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埃博拉病毒
作者:USMedEdu
发表时间:2014-08-04
更新时间:2014-08-04
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“埃博拉病毒”的前生今世,你知道吗?
2014-08-03 阅读 (80404) 医学论坛网

1.埃博拉病毒如何被发现

人类的故乡在中非,那里迄今还有一片很原始的地方,
除非坐小型飞机,否则只能乘船才能抵达那些散落的村
落,有的地方甚至得坐3周船才能抵达。

1976年9月中旬,位于扎伊尔北部本巴(Bumba)地区
扬布库村的一间小教会医院的医生报告几十例相同病
例,比疟疾症状严重,包括出血性呕吐、鼻出血、出血
性腹泻,其中14位病人死亡,其余病人的病情也很严
重。



扎 伊尔首都金沙萨收到电报后,扎伊尔卫生部请求国际
援助,10月初,该医院被迫关闭,几周后受扎伊尔卫生
部委派,一只国际专家组抵达扬布库村,成员包括来自
法国、比利时、加拿大、南非、扎伊尔和美国的专家,
来自美国的是CDC的9人团队,因此其领队卡尔·约翰逊
就成了专家组的组长。

约翰逊出掌专家组,一不是靠手下人多,二不是靠美国
的势力,而是用命换来的资格。

1962 年,正在巴拿马进行研究项目的约翰逊和麦肯齐
(Ron MacKenzie)一道前往玻利维亚马格达莱纳
(Magdelena),调查当地的一种出血热。他们抵达马
格达莱纳后,发现疾病流行情况非常严重,只好 返回美
国,争取到更多的资助的人手后,于次年重返玻利维
亚,进行深入的研究,可是没多久,两人也被感染,被
送到巴拿马抢救,幸好当地军队医院的医生有在韩 战期
间治疗流行病出血热的经验,用同样的办法救活了两
人。

恢 复过来后,两人认为自己已经具备了免疫力,再次来
到玻利维亚,成功地发现了病原,这是一种新型病毒,
被命名为马丘坡(MACHUPO)病毒,进一步发现当 地
的一种小鼠是这种病毒的携带者和传播者,通过灭鼠解
决了出血热流行。这场流行感染者470人死者192人,
死亡率40%。之后病毒消失,一直到1994 年才再次出
现,10人感染6人死亡,死亡率60%。

马丘坡病毒是现在已知的烈性病毒之一,可以通过血液
和接触感染,病毒在空气中能够存活。但这种病毒对人
类的威胁不大,因为其天然宿主Calomys Calosus小鼠
生存在玻利维亚丛林深处,由于交通不便,形成了一道
天然屏障,使得这种烈性病毒不能在人群中扩散。

14 年后,回想起在玻利维亚几乎丧命的经历依然心悸
的约翰逊来到扬布库村,先将血液样品送CDC等实验
室,经过电镜检查,确定是病毒感染。这种病毒和1967
年在西德和南斯拉夫出现的马尔堡(Marburg)病毒相
似。马尔堡病毒也引起出血热,那次流行31人发病,7
人死亡,死亡率23%。1975年在南非有 3人发病,1人
死亡。后来时有流行,最严重的一次是2004到2005年
在安哥拉的流行,252人感染,227人死亡,死亡率
90%。



扬布库村发现的病毒被按流经本地的埃博拉(Ebola)
河的名字被命名为埃博拉病毒,和马尔堡病毒组成新的
丝线状病毒科。

在 进行紧急处理之后,根据马丘坡病毒的先例,约翰逊
认为下一步要找到传播源,从而控制流行。埃博拉病毒
毫无疑问是一种动物病毒,也毫无疑问是一种能够从动
物 传染给人的病毒,其源头应该是某种不会得出血热的
携带埃博拉病毒的野生动物,很可能还有一种动物作为
中间宿主将埃博拉病毒从原宿主带入人群,这种中间宿
主 应该是一种和人类有接触的动物,而原宿主则是和人
类无接触的动物,这样才能解释为什么突然出现埃博拉
病毒流行。



