埃博拉治疗中心卫生防疫工作中遇到的问题及解决方案探讨

目的总结中国埃博拉治疗中心卫生防疫工作中遇到的问题及对策,为未来类似传染病的防控和医疗中心的管理提供借鉴。方法中国医疗队于2014年11月中旬奔赴利比里亚抗击埃博拉病毒病（EVD）,笔者作为抗埃援利医疗队中的一员,全程参与了医疗队卫生防疫组的日常工作,将卫生防疫工作遇到的问题及对策进行总结。结果面对含氯消毒剂泄漏、氯气污染、焚烧炉故障等问题,卫生防疫组积极采取了调整放水策略、防护氯气危害、维修旧炉并安装新炉等应对措施。由于处置得当,保证了医疗队各项工作的顺利开展,实现了医务人员“零感染”的目标。结论合理的设计、详尽的预案和对突发情况的灵活处理,是卫生防疫工作成功的关键,此次经验可以为以后的传染病疫情防控工作提供借鉴。     

埃博拉病毒病小常识

自2014年3月以来,西非四国——几内亚、利比里亚、塞拉利昂和尼日利亚相继出现了埃博拉病毒病疫情（以往称为埃博拉病毒性出血热）。截至2014年8月15日,全球共报告病例2127例,死亡1145例。埃博拉病毒病是世界上最凶猛的疾病之一,病死率高达90％。以下就埃博拉病毒病常见的问题作一简单介绍。     

35例埃博拉病毒病排查病例临床流行病学特征及防控措施探讨北大核心CSCD

目的探讨埃博拉病毒病疫区以外国家对埃博拉病毒病的排查方案及具体防控措施。方法对医院2014年8月-2016年5月收治的35例埃博拉病毒病排查患者的流行病学特征及临床资料进行回顾性分析,并通过WHO疫情通报收集非洲以外国家埃博拉确诊病例信息,对其流行病学特征进行分析。结果 35例患者均被排除埃博拉病毒病,皆非医务人员,无明确埃博拉病毒接触史,其中30例患者在21天内疫区居住及旅行史,5例患者来自非疫区国家,7例最后确诊为疟疾,经治疗后6例痊愈,1例死亡;非洲以外国家确诊埃博拉病毒病7例,其中6例为医务人员,所有病例皆有明确的接触史,其中输入性病例4例,二代病例3例,死亡1例。结论有明确埃博拉病毒接触史的医护人员是埃博拉病毒病的高危人群,可通过航空途径在潜伏期输入至疫区外国家,潜伏期传播风险低;对来自非洲的患者更应重视疟疾的诊断和经验性治疗;疑似病例应尽早完善各项基础检查,并进行早期基础治疗以降低死亡率。     

35例埃博拉病毒病排查病例临床流行病学特征及防控措施探讨

目的探讨埃博拉病毒病疫区以外国家对埃博拉病毒病的排查方案及具体防控措施。方法对医院2014年8月-2016年5月收治的35例埃博拉病毒病排查患者的流行病学特征及临床资料进行回顾性分析,并通过WHO疫情通报收集非洲以外国家埃博拉确诊病例信息,对其流行病学特征进行分析。结果 35例患者均被排除埃博拉病毒病,皆非医务人员,无明确埃博拉病毒接触史,其中30例患者在21天内疫区居住及旅行史,5例患者来自非疫区国家,7例最后确诊为疟疾,经治疗后6例痊愈,1例死亡;非洲以外国家确诊埃博拉病毒病7例,其中6例为医务人员,所有病例皆有明确的接触史,其中输入性病例4例,二代病例3例,死亡1例。结论有明确埃博拉病毒接触史的医护人员是埃博拉病毒病的高危人群,可通过航空途径在潜伏期输入至疫区外国家,潜伏期传播风险低;对来自非洲的患者更应重视疟疾的诊断和经验性治疗;疑似病例应尽早完善各项基础检查,并进行早期基础治疗以降低死亡率。     

援塞医疗队抗击埃博拉疫情的做法

目的：总结第二批中国援塞医疗队执行抗击埃博拉疫情任务的经验教训,为日后医疗分队执行类似任务提供参考。方法以第二批中国援塞医疗队的抽组、训练、派遣、执行任务等各环节的信息记录为基本资料,采用回顾性研究方法,对开展工作的情况进行分析和归纳。结果第二批援塞医疗队先期抽组参训65人,后方培训工作23天,实际派出41人,其中先遣队8人,在疫区工作66天,累计接诊疑似患者372人次,治疗确诊病例130例,其中治愈14例。结论科学合理的人员配置是完成任务的基本前提;全面严格的教育培训是完成任务的必备基础;细致充分的物资准备是完成任务的重要保障;打破常规、因地制宜的工作模式是完成任务的制胜法宝。     

