Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone.
Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone.
复制标题
DOI：
10.1371/journal.pntd.0004498
复制
发表时间：
2016-03
影响因子：
3.8
通讯作者：
Glass K
中科院分区：
文献类型：
--
作者：
Lokuge K;Caleo G;Greig J;Duncombe J;McWilliam N;Squire J;Lamin M;Veltus E;Wolz A;Kobinger G;de la Vega MA;Gbabai O;Nabieu S;Lamin M;Kremer R;Danis K;Banks E;Glass K
西非当前疫情的规模和地理分布使人们对既定控制方法的有效性产生怀疑。埃博拉病毒病于2014年5月在塞拉利昂凯拉洪区首次发现。尽管该国其他地方的病例数很高，但到2014年12月该地区已消除了传播。我们描述了在凯拉洪成功控制埃博拉病毒病的干预措施，以及对其他地区控制埃博拉病毒病的影响。分析了内部服务数据和应对机构发表的报告，以描述应对活动的结构和类型、埃博拉病毒病病例数和流行特征。这包括每日国家情况报告和地区一级数据以及塞拉利昂卫生和环卫部的报告，以及无国界医生组织的病人数据和内部流行病学报告。我们使用了世界卫生组织在疫情爆发过程中提供的EVD病例定义。评估的特征包括应对活动水平和流行病学特征，如报告的接触（是否与葬礼有关）、发病和进入埃博拉病毒病管理中心（EMC）之间的时间间隔、与工作有关的接触（是否为卫生工作者）和死亡率。我们在6月至7月（反应初期）和8月至12月（反应覆盖率和质量都有所提高）这两个时间段比较了这些特征。采用随机模型预测不同床位数量和不同社区病例检出率的每代病例数。2014年6月至12月在凯拉洪发生了652例埃博拉病毒病疑似/确诊病例。提供患者护理的EMC于6月开业。到2014年8月，在整个地区集水区实施了一项综合检测、治疗和预防战略。从2014年6月至7月至8月至12月，监测和接触者追踪工作人员从每例埃博拉病毒病确诊病例1.0人增加到8.8人，EMC能力从32张病床增加到100张病床，埋葬队数量增加了一倍，健康促进活动的覆盖面也有所扩大。这些改善与同一时期的以下变化有关：入住EMC的确诊/可能病例比例从35%增加到83% (χ2 p值< 0.001)，入住EMC的确诊患者比例从19%增加到37% (χ2 p值< 0.001)，入院患者报告的丧葬接触从33%减少到16% （χ2 p值< 0.001）。数学模型证实了患者管理能力以及监测和接触者追踪对埃博拉病毒病控制的重要性。我们的研究结果表明，包括在周边地区持续传播的背景下，通过对埃博拉病毒病风险和发展者进行识别和适当管理的既定干预措施，可以实现对埃博拉病毒病的控制。实现控制的关键因素是有足够的病人护理能力（包括将疑似病例和可能病例送至专门设施进行评估），并与社区病例发现和预防活动的适当人员配备和资源相结合。我们提出的应对结构和覆盖目标对通报当前和未来埃博拉病毒病疫情的有效控制具有价值。埃博拉病毒病（EVD）是一种严重疾病，通常通过照顾病人或在死者葬礼期间与尸体接触而在人与人之间传播。西非最近爆发的埃博拉病毒病在几内亚、塞拉利昂和利比里亚造成数千人患病和死亡。这是历史上最大和最难控制的埃博拉病毒病疫情，这导致人们对既定控制措施的有效性产生怀疑。我们的研究描述了塞拉利昂农村地区成功控制埃博拉病毒病的情况。与以前的疫情一样，我们发现，通过与社区合作，确定可能接触过埃博拉病毒病的人，实现了控制；如果他们后来生病，尽早将他们送到具有设备和程序以防止埃博拉病毒病传播给工作人员或其他患者的专门中心进行检测和护理，并由训练有素的工作人员带着适当的防护设备安全埋葬死于埃博拉病毒病的人。我们描述了有效实施这些措施所需的资源和反应结构，以及有助于控制未来疫情的信息。
The scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas. Internal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected. There were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ2 p-value<0·001), the proportion of confirmed patients admitted to the EMC <3 days of symptom onset increased from 19% to 37% (χ2 p-value <0·001), and reported funeral contact in those admitted decreased from 33% to 16% (χ2 p-value <0·001). Mathematical modelling confirmed the importance of both patient management capacity and surveillance and contact tracing for EVD control. Our findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks. Ebola Virus Disease (EVD) is a severe illness that is usually spread from person to person through caring for someone who is sick, or if they die, contact with their body during their funeral. The recent EVD outbreak in West Africa caused illness and death in many thousands in Guinea, Sierra Leone and Liberia. It has been the largest and most difficult to control of any EVD outbreak in history, and this led to doubts as to the effectiveness of established control measures. Our study describes the successful control of EVD in a rural district of Sierra Leone. As in previous outbreaks, we found that control was achieved by working with communities to identify people who may have been exposed to EVD; if they then became sick, their early admission for testing and care to specialised centres that have equipment and procedures to prevent EVD passing on to staff or other patients, and safe burial of those who die of EVD by trained workers with appropriate protective equipment. We describe the resources and response structure needed to implement such measures effectively, information that will assist in controlling future outbreaks.