根 据这个推论,专家组从扬布库村的动物开始,先在村
落里抓了818个臭虫,没有发现携带埃博拉病毒的痕
迹。下一个怀疑对象是蚊子,逮了很多蚊子,没有发现
埃 博拉病毒。那么就可能是家畜了,在村落里抽了10
头猪和1头母牛的血,一无所获。也许是鼠类,抓了69
只耗子、30只大鼠和8只松鼠,也一无所获。只好扩 大
范围,抓了6只猴子、2头鹿和7只蝙蝠,依旧一无所
获,也没有其他动物可以抓了。

此时患病者死亡率达到88%,专家组给扎伊尔卫生部提
出几条防疫建议,结束了这次行动。离开扬布库村时,
专家组有一种预感,埃博拉病毒不会像马丘坡病毒那样
重新返回丛林,因为这种凶悍病毒的宿主和传播途径都
是未知。



也是在1976年,苏丹西南部也发生不明原因的传染病流
行,WHO派出专家组,从重症病人身上抽血后送英国
微生物学研究所,希望那里的实验室能够发现病因。

1976年11月5日,在微生物研究所实验室工作的杰弗里·
普莱特(Geoffrey Platt)用注射器将一只感染了苏丹病
人血液的豚鼠的肝脏取出来,准备给另外一只豚鼠接
种,不小心针头扎到了自己的拇指。

普 莱特心里大叫不好,他知道苏丹疫区的病死率已经超
过50%,赶紧摘下手套,将拇指泡在消毒液中,努力地
想挤出几滴血,但挤不出来,他的情绪镇静下来,仔细
看看拇指,没有找到伤口。他知道有两种可能,一是没
有扎进去,二是伤口很小,已经愈合了。前者是好事,
后者则是坏事。普莱特尽力安慰自己,往第一种可能处
想,即便是第二种可能,按照其他病毒传播的情况,这
么一点点,应该不可能造成感染。

但是,4天后,普莱特病倒了。



苏丹的传染源也找到了:埃博拉病毒。

普莱特被送进一间特殊病房,按生物安全3级的标准,
房间为负压,医生护士戴口罩。先对他进行干扰素治
疗,然后从非洲空运来一位从埃博拉病毒感染中恢复过
来的病人的血清,给他注射。

4天后,普莱特的病情加重,呕吐腹泻之外,有免疫系
统衰竭的迹象,医生只能给他多用非洲运来的血清。

到第8天,普莱特从鬼门关上回来了,经过很长一段时
间的康复后出院,不仅体重下降,而且头发几乎掉光
了。

得益于及时的治疗,普莱特捡了一条命,也证明了一件
事:埃博拉病毒的感染力超强。

2.埃博拉病毒类型之谜

苏丹的流行发生在苏丹与扎伊尔边境,离扬布库村500
英里,死亡151人,占感染者总数的53%,低于扎伊尔
流行的死亡率。其病毒也和扎伊尔的病毒有很大区别,
这样就有了埃博拉病毒扎伊尔型和苏丹型。

埃博拉病毒为什么于1976年突然在扎伊尔和苏丹同时流
行,而且是两种不同的型?

没有答案。

次年,扎伊尔西南部的一家教会医院收住了一位得出血
热的9岁女孩,血样被送到CDC,约翰逊实验室进行培
养后,证实是埃博拉病毒,女孩死亡,其感染途径不得
而知。

两年后,在苏丹流行地再次出现埃博拉病毒流行,22人
死亡,死亡率65%,依旧低于扎伊尔型。

之后,埃博拉病毒在非洲消失15年之久。

由 于没有解决埃博拉病毒的宿主和传播问题,约翰逊一
直希望重返扎伊尔,但苦于没有经费。1979年,他利用
WHO在当地进行猴痘研究的机会,再次来到扎伊 尔,
在本巴地区、扎伊尔北部和喀麦隆东南部,大规模采取
动物样品,一共采集了1500多个动物,包括117种,
血、肝、脾、肾样品取出后,冷冻后送 CDC。

约翰逊后来在《传染病杂志》发表论文,对这次大规模
采样进行总结:一无所获。

埃博拉病毒的来源和传播途径成了约翰逊最大的遗憾。

埃博拉病毒在非洲两地同时流行,传播性强,死亡率极
高,使得科学家认为很可能是下一次瘟疫,但流行之
后,经过些许余波,埃博拉病毒归隐丛林,让科学家们
松了一口气,但他们不敢放松警惕,继续对扎伊尔、苏
丹等地进行埃博拉病毒流行病监测。

十年磨剑,埃博拉病毒在非洲毫无动静。但专家们万万
没有想到,埃博拉病毒竟然出现在一个意想不到的地
方。

十几年前在一次面试中,得知我的医学背景后,对方脱
口而出:你知道几年前机场路抓猴的事吗?