铿锵玫瑰绚丽绽放 记奋战在抗击埃博拉一线的解放军援塞医疗队女队员

为了崇高的使命,她们挺身而出,义无反顾。为了神圣的职责,她们无所畏惧,直面生死。她们,就是来自解放军第三〇二医院的解放军首支赴塞拉利昂抗击埃博拉疫情医疗队的11名女队员。2014年9月16日,她们随队远赴塞拉利昂抗击埃博拉疫情,担负着此次国际救援行动的护理、防控和翻译工作,犹如11朵铿锵玫瑰,绚丽绽放在没有硝烟却险象环生的特殊战场。与时间赛跑同心协力攻坚克难“首日即是首战开始。”医疗组护士长     

埃博拉病毒病的发病机制和诊疗策略

埃博拉病毒是一种强致死性病原体,可引起类似于感染性休克的严重出血热——埃博拉病毒病。埃博拉病毒病在2014年西非地区发生历史上最大的大流行疫情,其临床特点为凝血功能障碍、毛细血管渗漏综合征和休克。迄今为止尚无针对性抗病毒药物治疗。本文从病原学、感染途径、发病机制、临床特征、辅助检查、诊断及治疗特点等方面探讨埃博拉病毒病的机制和诊疗策略。     

国内外埃博拉防控装备发展研究

目的:研究国内外埃博拉防控装备发展现状。方法:在埃博拉疫情防控形势分析的基础上,探讨埃博拉防控装备保障需求,总结了国内外埃博拉防控装备的现况特点。结果:国内埃博拉防护装备性能已达到国际先进水平,但侦检装备、治疗疫苗等与国外相比尚存在一定差距。结论:提出了埃博拉防控装备发展对策建议,对国内埃博拉防控装备今后的发展具有重要的指导意义。     

西非埃博拉病毒病疫情的反思与启示

概述了西非埃博拉病毒病疫情流行现状及其特点,并进一步分析了疫情大规模流行的原因和不良影响。通过回顾和分析文献,认真反思此次西非埃博拉病毒病疫情从发生、传播、暴发、流行和应急处置的各环节中,疫情发生当事国及国际社会的反应及其应对措施,进而从中吸取教训,获得有益启示,为有效应对区域性和国际性重大突发公共卫生事件提供科学依据。     

塞拉利昂埃博拉疫情防控力量的运用与特点分析

目的系统分析评估塞拉利昂埃博拉疫情防控力量的运用与特点,为未来快速组建应急防控体系、探索援外抗疫的派兵模式提出有益借鉴。方法围绕塞拉利昂埃博拉疫情发生发展变化,对疫情防控力量来源构成、部署展开、调整使用的基本特点等进行分析。结果塞拉利昂暴发埃博拉疫情暴发后,政府和国际组织相继采取了一系列措施,从救援力量混杂,组织协同困难的状况逐渐形成了统一的塞全国埃博拉应对中心,健全了管理体系,最终形成了有效防控。结论塞拉利昂埃博拉疫情防控力量运用情况分析对我国未来有效应对烈性传染病防控提供了很好的经验和参考。     

Evolution of Ebola Virus Disease from Exotic Infection to Global Health Priority,Liberia, Mid-2014

Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country’s health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers.     

Effect of Recombinant Vesicular Stomatitis Virus–Zaire Ebola Virus Vaccination on Ebola Virus Disease Illness and Death,Democratic Republic of the Congo

We conducted a retrospective cohort study to assess the effect vaccination with the live-attenuated recombinant vesicular stomatitis virus–Zaire Ebola virus vaccine had on deaths among patients who had laboratory-confirmed Ebola virus disease (EVD). We included EVD-positive patients coming to an Ebola Treatment Center in eastern Democratic Republic of the Congo during 2018–2020. Overall, 25% of patients vaccinated before symptom onset died compared with 63% of unvaccinated patients. Vaccinated patients reported fewer EVD-associated symptoms, had reduced time to clearance of viral load, and had reduced length of stay at the Ebola Treatment Center. After controlling for confounders, vaccination was strongly associated with decreased deaths. Reduction in deaths was not affected by timing of vaccination before or after EVD exposure. These findings support use of preexposure and postexposure recombinant vesicular stomatitis virus–Zaire Ebola virus vaccine as an intervention associated with improved death rates, illness, and recovery time among patients with EVD.     

Pregnancy,Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services,United States

Many of the survivors of the 2014–2015 epidemic of Ebola virus disease (EVD) in West Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women’s pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.     

Ebola Virus Outbreak Investigation,Sierra Leone,September 28–November 11, 2014

During 2014–2015, an outbreak of Ebola virus disease (EVD) swept across parts of West Africa. The China Mobile Laboratory Testing Team was dispatched to support response efforts; during September 28–November 11, 2014, they conducted PCR testing on samples from 1,635 suspected EVD patients. Of those patients, 50.4% were positive, of whom 84.6% lived within a 3-km zone along main roads connecting rural towns and densely populated cities. The median time from symptom onset to testing was 5 days. At testing, 75.7% of the confirmed patients had fever, and 94.1% reported at least 1 gastrointestinal symptom; all symptoms, except rash and hemorrhage, were more frequent in confirmed than nonconfirmed patients. Virus loads were significantly higher in EVD patients with fever, diarrhea, fatigue, or headache. The case-fatality rate was lower among patients 15–44 years of age and with virus loads of <100,000 RNA copies/mL. These findings are key for optimizing EVD control and treatment measures.     

