Urban yellow fever outbreak-Democratic Republic of the Congo, 2016: Towards more rapid case detection
Urban yellow fever outbreak-Democratic Republic of the Congo, 2016: Towards more rapid case detection
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DOI：
10.1371/journal.pntd.0007029
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发表时间：
2018-12-01
影响因子：
3.8
通讯作者：
Kebela, Benoit I.
中科院分区：
文献类型：
--
作者：
Ingelbeen, Brecht;Weregemere, Nadine A.;Kebela, Benoit I.
背景2015年12月至2016年7月期间，黄热病（YF）疫情影响了安哥拉和刚果民主共和国（DRC）的城市地区。我们描述了在刚果民主共和国的爆发和评估的准确性YF的情况下定义，以促进早期诊断的情况下，在未来的城市outbreaks.Methodology/Principal findingsIn刚果民主共和国，疑似YF感染被定义为黄疸后2周内急性发热发作，并确认由IgM血清学或PCR的YF病毒RNA。我们使用了病例调查和住院表格。比较确诊和排除的疑似YF病例之间的临床体征，我们计算了确诊YF的每个体征的预测值和几个疑似YF病例定义的诊断准确性。78例确诊病例中有57例（73%）来自安哥拉：88%（50/57）为男性;中位年龄31岁（IQR 25-37）。15例（19%）确诊病例是在刚果民主共和国城市环境中本地感染的。从症状发作至医疗保健咨询的中位时间为7天（IQR 6-9），至出现黄疸的中位时间为8天（IQR 7-11），至样本采集的中位时间为9天（IQR 7-14），至住院的中位时间为17天（IQR 11-26）。病例定义包括发热或黄疸，结合肌痛或阴性疟疾试验，产生了提高的敏感性（100%）和特异性（57%）。结论/显着性黄疸出现晚，大多数情况下诊断为时已晚的支持性治疗和及时的载体控制。在已知有本地YF传播的地区，以无黄疸为基本标准的疑似病例定义可以促进YF的早期诊断、护理和控制。
BackgroundBetween December 2015 and July 2016, a yellow fever (YF) outbreak affected urban areas of Angola and the Democratic Republic of the Congo (DRC). We described the outbreak in DRC and assessed the accuracy of the YF case definition, to facilitate early diagnosis of cases in future urban outbreaks.Methodology/Principal findingsIn DRC, suspected YF infection was defined as jaundice within 2 weeks after acute fever onset and was confirmed by either IgM serology or PCR for YF viral RNA. We used case investigation and hospital admission forms. Comparing clinical signs between confirmed and discarded suspected YF cases, we calculated the predictive values of each sign for confirmed YF and the diagnostic accuracy of several suspected YF case definitions. Fifty seven of 78 (73%) confirmed cases had travelled from Angola: 88% (50/57) men; median age 31 years (IQR 25-37). 15 (19%) confirmed cases were infected locally in urban settings in DRC. Median time from symptom onset to healthcare consultation was 7 days (IQR 6-9), to appearance of jaundice 8 days (IQR 7-11), to sample collection 9 days (IQR 7-14), and to hospitalization 17 days (IQR 11-26). A case definition including fever or jaundice, combined with myalgia or a negative malaria test, yielded an improved sensitivity (100%) and specificity (57%).Conclusions/SignificanceAs jaundice appeared late, the majority of cases were diagnosed too late for supportive care and prompt vector control. In areas with known local YF transmission, a suspected case definition without jaundice as essential criterion could facilitate earlier YF diagnosis, care and control.