Discontinuous EBOV RNA synthesis events in patients with Ebola virus disease and their relationship to viral load and outcome of infection

Ebola virus (EBOV) is a negative strand RNA virus that causes Ebola virus disease (EVD) with a high case fatality rate. During the acute phase of infection, a subsequent fatal outcome is characterised by an increased upregulation of interferon and inflammatory pathways compared to survivors. Replication of genomes from negative strand RNA viruses (and RNA viruses in general) can result in the generation of defective genomes that may interfere with viral replication and stimulation of the innate immune response. We characterised the presence of defective genomes in blood samples from humans who were positive for EBOV and processed by the European Mobile Laboratory during the 2013-2016 West African EVD outbreak.