Global Epidemic of Ebola Virus Disease and the Importation Risk into China: An Assessment Based on the Risk Matrix Method / 生物医学与环境科学（英文）

OBJECTIVE@#To analyze the global epidemic status of the Ebola virus disease (EVD) and assess the importation risk into China.@*METHODS@#Data from World Health Organization reports were used. We described the global epidemic status of EVD from 1976-2021, and assessed and ranked the importation risk of EVD from the disease-outbreaking countries into China using the risk matrix and Borda count methods, respectively.@*RESULTS@#From 1976-2021, EVD mainly occurred in western and central Africa, with the highest cumulative number of cases (14,124 cases) in Sierra Leone, and the highest cumulative fatality rate (85%) in the Congo. Outbreaks of EVD have occurred in the Democratic Republic of the Congo and Guinea since 2018. The importation risk into China varies across countries with outbreaks of disease. The Democratic Republic of the Congo had an extremely high risk (23 Borda points), followed by Guinea and Liberia. Countries with a moderate importation risk were Nigeria, Uganda, Congo, Sierra Leone, Mali, and Gabon, while countries with a low importation risk included Sudan, Senegal, and Co

Historical epidemiology and global health history / Epidemiologia histórica e história global da saúde

Abstract The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

Resumo A subdisciplina epidemiologia histórica se propõe a criar um alicerce robusto e refinado para o processo de tomada de decisões em saúde pública global, aprofundando registros empíricos que nos ensinam sobre intervenções passadas. Este artigo se baseia na pesquisa epidemiológica histórica de três campanhas globais de saúde pública para ilustrar essa proposta: os esforços da Fundação Rockefeller para controle da ancilostomose (1909-c.1930), os projetos-piloto da Organização Mundial da Saúde para erradicação da malária na África tropical (décadas de 1950-1960), e os esforços internacionais de interrupção da transmissão do vírus Ebola durante surtos na África tropical (1974-2019).

Influencia de los procederes de enfermería en la sobrevivencia de los pacientes afectados por el Ébola / Influence of Nursing Procedures in the Survival of Patients Affected by Ebola

Introducción: El virus del Ébola causa una enfermedad grave sumamente infecciosa, que lleva rápidamente a la muerte, con una tasa de letalidad de hasta 90 por ciento, pero puede prevenirse. Objetivo: Describir relevancia de los procederes de enfermería en la sobrevivencia de los pacientes afectados por el Ébola Métodos: Estudio descriptivo, de corte transversal en Liberia, África Occidental, en el periodo de noviembre 2014 a febrero 2015. El universo estuvo constituido por 203 pacientes a quienes se les aplicó procederes de enfermería por enfermeros que integraron la brigada médica cubana. La información se obtuvo de la observación directa y la revisión de la base de datos estadística de la misión cubana en Liberia, se procesó mediante el Sistema SPSSS versión 11,5 a través de técnicas de estadística descriptiva. Resultados: Predominó el sexo masculino (55,66 por ciento), diciembre fue el mes de mayor ingreso (36,45 por ciento), la mayoría de los pacientes fueron ingresados en la salas de sospechosos (60,09 por ciento), predominó la administración de medicamentos por vía oral, con 820 procederes (52,59 por ciento), se logró que 51,25 por ciento de los pacientes atendidos egresaran vivos, siendo el mes de enero el de mayor letalidad (66,70 por ciento). Conclusiones: La labor realizada por los enfermeros cubanos en la lucha contra el Ébola en Liberia, África Occidental, y el cumplimiento estricto de los protocolos según procederes de enfermería contribuyó al control hemodinámico de los pacientes atendidos y a la disminución paulatina de la epidemia, así como la letalidad por dicho evento(AU)

Introduction: Ebola virus causes a highly infectious and serious disease, which quickly leads to death, with a death rate of up to 90 percent, but it can be prevented. Objective: To describe the relevance of nursing procedures in the survival of patients affected by Ebola. Methods: Descriptive, cross-sectional study carried out in West Africa, Liberia in the period from November 2014 to February 2015. The study population consisted of 203 patients who were applied nursing procedures by personnel who were part of the Cuban medical brigade. The information was obtained by direct observation and review of the statistical database of the Cuban mission in Liberia; and processed through the system SPSSS version 11.5, through descriptive statistics techniques. Results: The male sex predominated (55.66 percent). December was the month with highest admittance (36.45 percent); the majority of patients were admitted to the ward of suspects (60.09 percent). The administration of oral medications predominated, with 820 procedures (52.59 percent). It was achieved for 51.25 percent of the patients attended to be discharged alive, the month of January accounting for the highest mortality (66.70 percent). Conclusions: The work carried out by the Cuban nurses in the fight against Ebola in West Africa, Liberia and the strict compliance with the protocols according to nursing procedures contributed to the hemodynamic control of the patients attended and the gradual reduction of the epidemic, as well as the mortality for the event(AU)