Ebola Risk Perception in Germany, 2014

Ebola virus disease (EVD) outbreaks have occurred during the past 5 decades, but none has affected European countries like the 2014 epidemic in West Africa. We used an online questionnaire to investigate risk perceptions in Germany during this epidemic peak. Our questionnaire covered risk perceptions, knowledge about transmission routes, media use, reactions to the outbreak, attitudes toward measures to prevent the spread of EVD and vaccination against EVD, and willingness to volunteer for aid missions. Of 974 participants, 29% indicated that they worried about EVD, 4% correctly stated virus transmission routes, and 75% incorrectly rated airborne transmission and transmission by asymptomatic patients as possible. Many indicated that if a patient were flown to Germany for treatment in a nearby hospital, they would adapt preventive behavior. Although most participants were not worried about EVD at the current stage of the epidemic, misperceptions regarding transmission were common and could trigger inappropriate behavior changes.     

Risk Prediction Score for Pediatric Patients with Suspected Ebola Virus Disease

Rapid diagnostic tools for children with Ebola virus disease (EVD) are needed to expedite isolation and treatment. To evaluate a predictive diagnostic tool, we examined retrospective data (2014–2015) from the International Medical Corps Ebola Treatment Centers in West Africa. We incorporated statistically derived candidate predictors into a 7-point Pediatric Ebola Risk Score. Evidence of bleeding or having known or no known Ebola contacts was positively associated with an EVD diagnosis, whereas abdominal pain was negatively associated. Model discrimination using area under the curve (AUC) was 0.87, which outperforms the World Health Organization criteria (AUC 0.56). External validation, performed by using data from International Medical Corps Ebola Treatment Centers in the Democratic Republic of the Congo during 2018–2019, showed an AUC of 0.70. External validation showed that discrimination achieved by using World Health Organization criteria was similar; however, the Pediatric Ebola Risk Score is simpler to use.     

丙型肝炎病毒职业暴露处理与追踪随访

目的了解临床医务人员发生丙型肝炎病毒(HCV)职业暴露后处理过程及感染情况,为HCV职业暴露的防护提供经验。方法调查5例发生HCV职业暴露医务人员的暴露环节、暴露后处理方法及追踪随访结果。结果5例发生HCV职业暴露的医务人员均为临床护士,1例确诊为职业暴露后急性感染HCV。发生HCV暴露后,均给予常规心理支持和咨询,4例排除感染者很快恢复正常的工作和生活;确诊被感染者暂时调离临床一线岗位,加强心理支持,坚持完成1年聚乙二醇干扰素联合利巴韦林的抗病毒治疗后痊愈。结论医务人员发生HCV职业暴露后及时上报、进行HCV RNA感染监测;确诊感染HCV后尽早联合聚乙二醇干扰素及利巴韦林抗病毒治疗,是治愈HCV急性感染的关键措施。     

Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes

We investigated the genetic profiles of killer cell immunoglobulin-like receptors (KIRs) in Ebola virus–infected patients. We studied the relationship between KIR–human leukocyte antigen (HLA) combinations and the clinical outcomes of patients with Ebola virus disease (EVD). We genotyped KIRs and HLA class I alleles using DNA from uninfected controls, EVD survivors, and persons who died of EVD. The activating 2DS4–003 and inhibitory 2DL5 genes were significantly more common among persons who died of EVD; 2DL2 was more common among survivors. We used logistic regression analysis and Bayesian modeling to identify 2DL2, 2DL5, 2DS4–003, HLA-B-Bw4-Thr, and HLA-B-Bw4-Ile as probably having a significant relationship with disease outcome. Our findings highlight the importance of innate immune response against Ebola virus and show the association between KIRs and the clinical outcome of EVD.     

The development of a massive open online course during the 2014–15 Ebola virus disease epidemic

PurposeTimely training was urgently needed at the onset of the 2014 Ebola virus disease epidemic. Massive open online courses (MOOCs) have grown in popularity, though little is known about their utility in time-sensitive situations, including infectious disease outbreaks.MethodsWe created the first English language massive open online course on Ebola virus disease. Designed by a team representing various units of Emory University and six partner institutions, the six module course was aimed at a global general audience but also relevant for health care professionals.ResultsOver 7,000 learners from 170 countries participated in the initial course offering. More than a third of learners were from emerging economies, including seven percent from Africa, and another 13% from countries outside the United States who received individuals requiring treatment for Ebola virus disease.ConclusionsCreating and producing the first English language MOOC on EVD in a short time period required effective collaboration and strong coordination between subject matter and course development experts from Emory. Through these collaborative efforts, the development team was able to provide urgently needed training and educational materials while the epidemic of EVD continued to radiate through West Africa.