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背景 2014年3月23日WHO发布了几内亚爆发埃博拉病毒病(EVD)的通知,8月8日WHO认定此次爆发的流行病属于“世界关注的公共卫生紧急事件”。方法截止至2014年9月14日,已经有疑似和确诊病例4 507例,其中包括西非5个国家(几内亚、利比里亚、尼日利亚、塞内加尔及塞拉利昂)报告的2 296例死亡病例。本研究对几内亚、利比里亚、尼日利亚及塞拉利昂报告的3 343例确诊病例和667例疑似病例的数据子集进行细化分析。结果大多数感染者的年龄处于15~44岁(49%为女性),估计病死率为70.8%〔95%CI(69,73)〕。此次爆发与以往状况类似,包括感染体征和症状、潜伏期(11.4 d)及连续间歇期(15.3 d)。根据初期成倍增长速度,估算基本再生数目(R0):几内亚为1.71〔95%CI(1.44,2.01)〕;利比里亚为1.83〔95%CI(1.72,1.94)〕;塞拉利昂为2.02〔95%CI(1.79,2.26)〕。估算当前再生数目(R):几内亚为1.81〔95%CI(1.60,2.03)〕;利比里亚为1.51〔95%CI(1.41,1.60)〕;塞拉利昂为1.38〔95%CI(1.27,1.51)〕。估算对应倍增时间:几内亚为15.7 d〔95%CI(12.9,20.3)〕;利比里亚为23.6 d〔95%CI(20.2,28.2)〕;塞拉利昂为30.2 d〔95%CI(23.6,42.3)〕。如不改变本次流行病的控制措施,预计到2014年11月2日,累计报告确诊和疑似病例数将超过2万例,其中几内亚5 740例、利比里亚9 890例、塞拉利昂5 000。结论如果控制措施得不到根本性改善,未来几个月内,EVD的患病例数和死亡例数将达到每周几百至几千例,且呈持续增长趋势。
Background On March 23, 2014, WHO released the notification of Ebola virus disease (EVD) outbreak in Guinea and the WHO epidemic identified as “the public health emergency of concern to the world” on August 8. Methods As of September 14, 2014, there were 4,507 suspected and confirmed cases, including 2 296 deaths reported by five countries in West Africa (Guinea, Liberia, Nigeria, Senegal and Sierra Leone). This study provides a detailed analysis of a subset of 3 343 confirmed cases and 667 suspected cases reported by Guinea, Liberia, Nigeria and Sierra Leone. Results The majority of those infected were 15-44 years old (49% women) with an estimated case-fatality rate of 70.8% (95% CI, 69,73). The outbreak was similar to past conditions and included signs and symptoms of infection, latency (11.4 days), and continuous intermission (15.3 days). The basic number of reproductions (R0) was estimated based on the rate of initial multiplication: Guinea 1.71 [95% CI (1.44, 2.01)], Liberia 1.83 (95% CI 1.72, 1.94) and Sierra Leone 2.02 (95% CI (1.79, 2.26)]. The current number of regeneration (R) is estimated: Guinea 1.81 [95% CI (1.60,2.03)]; Liberia 1.51 [95% CI (1.41,1.60)]; Sierra Leone 1.38 [95% CI (1.27,1.51)]. The corresponding doubling time is estimated as follows: Guinea is 15.7 d [95% CI (12.9,20.3)]; Liberia is 23.6 d [95% CI (20.2,28.2)]; Sierra Leone is 30.2 d [95% CI (23.6, 42.3)]. As of November 2, 2014, the total number of confirmed and suspected cases of the cumulative report is expected to exceed 20,000 if no control measures are changed for the current epidemic, including 5740 in Guinea, 9,890 in Liberia and 5 000 in Sierra Leone. Conclusion If the control measures can not be fundamentally improved, the number of cases of EVD and the number of deaths in the next few months will reach hundreds to thousands of cases per week, and the trend of continuous increase.