Recurrent Ebolavirus disease in the Democratic Republic of Congo: update and challenges
Recurrent Ebolavirus disease in the Democratic Republic of Congo: update and challenges
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DOI：
10.3934/publichealth.2019.4.502
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Odio, Ossam J.
中科院分区：
文献类型：
--
作者：
Inungu, Joseph;Iheduru-Anderson, Kechi;Odio, Ossam J.
目前在北基伍省和伊图里省爆发的埃博拉病毒病（EVD）是影响刚果民主共和国（DRC）的第十次爆发;第一次爆发发生在战争背景下，也是继2014年西非爆发之后有记录以来第二次最致命的埃博拉病毒爆发。刚果民主共和国政府的应对措施包括采取一揽子干预措施，包括病例检测和快速隔离、接触者追踪、人口绘图以及识别高风险地区，以指导协调工作。协调工作是使用GeneXpert（Cepheid）聚合酶链反应进行筛查、接种疫苗和实验室诊断。这一努力还包括确保安全和有尊严的埋葬，促进风险沟通、社区参与和社会动员。在通过“紧急使用未注册产品方案”后，对所有同意的实验室确认的EVD患者进行了四种研究治疗（mAb114，ZMapp和REGN-EB3和Remdesivir）的随机对照试验。REGN-EB3和mAb114显示出作为EVD治疗的前景。此外，首先使用一种研究性疫苗（rVSV-ZEBOV-GP），然后使用第二种预防性疫苗（Ad26.ZEBOV/MVA-BN-Filo）以加强预防。尽管提供临床支持性护理仍然是埃博拉病毒病疫情管理的基石，但刚果民主共和国的应对措施面临着严峻的挑战，包括普遍的不安全、暴力和社区抵制、令人震惊的贫困以及对当局根深蒂固的不信任。埃博拉病毒仍然是一个公共卫生威胁。考虑到传播背景、人畜共患病的性质、任何治疗干预的有效性限制以及出现的时间，完全治愈性治疗不太可能改变游戏规则。
The current Ebolavirus disease (EVD) outbreak in the provinces of North Kivu and Ituri is the tenth outbreak affecting the Democratic Republic of Congo (DRC); the first outbreak occurring in a war context, and the second most deadly Ebolavirus outbreak on record following the 2014 outbreak in West Africa. The DRC government's response consisted of applying a package of interventions including detection and rapid isolation of cases, contact tracing, population mapping, and identification of high-risk areas to inform a coordinated effort. The coordinated effort was to screen, ring vaccinate, and conduct laboratory diagnoses using GeneXpert (Cepheid) polymerase chain reaction. The effort also included ensuring safe and dignified burials and promoting risk communication, community engagement, and social mobilization. Following the adoption of the "Monitored Emergency Use of Unregistered Products Protocol," a randomized controlled trial of four investigational treatments (mAb114, ZMapp, and REGN-EB3 and Remdesivir) was carried out with all consenting patients with laboratory-confirmed EVD. REGN-EB3 and mAb114 showed promise as treatments for EVD. In addition, one investigational vaccine (rVSV-ZEBOV-GP) was used first, followed by a second prophylactic vaccine (Ad26.ZEBOV/MVA-BN-Filo) to reinforce the prevention. Although the provision of clinical supportive care remains the cornerstone of EVD outbreak management, the DRC response faced daunting challenges including general insecurity, violence and community resistance, appalling poverty, and entrenched distrust of authority. Ebolavirus remains a public health threat. A fully curative treatment is unlikely to be a game-changer given the settings of transmission, zoonotic nature, limits of effectiveness of any therapeutic intervention, and timing of presentation.