这一问让我借来理查德·普雷斯顿(Richard Preston)
的《The Hot Zone》,看完后按图索骥般地实地考察,
那是一片和我现在公司所在地极其相似的郊区办公区,
离我现在公司所在地不远,离我家也不过10英里之遥。

莱斯顿(Reston),位于维吉尼亚州北部,临杜勒斯国
际机场,距美国首都哥伦比亚特区20英里,是美国的IT
重镇之一。



1989 年,位于莱斯顿的康宁公司下属Hazelton
Research Products公司的莱斯顿灵长类检疫中心来了
一批从菲律宾进口的用于医学实验的长尾猕猴,到货的
时候发现在路上死了两只,这种情况不算什么,类似的
动 物长途运输常常会导致动物死亡,有时候甚至全军尽
没。

猕 猴被运到莱斯顿的灵长类检疫中心后继续发生死亡事
件,这一下就不正常了,在美国,猴子这种大型的实验
动物很贵,照顾起来比对自己家的孩子还要精心,绝对
不 会发生虐待的事情,猴子是得病死的,每天死两到三
只猴子说明是一种传染病,引起了中心人员的警惕,进
一步观察,死亡的猴子有出血热症状,有人突然想到埃
博 拉病毒。

这 一下就成为美国卫生防疫最大的警报了,陆军传染病
研究所闻讯而来,场景如同好莱坞大片,军方将中心剩
下的猴子全部杀死,对中心进行全面消毒,后来房屋被
推 倒重建。实验室发现确实是埃博拉病毒,和扎伊尔
型、苏丹型有区别,进而发现中心的6位工作人员血液
中出现该病毒的抗体,表明已经被感染,根据这些情
况,专 家认为此型病毒可以通过空气传播。

也就是说,这型埃博拉病毒具备流感病毒的传播能力,
参照扎伊尔和苏丹的流行情况和死亡率,加上美国首都
郊区密集的人口,一场大祸临头。

不仅相关人员陷入死亡的恐惧中,整个华府开始骚动,
高层寝食难安,不知道疫情扩散的情况,更不知道一旦
出现埃博拉病毒流行,华府地区以至美国会发生什么情
况?

山雨欲来风满楼之际,这几位感染者居然一直没有发
病,让大家把心放回肚子里。专家前往菲律宾,在马尼
拉附近的一家猴出口商处发现大批死于埃博拉病毒感染
的猴子,也发现了12名血液中有该病毒抗体的菲律宾
人,这12位感染者同样没有任何症状。

于是埃博拉病毒又多了一型,莱斯顿型。这型埃博拉病
毒可以感染猴而且死亡率极高,也可以感染人可是不会
引起任何症状。

1992 年11月,位于西非的科特迪瓦的一家国家公园内
的黑猩猩开始死亡。瑞士生物学家克里斯托弗·伯施
(Christophe Boesch)在此研究黑猩猩15年了,发现
黑猩猩数量减少,一部分黑猩猩死亡,另外一部分不见
了。1994年,在解剖一具黑猩猩尸体的时候,一位34
岁 的瑞士籍女研究生发病,被送进医院,按疟疾进行治
疗,病情恶化后被运回瑞士。在瑞士,医生们用各种病
毒的抗体,包括埃博拉病毒已知三型病毒的抗体进行检
测,查不出病因。最后经过进一步检查,发现了另外一
型埃博拉病毒,科特迪瓦型。

这位女科学家幸运地活了下来,体重减轻了十几磅,头
发也几乎掉光了,并且成为第一位将埃博拉病毒带出非
洲大陆的人。

3.埃博拉病毒宿主猜想

基克威特(Kikwit)是扎伊尔班敦杜(Bandundu)省
最大的城市,1995年人口超过20万,尽管如此,这座
城市依旧被丛林环绕。

1995年1月6日,基克威特郊外的一位42岁的农民死于
出血热。

很 快,他的三名家庭成员死于出血热。一周后,村里有
10个与死者接触过的人死于出血热,其中有人去过城里
的妇产医院,导致一名实验室技术员被感染。该技术员
被送到基克威特总医院进行治疗,院方认为是伤寒导致
的腹部穿孔,对他进行了腹部手术,结果做手术的几名
医生和护士都被感染,前来为他祈祷的两位意大利籍修
女也被感染,病人和两位修女很快去世。本地卫生部门
对此认为是痢疾流行,没有采取任何措施,于是本地几
家医院的医护人员和病人相继被感染。

