据报道,首例埃博拉病毒病病例于 1976 年出现于扎伊尔(现称为刚果民主共和国 [Democratic Republic of the Congo, DRC])。此次暴发共有 318 例病例,其中 280 例死亡,病死率高达 88%。[24]Report of an International Commission. Ebola haemorrhagic fever in Zaire, 1976. Bull World Health Organ. 1978;56(2):271-93.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395567/pdf/bullwho00439-0113.pdf
http://www.ncbi.nlm.nih.gov/pubmed/307456?tool=bestpractice.com
此次埃博拉病毒感染疫情暴发期间病毒传播的原因在于扬布库教会医院 (Yambuku Mission Hospital) 门诊部使用的受污染针头。此后,中非和西非国家经常暴发埃博拉病毒感染疫情。[25]Peterson AT, Bauer JT, Mills JN. Ecologic and geographic distribution of filovirus disease. Emerg Infect Dis. 2004 Jan;10(1):40-7.
https://wwwnc.cdc.gov/eid/article/10/01/03-0125_article
http://www.ncbi.nlm.nih.gov/pubmed/15078595?tool=bestpractice.com
导致疫情暴发的最常见病毒种为埃博拉病毒(扎伊尔型正埃博拉病毒),其次是苏丹型病毒(苏丹型正埃博拉病毒)。
埃博拉病毒是 2014-2016 年西非疫情暴发的病原体。此次疫情在 2014 年 3 月被首次报道,这也是自 1976 年发现该病毒以来最大规模的暴发。基因测序显示,2014 年暴发期间从感染患者体内分离出来的病毒与 1976 年首次出现的病毒基因相似度达 97%。[26]Centers for Disease Control and Prevention. 2014: CDC laboratories produce first genomic sequence of Liberian Ebola. Mar 2019 [internet publication].
https://archive.cdc.gov/#/details?url=https://www.cdc.gov/amd/whats-new/ebola.html
此后,还在刚果民主共和国造成了较小规模的暴发。据报道,该病毒在既往暴发中的病死率高达 90%。[4]Leroy EM, Gonzalez JP, Baize S. Ebola and Marburg haemorrhagic fever viruses: major scientific advances, but a relatively minor public health threat for Africa. Clin Microbiol Infect. 2011 Jul;17(7):964-76.
https://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03535.x/full
http://www.ncbi.nlm.nih.gov/pubmed/21722250?tool=bestpractice.com
对于不同埃博拉治疗中心和疫情暴发之间病死率的直接比较,应谨慎解读,因为即使是大型队列研究,许多变量也可引起数据偏倚和倾斜。在 2014 年的疫情暴发期间,入院接受治疗的患者病死率高达 64.3%,西非国家一些治疗中心的患者病死率降至 31.5%,在西非以外地区接受治疗的患者的病死率为 20% 左右。[18]WHO Ebola Response Team. Ebola virus disease in West Africa: the first 9 months of the epidemic and forward projections. N Engl J Med. 2014 Oct 16;371(16):1481-95.
https://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=article
http://www.ncbi.nlm.nih.gov/pubmed/25244186?tool=bestpractice.com
[27]Ansumana R, Jacobsen KH, Idris M, et al. Ebola in Freetown area, Sierra Leone - a case study of 581 patients. N Engl J Med. 2015 Feb 5;372(6):587-8.
https://www.nejm.org/doi/full/10.1056/NEJMc1413685
http://www.ncbi.nlm.nih.gov/pubmed/25539447?tool=bestpractice.com
[28]New York Times. How many Ebola patients have been treated outside of Africa? January 2015 [internet publication].
https://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html
相比之下,在既往暴发期间,苏丹型埃博拉病毒感染的病死率较低,为 39%-65%,最大规模的暴发出现在 2000 年的乌干达(425 例病例)。[4]Leroy EM, Gonzalez JP, Baize S. Ebola and Marburg haemorrhagic fever viruses: major scientific advances, but a relatively minor public health threat for Africa. Clin Microbiol Infect. 2011 Jul;17(7):964-76.