A comprehensive district-level laboratory intervention after the ebola epidemic in Sierra Leone

Background: The 2014­2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms.Objective: We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital's general laboratory serving a population of over 500 000 in a rural district.Methods: The intervention focused on (1)supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation.Results: We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements.Conclusion: This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers

Strengthening healthcare workforce capacity during and post Ebola outbreaks in Liberia : an innovative and effective approach to epidemic preparedness and response

Introduction: the 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.Methods: data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.Results: the ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events.Conclusion: no infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings

Enfermedad por el virus Ébola medidas de bioseguridad / Ebola virus disease biosafety measures

Resumen El virus Ébola representa el patógeno prototipo de fiebre hemorrágica viral, causando una enfermedad severa de alta tasa de mortalidad. Esta alta mortalidad, combinada con la ausencia de vacunación y de un tratamiento específico, hace que el virus Ébola sea un patógeno importante para la salud pública. La fiebre hemorrágica de Ébola se cree es una zoonosis con persistencia del virus en especies de reservorios encontrados en áreas endémicas. A pesar de todos los esfuerzos realizados en cada brote para identificar los reservorios naturales no se conocen huéspedes potenciales ni los artrópodos vectores. El manejo de los casos está basado en el aislamiento de los pacientes y en el uso de barreras de aislamiento, tales como ropa e implementos de protección como respiradores. Debido a su rápida propagación la OMS declaró que la enfermedad por el virus Ébola representa una emergencia de salud pública más allá de las fronteras y exhortó a la comunidad internacional a tomar las acciones necesarias para detener la epidemia.

Abstract Ebola virus is regarded as the prototype pathogen of viral hemorrhagic fever, causing severe disease and high case fatality rates. This high fatality, combined with the absence ot treatment and vaccination options, makes Ebola virus an important public health pathogen. Ebola hemorrhagic fever is thought to be a classic zoonosis with persistence of the Ebola virus in a reservoir species generally found in endemic areas. Although much effort has been made to identify the natural reservoirs with every large outbreak of Ebola hemorrhagic fever, neither potential hosts norarthropod vectors have been identified. Case management is based on isolation of patients and use of strict barrier nursing procedures, such as protective clothing and respirators. In addition, its rapid propagation has led the Word Health Organization (WHO) to declare on August 2014 that Ebola virus disease represents a public health emergency of international concern and urged the international community to take action to stop its spread.

Review of past and present ebola hemorrhagic fever outbreaks in the Democratic Republic of Congo 1976 -2014

Background: Ebola Hemorrhagic Fever (EHF) has become well known all over the world; especially following the West African outbreak in Guinea; Sierra Leone and Liberia (December 2013). The Ebola virus was first discovered in the Democratic Republic of Congo (DRC); an African country that has continued to register Ebola outbreaks. This study aims to summarize old and new experiences of Ebola in the DRC; in order to propose strategies for better prevention.Materials and Methods: Information was taken from databases such as PubMed and Cochrane library. A total of eleven full text and three abstracts were identified for the data extraction. Results: Since its discovery in the DRC; there have been seven Ebola outbreaks; accounting for a total of 1032 cases and 795 deaths. The presence of Non-Human Primates; also considered as the natural reservoir and susceptible host of Ebola virus; can be one major factor that has contributed to the increased number of Ebola outbreaks and cases in the Equatorial region. The existence of rumors and legends related to Ebola in DRC obscure the the viral nature of the disease; and lead to difficulty for health workers; to easily accomplish their tasks.Conclusion :It is important ;to scale up community education campaigns designed to give more details on the viral nature of the EHF; establish national agencies and institutions specialized in controlling hunting in the Equatorial region; for better prevention; since there is not yet a specific drug or vaccine to the Ebola Virus

Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

O risco da contaminação global: o combate à epidemia de Ebola na África como vetor de cooperação internacional / The global contamination risk: the battle against Ebola epidemic in Africa as a vector of international cooperation / /El riesgo de contaminación global: la lucha contra la epidemia por el virus del Ebola en África como un vector de la cooperación internacional

