Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April-May, 2018: an epidemiological study
Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April-May, 2018: an epidemiological study
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DOI：
10.1016/s0140-6736(18)31387-4
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发表时间：
2018-07-21
期刊：
影响因子：
168.9
通讯作者：
Yuma, Etienne
中科院分区：
文献类型：
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作者：
Ahuka-Mundeke, Steve;Ahmed, Yahaya Ali;Yuma, Etienne
背景2018年5月8日，刚果(金)政府报告称，该国西北部赤道省爆发埃博拉病毒病。受影响最严重的社区地处偏远，而且有一个与首都和邻国相连的城市中心参与其中，这使此次疫情成为刚果民主共和国经历过的最复杂和最高风险的疫情。我们提供了正在进行的疫情调查中产生的早期流行病学信息。方法我们根据刚果民主共和国公共事务部的国家病例定义将病例归类为疑似病例、可能病例或确诊病例。我们调查了所有病例，以获得人口统计学特征，确定可能的暴露，描述体征和症状，并确定需要跟踪21天的接触者。我们还估计了从2018年5月25日到2018年6月21日这4周期间的复制数量和预计病例数量。截至2018年5月30日，刚果民主共和国报告了50例扎伊尔埃博拉病毒病例(37例确诊病例，13例可能病例)。比科罗报告了21例(42%)，伊博科报告了25例(50%)，旺加塔卫生区报告了4例(8%)。旺加塔是赤道省城市首府姆班达卡的一部分，姆班达卡连接着国内和国际的主要交通路线。截至2018年5月30日，已报告25例死于埃博拉病毒病，经审查调整后的病死率为56%(95%可信区间39-72)。这一病死率与对2014年至2016年西非埃博拉病毒疫情的估计一致(p=0.427)。确诊或可能感染的人的中位年龄为40岁(8-80岁)，其中30人(60%)为男性。确诊或疑似埃博拉病毒感染者最常见的体征和症状是发烧(42例中有40例[95%])、全身剧烈乏力(41例中37例[90%])和食欲不振(41例中37例[90%])。胃肠道症状经常被报告，43人中有14人(33%)报告出血体征。从发病、住院到样本检测的时间随着时间的推移而减少。截至2018年5月30日，已确定1458名接触者，其中746人(51%)仍在积极跟进中。估计复制数量为1.03(95%可信区间0.83-1.37)，预计到2018年6月21日疫情的累计病例发病率为78例确诊病例(37-281例)，假设具有异质性传播。解释刚果民主共和国正在爆发的埃博拉病毒与之前爆发的埃博拉病毒疾病具有相似的流行病学特征。早期发现、患者快速隔离、接触者追踪和正在进行的疫苗接种计划应足以控制暴发。如果流行病学情况没有改变，对病例数量的预测不会超过目前的应对能力。所提供的信息虽然是初步的，但对于指导正在进行的调查和应对此次疫情至关重要。版权所有(C)2018年世界卫生组织。爱思唯尔有限公司出版。保留所有权利。
Background On May 8, 2018, the Government of the Democratic Republic of the Congo reported an outbreak of Ebola virus disease in Equateur Province in the northwest of the country. The remoteness of most affected communities and the involvement of an urban centre connected to the capital city and neighbouring countries makes this outbreak the most complex and high risk ever experienced by the Democratic Republic of the Congo. We provide early epidemiological information arising from the ongoing investigation of this outbreak.Methods We classified cases as suspected, probable, or confirmed using national case definitions of the Democratic Republic of the Congo Ministere de la Sante Publique. We investigated all cases to obtain demographic characteristics, determine possible exposures, describe signs and symptoms, and identify contacts to be followed up for 21 days. We also estimated the reproduction number and projected number of cases for the 4-week period from May 25, to June 21, 2018.Findings As of May 30, 2018, 50 cases (37 confirmed, 13 probable) of Zaire ebolavirus were reported in the Democratic Republic of the Congo. 21 (42%) were reported in Bikoro, 25 (50%) in Iboko, and four (8%) in Wangata health zones. Wangata is part of Mbandaka, the urban capital of Equateur Province, which is connected to major national and international transport routes. By May 30, 2018, 25 deaths from Ebola virus disease had been reported, with a case fatality ratio of 56% (95% CI 39-72) after adjustment for censoring. This case fatality ratio is consistent with estimates for the 2014-16 west African Ebola virus disease epidemic (p=0.427). The median age of people with confirmed or probable infection was 40 years (range 8-80) and 30 (60%) were male. The most commonly reported signs and symptoms in people with confirmed or probable Ebola virus disease were fever (40 [95%] of 42 cases), intense general fatigue (37 [90%] of 41 cases), and loss of appetite (37 [90%] of 41 cases). Gastrointestinal symptoms were frequently reported, and 14 (33%) of 43 people reported haemorrhagic signs. Time from illness onset and hospitalisation to sample testing decreased over time. By May 30, 2018, 1458 contacts had been identified, of which 746 (51%) remained under active follow-up. The estimated reproduction number was 1.03 (95% credible interval 0.83-1.37) and the cumulative case incidence for the outbreak by June 21, 2018, is projected to be 78 confirmed cases (37-281), assuming heterogeneous transmissibility.Interpretation The ongoing Ebola virus outbreak in the Democratic Republic of the Congo has similar epidemiological features to previous Ebola virus disease outbreaks. Early detection, rapid patient isolation, contact tracing, and the ongoing vaccination programme should sufficiently control the outbreak. The forecast of the number of cases does not exceed the current capacity to respond if the epidemiological situation does not change. The information presented, although preliminary, has been essential in guiding the ongoing investigation and response to this outbreak. Copyright (C) 2018 World Health Organization. Published by Elsevier Ltd. All rights reserved.