扎伊尔卫生部的一位医生觉得是病毒性出血热,能够导
致这么严重出血热等很可能是埃博拉病毒感染,在他的
建议下,病人血液样本送到美国CDC,确定是埃博拉病
毒感染,已经是5月9日了。整个流行期间,死亡245
人,包括60名医护人员。

时 隔超过15年,埃博拉病毒在扎伊尔再现,尽管确定
病因已经太晚,对控制感染流行毫无帮助,但美国CDC
还是组织了由CDC、美国陆军传染病研究所专家组成 的
团队,在扎伊尔专家的陪同下来到基克威特,希望完成
约翰逊当年没有完成的任务,找出埃博拉病毒的宿主,
为此,专家组还请来一位对啮齿类动物很有研究的丹 麦
专家。



专家组先来到第一位死者的农场,花了三个月的时间抓
了上千只动物,主要是一些小动物和鸟类,在城中则逮
了一批蝙蝠。然后将这些动物杀死,取出脾脏和血样,
还取出部分肝脏和肾脏,也抽了当地猪、牛和猴子的
血,一共采集了3066份血样和2730个脾,送CDC检
测。

结果和约翰逊当年一样:一无所获。

埃博拉病毒的来源和传播途径还是一个未解之谜。

埃博拉病毒再一次突然出现,然后又突然地归隐丛林。

专家组认为他们错过了埃博拉病毒的流行期,但根据原
有的资料和这三个月的研究,对埃博拉病毒的来源提出了
三点假设。

1。埃博拉病毒的原宿主是哺乳动物。
2。埃博拉病毒流行都和丛林有关,因为其原宿主是一
种丛林动物。
3。这种动物或者是一种稀有动物,或者和人类接触的
机会极其罕见。

1996年,俄国国防部下属一家病毒学研究所的一位女研
究人员在从事制备马抗埃博拉病毒时被感染后死亡,成
为第一位死于埃博拉的非非洲人和第一位因为研究埃博
拉病毒而死的研究人员。因为俄国的埃博拉病毒研究有
生物战的背景,整个事故的详细情况不得而知。

加蓬与扎伊尔交界处有一个隔绝的小村庄,叫梅依波特
2(Mayibout 2),取这个名字的原因是在伊温多
(Ivindo)河下游1英里处还有一个较大的村庄叫梅依
波特。

1996年2月,梅依波特2号村里有18人突然同时生病。

在生病之前他们一起做了一件事:屠宰了一只黑猩猩,
然后饱餐一顿。
黑猩猩肉是非洲人饮食结构的一个组成部分,当然黑猩
猩也不示弱,抽空会掠走小孩然后吃掉。黑猩猩的武力
胜于人类,非洲猎人又不屑用现代化武器,于是在狩猎
中人类与黑猩猩之间的密切接触甚多,据推测艾滋病就
是这么样从黑猩猩传到人类。

但是,这一次梅依波特2号村的村民是不劳而获。村里
的几个孩子在丛林中发现了一只死去的黑猩猩,合力把
它运回村子,那只猩猩的肚子鼓鼓的,但很久没有敞开
肚皮吃肉的村民不在乎,兴高采烈地把它吃了。

18位病人的症状包括发烧、喉咙疼、头疼、呕吐、眼眶
出血、肌肉疼,牙龈出血、便血等,一看大事不好,村
长下令:送医院。

最 近的医院在50英里外的马科库(Makokou)镇,沿
河而下要走7个小时,到达马科库后,四名病人在两天
内死亡,其中一具尸体被运回梅依波特2号村下 葬,还
有一位病人逃出医院,挣扎着回到梅依波特2号村并死
在这里。很快感染蔓延开来,一共31人患病,21人死
亡,死亡率为68%。流行期间,有加蓬医生 和法国医生
组成的专家组来到梅依波特2号村,发现流行的是埃博
拉病毒。



