Ebola Conquers West Africa - More to Come?
Ebola Conquers West Africa - More to Come?
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埃博拉征服西非——还会有更多的事情发生吗？
DOI：
10.1016/j.ebiom.2014.10.004
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发表时间：
2014
期刊：
影响因子：
11.1
通讯作者：
Kawaoka,Yoshihiro
中科院分区：
文献类型：
--
作者：
Halfmann,Peter;Neumann,Gabriele;Feldmann,Heinz;Kawaoka,Yoshihiro
1976年，世界的注意力被两次几乎同时爆发的一种新的病毒和一种神秘的病毒所吸引，这两次病毒分别在苏丹和当时的扎伊尔，即现在的刚果民主共和国爆发。自那时以来，埃博拉病毒引起的零星疫情已导致约2387例病例和1590例死亡（http：//www. who. int/mediacentre/factsheets/fs103/en/）。今年，埃博拉病毒回到了中心舞台，因为西非国家几内亚，利比里亚和塞拉利昂正面临着由一种新的扎伊尔埃博拉病毒株引起的前所未有的和不受控制的爆发，流行病学证据将其与2013年12月死于感染的潜在“零号病人”联系起来（Baize et al.，2014年）。这次疫情的病例数超过了以前报告的所有埃博拉病毒疫情的总和。截至2014年9月18日，已有超过5347例病例，2630人死亡;这些数字包括318名受感染的医护人员，其中一半已死亡（http：//www.hk.org）。CDC. gov/vhf/ebola/outbreaks/guinea/index. html）。在过去的疫情中，病死率从25%到90%不等（http：//www. who. int/mediacentre/factsheets/fs 103/en/）;目前疫情的病死率为53%（http：//www.factsheets/fs103/en/）。CDC. gov/vhf/ebola/outbreaks/guinea/index. html.）。然而，由于获得埃博拉治疗单位的机会有限以及与这种疾病相关的耻辱，许多感染可能没有报告，因此真实的感染人数很可能要高得多，并且真实的病死率在疫情结束之前无法得知。埃博拉病毒出血热的早期症状是非特异性的：发热、不适、肌肉疼痛、腹泻和呕吐。最终，可识别的出血症状是明显的，包括吐血，流鼻血，和特征性皮疹，在疾病的后期，大约一半的感染者（http：//www. who. int/mediacentre/factsheets/fs103/en/）。通过直接接触受病毒污染的体液（血液、分泌物或其他体液）、被这些体液污染的材料（如床上用品）、处理和制备受污染的食物（如丛林肉）或直接或间接接触受感染的蝙蝠（埃博拉病毒的潜在动物宿主）进行传播（http：//www. who. int/mediacentre/factsheets/fs 103/en/; Leroy等人，2009).在发现埃博拉病毒近40年后，我们仍然缺乏获得许可的疫苗和抗病毒疗法来治疗埃博拉病毒感染的患者。然而，近年来已经取得了相当大的进展，目前的疫情已经推动了在临床试验中评估候选疗法的重大努力。支持性治疗主要包括口服含电解质溶液的补液，这是埃博拉感染患者的典型治疗过程。目前，几种实验性埃博拉病毒疫苗在动物模型中具有不同程度的保护效力。理想的埃博拉病毒疫苗将在单次免疫后引起强烈的保护性反应，并具有治疗益处。最广泛测试的埃博拉病毒疫苗平台之一是基于表达埃博拉病毒糖蛋白（主要病毒免疫原）的可复制水泡性口炎病毒（VSV）。在非人灵长类动物模型的预防和暴露后情况下，单剂量的107重组VSV颗粒已显示出有效对抗埃博拉病毒及其近亲马尔堡病毒（综述; Marzi et al.，2011年）。使用具有复制能力的疫苗病毒总是会引起安全性问题;然而，这种问题...
In 1976, the world's attention was caught by two almost simultaneous outbreaks of a new and then a mysterious virus named Ebola (Fig. 1) in the Sudan and what was then Zaire, now known as the Democratic Republic of Congo. Since then, sporadic outbreaks caused by Ebola virus have resulted in approximately 2387 cases and 1590 deaths (http://www. who. int/mediacentre/factsheets/fs103/en/). This year, Ebola virus returned to the center stage as the Western African countries of Guinea, Liberia, and Sierra Leone are facing an unprecedented and uncontrolled outbreak caused by a new Zaire ebolavirus strain that has been linked by epidemiological evidence to a potential “patient zero” who succumbed to infection in December, 2013 (Baize et al., 2014). The number of cases in this outbreak has surpassed that for all previously reported Ebola virus outbreaks combined. As of September 18, 2014, there have been more than 5347 cases with 2630 deaths; these numbers include 318 infected healthcare workers, half of whom have died (http://www. cdc. gov/vhf/ebola/outbreaks/guinea/index. html). In past outbreaks, the case fatality rates have varied from 25% to 90%(http://www. who. int/mediacentre/factsheets/fs103/en/); the case fatality rate of the current outbreak is 53%(http://www. cdc. gov/vhf/ebola/outbreaks/guinea/index. html.). However, due to limited access to Ebola treatment units and the stigma associated with this disease, many infections may have gone unreported, so the true number of infected people is most likely much higher, and the true case fatality rate will not be known until the outbreak is over. The early symptoms of Ebola virus hemorrhagic fever disease are non-specific: fever, malaise, muscle pain, diarrhea, and vomiting. Eventually, recognizable hemorrhagic symptoms are evident including vomiting of blood, nosebleeds, and a characteristic rash, late in the course of the disease, in roughly half of those infected (http://www. who. int/mediacentre/factsheets/fs103/en/). Transmission occurs through direct contact with virus-contaminated body fluids (blood, secretions, or other bodily fluids), materials such as bedding contaminated with these fluids, through the handling and preparation of contaminated food such as bush meat, or through direct or indirect contact with infected bats, a potential animal reservoir for Ebola virus (http://www. who. int/mediacentre/factsheets/fs103/en/; Leroy et al., 2009).Nearly four decades after the discovery of Ebola virus, we still lack licensed vaccines and antiviral therapeutics to treat Ebola virusinfected patients. However, considerable progress has been made in more recent years, and the current outbreak has fuelled major efforts to evaluate candidate therapeutics in clinical trials. Supportive care that includes largely oral rehydration with solutions containing electrolytes is the typical course of treatment for Ebolainfected patients. Currently, several experimental Ebola virus vaccines confer varying degrees of protective efficacy in animal models. An ideal Ebola virus vaccine would elicit strong and protective responses after a single immunization and have therapeutic benefits. One of the most extensively tested Ebola virus vaccine platforms is based on a replication-competent vesicular stomatitis virus (VSV) expressing Ebola virus glycoprotein (s)(the major viral immunogen). A single dose of 107 recombinant VSV particles has been shown to be effective against Ebola, and its close relative Marburg virus, in prophylactic and post-exposure situations in nonhuman primate models (review; Marzi et al., 2011). The use of replication-competent vaccine viruses always raises safety concerns; however, such concerns …