https://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03535.x/full
http://www.ncbi.nlm.nih.gov/pubmed/21722250?tool=bestpractice.com
[29]World Health Organization. Disease outbreak news. Ebola disease caused by Sudan ebolavirus – Uganda. January 2023 [internet publication].
https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON433
迄今仅一次暴发由本迪布焦型病毒(本迪布焦型正埃博拉病毒)引起:发生在 2007 年乌干达西部,此次暴发的病死率为 25%。[6]Roddy P, Howard N, Van Kerkhove MD, et al. Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008. PLoS One. 2012 Dec 28;7(12):e52986.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052986
http://www.ncbi.nlm.nih.gov/pubmed/23285243?tool=bestpractice.com
近期暴发
2022 年:2022 年 8 月 21 日,刚果民主共和国北基伍省报告了一例病例。该病例是一名 46 岁的女性,在住院 23 日后死亡,死亡原因被认为是与已知并发症相关的症状。[30]World Health Organization. Disease outbreak news: Ebola virus disease - Democratic Republic of the Congo. Aug 2022 [internet publication].
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON404
未发现其他确诊或拟诊病例,此次暴发于 2022 年 9 月 27 日宣布结束。
2022 年:刚果民主共和国第 14 次暴发于 2022 年 4 月 23 日在赤道省开始,并于 2022 年 7 月 4 日宣布结束,共有 5 例病例,5 例死亡(病死率 100%)。这是该省在过去 4 年中的第 3 次疫情暴发。[31]World Health Organization. Ebola virus disease - Democratic Republic of the Congo. Jul 2022 [internet publication].
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON398
2021 年:刚果民主共和国第 13 次暴发于 2021 年 10 月 8 日在北基伍省开始,并于 2021 年 12 月 16 日宣布结束,共有 11 例病例,9 例死亡(病死率 82%)。[32]World Health Organization. Disease outbreak news. Ebola virus disease – Democratic Republic of the Congo. Dec 2021 [internet publication].
https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON351
2020 年:刚果民主共和国第 11 次暴发于 2020 年 6 月 1 日在赤道省开始,并于 2020 年 11 月 18 日宣布结束,共有 130 例病例,55 例死亡(病死率 42%)。[35]World Health Organization. Disease outbreak news: Ebola virus disease - Democratic Republic of the Congo. Nov 2020 [internet publication].
https://www.who.int/emergencies/disease-outbreak-news/item/ebola-virus-disease-democratic-republic-of-the-congo-draft
2018-2020 年:世界第二大规模暴发在 2018 年出现于刚果民主共和国北基伍省和伊图里省,2020 年 6 月 25 日宣布结束,共有 3481 例病例和 2299 例死亡(病死率 66%)。[36]World Health Organization. Ebola health update: north Kivu/Ituri, DRC, 2018-2020. Jul 2020 [internet publication].
https://www.who.int/emergencies/situations/Ebola-2019-drc-
2018:DRC 小暴发期间,出现 54 例病例和 33 例死亡(病死率 61%)[3]World Health Organization. Ebola virus disease fact sheet. Apr 2023 [internet publication].
https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease
2014-2016 年:世界第一大规模暴发在 2014 年于 DRC 开始,2016 年结束,共有超过 28,000 例病例和 11,000 例死亡(病死率 46%)。[3]World Health Organization. Ebola virus disease fact sheet. Apr 2023 [internet publication].
https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease
如果在最后一次可能暴露于最后一例发生病例之后的 42 天(即最长潜伏期两倍时间)未出现确诊病例或拟诊病例,WHO 会宣布暴发结束;然而 WHO 推荐在这 42 天期间以及之后至少 6 个月加强监测和应对活动。[37]World Health Organization. WHO recommended criteria for declaring the end of the Ebola virus disease. Mar 2020 [internet publication].
https://www.who.int/publications/m/item/who-recommended-criteria-for-declaring-the-end-of-the-ebola-virus-disease-outbreak
CDC: ebola outbreak history
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UK Health Security Agency: ebola and Marburg haemorrhagic fevers - outbreaks and case locations
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