就这样,黑猩猩走进了埃博拉的盛宴。

黑猩猩是人类最亲的动物,再远还有大猩猩。黑猩猩的
数量超过10万,大猩猩的数量不足5万而且一直在下
降。

梅 依波特2号事件之后,在中非进行野生动物研究的科
学家们注意到在野外看到的大猩猩越来越少。到了2002
年,常常会见到大猩猩的尸体,其中一些血液呈埃博 拉
病毒阳性。短短几个月内,一组科学家跟踪的143只大
猩猩的90%不见了,不知道是逃离家园还是死于埃博拉
病毒感染。科学家们估计,埃博拉病毒至少已经 杀死了
5000只大猩猩。

按这个很保守的估计,埃博拉病毒杀死了超过10%的大
猩猩。

如果这场灾难换成人类,将有多少人死亡?

4.埃博拉病毒感染事件

2000年,乌干达加入埃博拉病毒大家庭,在与苏丹交接
的北方的古鲁(Gulu)镇出现苏丹型埃博拉病毒流行。
埃博拉病毒从一个村庄传到另外一个村庄,也通过病人
从一家医院传到另外一家医院,从北方传到西南方,一
共杀死224人,占感染者的53%。

非常巧合,这型病毒1976年在苏丹流行的死亡率也是
53%。

2001年到2003年,科学家在加蓬和刚果再一次进行大
规模调查,希望找到埃博拉病毒的宿主。他们收集了
222个不同鸟类的样品、129个小动物样品和679个蝙蝠
的样品,用抗体法和PCR法同时检测,这一次在三种蝙
蝠样品中发现埃博拉病毒感染的迹象。



这 三种蝙蝠都是体型很大的水果蝙蝠,其中最大的一种
体型如牛,非洲人将之猎来当食物。16个蝙蝠样品有埃
博拉病毒抗体,13个蝙蝠样品有埃博拉病毒基因片
段,一共29个样品,相比采集的679个蝙蝠样品,只占
4%。这些阳性样品中,或者有抗体或者有病毒基因,
没有两者兼有的,也没有从蝙蝠体内发现活病毒, 因此
这项调查虽然和前几次调查相比,终于获得了有价值的
东西,但蝙蝠作为埃博拉病毒宿主的证据还不充分,之
后科学家继续在非洲疫区抓蝙蝠,希望能分离到埃 博拉
病毒,始终没有成功。

蝙蝠从一开始就被怀疑,原因之一是非洲的一些蝙蝠体
型很大,是非洲人肉食的一部分。原因之二是蝙蝠特别
是水果蝙蝠有劣迹。

1999年,马来西亚和新加坡发生尼帕(Nipah)病毒流
行,病毒的名字来自第一次检测到病毒流行的村庄。
257人感染,100人死亡,死亡率39%,存活者中超过
50%留下严重的脑部损伤。

一开始,这场病毒感染流行被认为是日本脑炎(乙脑)
病毒引起的,因为得病者都是养猪场的工人,而猪是日
本脑炎病毒的扩增体。但其症状使得研究人员认定是一
种新型病毒,从而发现了这株病毒。

新病毒病出现,首先怀疑是来自动物的,对尼帕病毒也
一样,研究人员马上着手发现其宿主和传播途径,经过
多年的研究,搞清了尼帕病毒的前因后果。

在尼帕病毒的传播中,猪起到了中间宿主的作用,这是
很容易断定的,因为马来西亚的养猪业存栏猪的密度很
高,非常容易传播和扩散传染性动物源疾病。

马 来西亚养猪业为了效益,在猪厂了种了很多芒果树,
这样养猪的同时还能收获芒果。对这种安排,猪很高
兴,因为常用熟透的芒果从树上掉下来,成为猪的佳
肴。另 外还有一种动物很高兴,因为它们有芒果吃了,
这是一种水果蝙蝠,以吃水果为食,学名叫Pteropus。
当地人没这么斯文,称之为飞狐。

金庸写《雪山飞狐》,不知是否从马来水果蝙蝠处得到
灵感?

