Diagnostic Surge Capacity (DiSC) created in 2024 is a community of practice of lab specialists and experts, incorporating a network of RRMLs and their parent organisations. The group helps to ensure high-quality diagnostics, seamless cooperation with health systems, and effective emergency response.
Before GOARN DiSC was formally established, the RRML network that forms the core of the community set about creating, testing and refining a common set of RRML Minimum Operational Standards. The standards aim to ensure a consistent, high quality and interoperable response between different RRML teams based across the world, who may be jointly deployed to respond to outbreaks.
As a part of the RRML Network, UK-PHRST took part in the first ever Interregional Field Simulation Exercise (IFX): a three-part exercise to review and test the proposed minimum standards across the whole RRML life cycle, from pre-deployment, during outbreak response and end-of-mission phases. The exercise also tested how RRMLs work alongside other WHO health emergency workforce assets, such as Emergency Medical Teams (EMTs), just as in a real outbreak. Read about the highlights, challenges and learnings from the three-part exercise.
UK-PHRST microbiology team members are also part of the GOARN DiSC technical working group creating a WHO certified recognition system for RRMLs, based on the Minimum Operating Standards developed by the RRML Network. UK-PHRST's Director Ed Newman is the current Chair of the GOARN DiSC Coordination Board.
The Rapid Response Mobile Lab: powered by UK-PHRST microbiology expertise
RRMLs cannot function effectively without the experts behind it – microbiologists. The UK-PHRST microbiology team brings diverse expertise in molecular diagnostics, whole genome sequencing, serology, and experience establishing and operating within high-containment laboratories in low- and middle-income countries, often in remote or difficult to access regions.
During outbreaks, their work forms a critical link enabling other specialists like epidemiologists, infection prevention and control teams and social scientists to design and implement targeted interventions. Members of the team have national and international experience with many disease outbreaks including Chikungunya, Crimean-Congo Haemorrhagic Fever, Ebola, mpox, cholera and COVID-19, consistently prioritising peer-to-peer learning, capacity strengthening and international co-operation.
UK-PHRST's Rapid Response Mobile Lab – what’s in the cases?
The RRML consist of a series of modules - the exact number depending on the scope of the mission - containing several components. Importantly, the availability and number of components is constantly reviewed by the UK-PHRST microbiology team to ensure they can provide the best possible response.
The UK-PHRST biosafety module provides the highest levels of safety in-the-field when working with hazardous samples containing bacteria and viruses. Equipped with high-containment equipment such as gloveboxes and flexible film isolators (FFIs), the module provides a controlled environment to protect both lab personnel as well as the community and environment outside the lab. This allows safe sample handling, testing and waste disposal whether the team are dealing with known or unknown pathogens during outbreaks.
Image credit: WHO Europe
The polymerase chain reaction (PCR) module allows fast and sensitive detection of bacteria, parasites and viruses from a variety of sample types such as blood and swabs. PCR works by amplifying small amounts of DNA or RNA (the genetic information from a pathogen) that are present a sample during early infection. The PCR method also allows early and accurate diagnosis within a few hours of receiving a sample into the lab. This module is ideal for rapidly identifying specific diseases, monitoring infections over time and understanding how outbreaks are spreading.
Image credit: WHO Europe
The sequencing module provides in depth data about the genetic code of viruses and bacteria which is important for understanding how diseases spread, how pathogens evade vaccines or treatments, and allows improved tests to be developed. Designed for rapid deployment and field use, the sequencing module utilises techniques such as metagenomics and whole genome enrichment. This allows the laboratory to respond to a wide range of different outbreaks whether the pathogen is known, unknown or just one of many pathogens circulating during an outbreak.
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The syndromic testing module allows screening for a broad panel of pathogens using a single test, guided by the patients’ symptoms. Using multiplex molecular diagnostics - several PCR tests combined together - this approach can simultaneously detect a wide range of bacteria, viruses and parasites which cause similar symptoms. This approach is valuable in outbreaks where patients present with non-specific symptoms such as fever, respiratory distress or gastrointestinal problems allowing rapid identification of diseases causing an outbreak and ensuring appropriate diagnosis and treatment.
The serology module is used to detect antibodies produced by the immune system in response to infection. Serology is a powerful tool for understanding whether a patient has been exposed to a pathogen, whether that be during an active outbreak or for longer-term surveillance. Serology can also be used to monitor vaccine responses or population immunity, offering a flexible and reliable method for studying disease dynamics during a deployment.
A fully functional mobile lab needs more than just diagnostic tests; it needs reliable infrastructure. This module includes everything required to operate in challenging environments including items such as rugged tent shelters, back-up power units and fridges/freezers for storage of samples and sensitive reagents. Designed with mobility, durability and rapid deployment in mind, this module allows scientific work to continue uninterrupted in remote or rural settings during an outbreak.
Image credit: WHO Europe