Considerada a maior epidemia de Ebola desde o primeiro surto em 1976, o oeste africano tem enfrentado grandes desafios, sobretudo endógenos, para conter a disseminação da doença. Objetiva-se analisar a atual epidemia de Ebola à luz do neoinstitucionalismo liberal e da lógica da ação coletiva, utilizando como metodologia a estratégia de nested analisys. Conclui-se que o risco de uma pandemia de Ebola tem funcionado como incentivo para que os atores envolvidos cooperem. Os resultados deslocam a discussão para uma área pouco explorada academicamente: a ética médica no âmbito das relações internacionais, que suscita indagações, tais como “por que africanos não têm prioridade no tratamento diferenciado contra o Ebola?” e “qual o verdadeiro papel da OMS ao lidar com grandes epidemias?”. O presente trabalho inova ao tratar lógicas por trás da cooperação internacional em matéria de saúde no continente africano e por agregar a infografia cartográfica à literatura sobre política internacional...

Considered the largest epidemic of Ebola since the first outbreak in 1976, West Africa has faced great challenges, especially endogenous, to contain the disease spreading. Our objective is to analyze the current epidemic of Ebola in the light of the neoliberal institutionalism and the logic of collective action, using as methodology the strategy of nested analysis. It is concluded that the risk of an Ebola pandemic has worked as an incentive for the involved actors want to cooperate. The results lead the discussion to an area little explored academically: the international medical ethics, which raises questions like: “why is not given priority to Africans in the differential treatment against Ebola?” and “what is the true role played by WHO when dealing with large epidemics?” The study breaks new ground when it deals with the logic behind the international cooperation concerning health in Africa and adds infographic maps to international politics literature...

Considerada la mayor epidemia por el virus del Ébola desde el primer brote en 1976, África Occidental ha enfrentado a grandes desafíos, en especial endógenos, para contener la propagación de la enfermedad. Este trabajo tiene como objetivo analizar la actual epidemia por el virus del Ébola de acuerdo con el neoinstitucionalismo liberal y la lógica de la acción colectiva, utilizando como metodología la estrategia de“nested analysis”. Se concluye que el riesgo de una pandemia por el virus del Ébola ha funcionado como un incentivo para que los actores interesados quieran cooperar. Los resultados llevan la discusión a una área poco trabajada en la academia: la ética médica en las relaciones internacionales, que suscita preguntas como: “¿por qué los africanos no tienen prioridad en el tratamiento diferenciado contra el virus del Ébola?”y “¿cuál es el verdadero papel de la OMS cuando trabaja contra grandes epidemias?”. El estudio abre nuevos caminos al tratar de la lógica detrás de la cooperación internacional en materia de salud en África y al agregar mapas infográficos a la literatura política internacional...

Post-exposure treatment of Ebola virus using passive immunotherapy: proposal for a new strategy

Background: Better treatments are urgently needed for the management of Ebola virus epidemics in Equatorial Africa. Methods: We conducted a systematic review of the literature on the use of passive immunotherapy for the treatment or prevention of Ebola virus disease. We placed findings from this review into the context of passive immunotherapy currently used for venom-induced disease, and recent improvements in manufacturing of polyvalent antivenom products. Results: Passive immunotherapy appears to be one of the most promising specific treatments for Ebola. However, its potential has been incompletely evaluated, considering the overall experience and recent improvement of immunotherapy. Development and use of heterologous serum derivatives could protect people exposed to Ebola viruses with reasonable cost and logistics. Conclusion: Hyperimmune equine IgG fragments and purified polyclonal whole IgG deserve further consideration as treatment for exposure to the Ebola virus.

Ebola virus disease: Getting to know a new emerging foe.

Viral hemorrhagic fevers have been at the top of the severity scale in terms of morbidity and mortality among human beings. Many of the viruses have their reservoirs in animal kingdom and from time to time they get introduced to humans and cause sporadic outbreaks and epidemics. Thousands of people from the Western African region have already succumbed to the complications due to Ebola virus infection.</p> <p>The South East Asian region including India has been affected by several outbreaks of communicable diseases like SARS, bird flu, swine flu etc. The current outbreak has been a global concern due to its spread beyond the African continent. WHO has declared EVD as an international health emergency and worldwide efforts have been enhanced to escalate research to find a vaccine or cure for the disease.