正是飞狐这种野生动物携带了尼帕病毒,在吃芒果时将
病毒通过唾液和尿液留在吃剩的芒果里,这些芒果掉在
猪圈里,让猪吃了,感染在猪群里扩散,等猪出栏了,
尼帕病毒就由猪传播到其他地方。

尼帕病毒在人群中出现,得益于亚洲饲养业的大力发
展。之后,南亚共发生12起尼帕病毒流行。在孟加拉和
印度,主要是因为吃了被病毒感染的水果或水果制品所
致,而且出现从人到人的传播,甚至多达半数。
2003年萨斯(SARS)引起轩然大波,其源头最后被指
向蝙蝠。

近年来出现的新型冠状病毒感染,也是来自蝙蝠。

从传染病的角度,蝙蝠成为人类的大敌。

非洲蝙蝠和埃博拉病毒的相关性始终没有得到确定,只
能证明蝙蝠能够被该病毒感染。近年在亚洲蝙蝠中也发
现埃博拉病毒的抗体,在孟加拉进行的研究发现3.5%的
蝙蝠有扎伊尔型或莱斯顿型埃博拉病毒抗体,提示埃博
拉病毒可能从非洲到了亚洲。

蝙蝠是埃博拉病毒的原宿主还是中间宿主?蝙蝠能否传
播埃博拉病毒?这些问题依然没有答案。埃博拉病毒的
来源和传播途径还是一个谜。



2004 年,俄国再次出现实验室事故,这一次外界得知
了详情。4月5日,中西伯利亚Vektor州立病毒学和生物
技术研究中心46岁的研究员Antonina Presnyakova在进
行埃博拉病毒研究时扎伤了自己,很快出现症状,于5
月19日去世。这里于1988年和1990年两次出现马尔堡
病毒扎伤事故, 研究人员一人死亡一人存活。

2007年11月,第五次埃博拉病毒流行出现在乌干达西
部。

2007 年11月5日,乌干达卫生部收到报告,在于刚果交
界的山村本迪布焦(Bundibugyo)出现20例不明死
亡。因为死亡者中只有少数有出血症状,一开始 并没有
怀疑是埃博拉病毒感染。血样送美国CDC,到11月28
日,CDC回复:是一种新型埃博拉病毒。这种新型埃博
拉病毒就被称为本迪布焦型。这次流行导 致116人感
染,39人死亡,死亡率34%。

除了上面所述上百名感染者的流行外,还有很多次感染
者在百人以下的小规模流行,死亡率从47%到91%。最
近的是2012年分别发生在乌干达和刚果的小规模流行。



埃博拉病毒并没有归隐丛林。

5.埃博拉病毒究竟是什么

2007年乌干达西部大流行为埃博拉病毒分型画了一个句
号,迄今发现了5型埃博拉病毒,只有莱斯顿型仅感染
和致死猴子,能感染人但不出现症状,其余四型对人类
都有剧毒,而且能在人与人之间传播,因此被成为第四
级病毒,是人类面临的最凶狠的病毒。

埃博拉病毒虽然凶狠,但这四型对人有剧毒的埃博拉病
毒均局限在非洲大陆,而且局限在中非和西非,虽然多
次流行,但感染者多不过数百人,疫情范围也局限在本
地区,因此并没有成为人类迫在眉睫的危机。

但 以埃博拉病毒为首的烈性动物病毒一直是人类的心腹
之患。人类的烈性传染病的病原最早都是来自动物,是
动物携带的微生物进入人类并具备在人与人之间传播能
力 后形成的瘟疫。从这个角度,埃博拉病毒已经具备了
瘟疫病毒的能力,相比之下,禽流感并不能在人与人之
间传播。但是,埃博拉病毒虽然传播能力强,其传播有
很 强的地域局限性,传播的持续能力也不足,才没有引
起大范围的流行。



但 是,以菲律宾为源头的莱斯顿型埃博拉病毒则敲响了
警钟。按理说,埃博拉病毒都源自非洲,蝙蝠是不可能
从中非飞到菲律宾的,究竟是怎么传过去的?其他型埃
博 拉病毒是否也会通过其他途径传出来?或者被飞机带
出中非?一旦出现这种情况,埃博拉病毒传播的局限就
有可能被打破,比如出现在大城市里,那样会是什么情
况?

