JIDC：早期筛查是避免大型埃博拉疫情爆发的关键

检验之星

近日，研究发现提高诊断严重发烧症状的方法对于抵抗埃博拉病毒是非常有必要的，这项研究发表在《Journal of Infection in Developing Countries》上。

美国宾夕法尼亚州梅西大学和哈弗学院的研究人员使用灵敏-暴露-感染-移除（SEIR）的方法较对和分析了1995年在刚果民主共和国kikwit爆发的埃博拉病毒疫情。

Thomas Pfeiffer教授说在卫生资源缺乏的非洲，疫情的爆发有时持续几周甚至几个月才得知。

类似埃博拉病毒的拉沙热病毒和马尔堡病毒，这些病毒疫情的爆发相对来说比较罕见，除非这种病毒疫情正在持续进行中，否则它们不会被考虑在因发烧所诊断的疾病中。比如，在疟疾流行区域发烧通常被首诊为疟疾，除非在抗疟疗法失败后发烧才有可能被诊断为其他疾病。这样一来，由于诊断的延误而导至了该病毒疫情的爆发。

通过在电脑上模拟流行病的方法，我们测试了一种诊断步骤，这种步骤可以快速检测到疫情的爆发情况。我们的模拟实验表明实现这种步骤，比如隔离对抗疟和抗菌疗法均无疗效的病人，用这种步骤对这种未知原因的案例进行检验是非常有效的。用这种步骤应对面临风险的健康工作者的早期疫情检测也是非常有效的。

Thomas Pfeiffer教授说实验室诊断和诊断步骤的使用会减少危险病毒性发烧像埃博拉病毒传播的可能性，还将提高诊断鉴别普通发烧的原因并提高现代非洲的卫生保健水平。

目前西非国家埃博拉病毒爆发的严重性和传播广泛性看起来非常严重，但是在未来提高诊断辅助资源的水平，加强诊断辅助资源的利用可以有助于避免这样的灾难性事件。（生物谷Bioon.com）

本文系生物谷原创编译整理，欢迎转载！转载请注明来源并附原文链接。谢谢！

doi:10.3855/jidc.4636
PMC:
PMID:

Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks

Iruka N Okeke1, Robert S Manning2, Thomas Pfeiffer3

Abstract Introduction: Viral hemorrhagic fever (VHF) outbreaks, with high mortality rates, have often been amplified in African health institutions due to person-to-person transmission via infected body fluids. By collating and analyzing epidemiological data from documented outbreaks, we observed that diagnostic delay contributes to epidemic size for Ebola and Marburg hemorrhagic fever outbreaks. Methodology: We used a susceptible-exposed-infectious-removed (SEIR) model and data from the 1995 outbreak in Kikwit, Democratic Republic of Congo, to simulate Ebola hemorrhagic fever epidemics. Our model allows us to describe the dynamics for hospital staff separately from that for the general population, and to implement health worker-specific interventions. Results: The model illustrates that implementing World Health Organization/US Centers for Disease Control and Prevention guidelines of isolating patients who do not respond to antimalarial and antibacterial chemotherapy reduces total outbreak size, from a median of 236, by 90% or more. Routinely employing diagnostic testing in post-mortems of patients that died of refractory fevers reduces the median outbreak size by a further 60%. Even greater reductions in outbreak size were seen when all febrile patients were tested for endemic infections or when febrile health-care workers were tested. The effect of testing strategies was not impaired by the 1-3 day delay that would occur if testing were performed by a reference laboratory. Conclusion: In addition to improving the quality of care for common causes of febrile infections, increased and strategic use of laboratory diagnostics for fever could reduce the chance of hospital amplification of VHFs in resource-limited African health systems.

来源：生物谷