因此,必须继续研究埃博拉病毒,特别是搞清其传播途
径,但这一点很困难,因为埃博拉病毒一出现往往在几
天内就杀死感染者,而且都发生在边远地区,流行也没
有什么规律,使得流行病学研究很困难,往往等专家赶
到了,流行已经结束了,埃博拉病毒踪迹全无。



目前对埃博拉病毒和马尔堡病毒的疫苗研究一直在进行
中,希望有朝一日能研制成功有效的疫苗。

对于埃博拉病毒本身则有两种截然不同的看法,一种认
为这是一种很古老的病毒,另一种认为这是一种新型病
毒。

第 一种看法认为埃博拉病毒早就在丛林中存在的,自
1976年以来的历次流行都是偶然事件,是人类由于种种
原因接触了埃博拉病毒的感染对象和宿主而导致的。第
二种看法则认为埃博拉病毒很可能是一种古老病毒演化
出来的新种,自1976年以来的所有流行都是埃博拉病毒
逐渐扩散的结果,所有埃博拉病毒都来自1976 年扎伊
尔流行株。这两种看法都有根据也都没有确凿的证据,
双方的共同点是倾向于蝙蝠是宿主,但并非唯一宿主,
可能还有另外一种更古老的动物也是埃博拉病毒 的宿
主。目前埃博拉病毒主要在大猩猩中流行,对人类的危
害还不大。

这 两种看法中第二种的可能性最大,因为如果是偶然事
件的话,应该一直有埃博拉病毒流行,而不是从1976年
才开始。近代来在中非并没有出现人类大规模侵袭丛 林
的迹象,也没有艾滋病毒扩散那种社会生态变化。然
而,第二种看法对于人类来说是不寒而栗的,它预示一
种中者死亡过半的烈性传染病正在走出丛林,渐渐地在
非洲扩散,终有一日,这种烈性传染病会真正走出丛
林、走出非洲,成为下一个瘟疫。

埃博拉病毒是动物源传染病的代表,和禽流感等疾病不
一样,埃博拉病毒不是因为人类侵袭动物领地或者大规
模进行饲养业造成的,埃博拉病毒等动物病毒来自人类
早已走出的丛林,是动物病毒主动出击。

从 牛痘苗到磺胺、抗生素,人类陆续征服了很多烈性传
染病,导致人口膨胀、人类平均寿命大幅度提高,文明
水平也突飞猛进,让人类认为已经掌握了自己的命运。
自 从进入农耕社会之后,人类也进入了瘟疫时代,烈性
传染病相继出现,甚至常年流行。相比于我们的祖辈,
由于微生物学和免疫学的进步,我们所受到的传染病的
威 胁已经大大地降低了,但并不表明我们已经走出瘟疫
时代,艾滋病就是一个典型的例子。埃博拉病毒则预示
了另外一种可能,我们快要走出瘟疫时代的幸福时光,
很 快就要重新进入黑暗时光。



人类来自非洲丛林,埃博拉病毒也来自非洲丛林,从这
一点上来说,它和其他丛林病毒才是真正可怕的。人类
之所以走出丛林,就是因为无法征服丛林。黑猩猩、大
猩猩之所以没有成为人类,就因为它们没有走出丛林。

既然走出丛林,就只能靠科学的力量去面对丛林中的恶
魔。

来源:京虎子博客

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共有13条评论
1   [dokknife 于 2014-08-26 15:37:42 提到] [FROM: 72.]
一医生死于埃博拉 服用了试验药

2014-08-26 12:19:33 纽约时报

  官员周一透露,一名感染埃博拉病毒的利比里亚医生服用了试验药物
ZMapp,但已经死亡。两名受感染的美国人也服用了相同的药物。

  美联社(The Associated Press)援引利比里亚信息部长的话报
道,利比里亚最大医院的副首席医师亚伯拉罕·柏伯(Abraham Borbor)
得到了圣迭戈一家公司生产的这种药物中,仅存不多的一些。
  两名服用ZMapp的美国人都供职于慈善机构撒玛利亚救援会
(Samaritan's Purse),这两人在亚特兰大的埃默里大学医院(Emory
University Hospital)接受治疗后活了下来。两人上周出院后,为他
们进行治疗的医生表示,不知道这种药物是帮助了他们,还是没有效果,或
者甚至延缓了康复。这种药物是在烟草植株中培育的老鼠抗体制备的“鸡尾
酒”药物。

  一名西班牙神父得到了最初六剂药物中的一剂。之后这位神父也去世
了,不过部分原因在于他75岁的年龄。

  还是在周一,刚果民主共和国东北部一座偏远村庄,爆发了另一起埃博
拉病毒疫情。该国政府的一家实验室透露,爆发的疫情属于一个不同的变
种,与近3000英里以外的西非爆发的疫情无关。

  世界卫生组织(World Health Organization)指定的一家实验室
将会检验这次疫情中提取的样本。此次疫情是在赤道省爆发的。

  现在已知民主刚果爆发的疫情造成了13人死亡。这个国家旧称扎伊尔,
自从1976年在民主刚果的埃博拉河(Ebola River)附近的一个村庄发现
这种病毒以来,疫情已在该国爆发过六次。

  周一,尼日利亚将该国的埃博拉病例人数从14人减少到13人。卫生部
长表示,最近的一个病例系假阳性。

  一名在塞拉利昂感染病毒的英国护士周日晚间由英国皇家空军(Royal
Air Force)接回英国,并在伦敦入院治疗。

  此次疫情中,已有240名医疗工作者患病,世卫组织周一透露,其中半
数已经死亡。该组织透露,在过去爆发的疫情中,在得知患者感染的是埃博
拉病毒,并采取个人防护措施后,医护人员的死亡率会大幅降低。

  世卫组织上周五发布的数据更新显示,已有四个国家的2615人感染,
1427人死亡。

  上述的29岁护士威廉·普利(William Pooley)自3月以来就在塞拉
利昂,为即将因癌症或艾滋病而去世的患者提供安宁疗护,当时埃博拉病毒
也开始在那里蔓延。他志愿前往凯内马医院(Kenema Hospital)工作。
那所医院已经有22名当地医疗工作者去世,被人形容为“死亡陷阱”。普利
在隔离病房里,在传染性很强的患者当中工作了很长时间。

  世卫组织还表示,一位与其合作机构相关的传染病专家也在塞拉利昂感
染了埃博拉病毒。该组织发言人格里高里·哈特(Gregory Hartl)说,感
染者是塞内加尔人,供职于全球疫情警报和反应网络(Global Outbreak
Alert and Response Network)。世卫组织与其他一些机构正是通过
这个网络,来应对医疗危机的。

  日本周一表示,已经做好准备,可以提供一款新型流感药物抗击埃博拉
病毒。这款药物叫做“法匹拉韦”(favipiravir)或Avigan,由日本富山
化学工业株式会社(Toyama Chemical Company)生产。还没有证据表
明它对埃博拉病毒有效。一名卫生官员表示,已经准备好4万剂药物。

  加拿大也表示,可以提供一种由特克米拉制药公司(Tekmira
Pharmaceuticals)生产的试验疫苗。目前也没有证据表明,这种药物对
人类有效。

  作者DONALD G. McNEIL Jr. 2014年08月26日。Ben C.
Solomon自塞拉利昂有报道贡献。 翻译:王童鹤
 
2   [dokknife 于 2014-08-19 13:41:10 提到] [FROM: 72.]
世卫最强警告:埃博拉被“严重低估”

2014-08-19 08:16:08 美国之音

  世界卫生组织表示,袭击了西非并夺去了1000人多性命的埃博拉危机
被“严重低估了”。另外,人道主义组织无国界医生说,这场危机可能将再持
续至少六个月。

  几内亚的安全部队在上周四拆毁了位于首都科纳克里的一处贫民窟以试
图抵御埃博拉在西非的扩散。这一行动是总统下令的清理易于病毒传播的拥
挤区域的行动的一部分。
  总统代表班古拉·卡马拉说:“说到贫民窟,这意味着各种各样的危险。
所以我们很高兴今天能够获得帮助来摧毁这些房子。这个区域对民众,对晒
鱼干的妇女以及总统卫队营房的安全都带来了危险。”

  科纳克里被认为是西非最脏乱的城市之一。但是对于住在这里的人来
说,这里是家。

  一名科纳克里贫民窟居民说:“他们对我们所做的不是好事。我们是几
内亚人,我们不是这里的外人。为什么拆毁这里?因为埃博拉。别管我们,
就让埃博拉杀死我们,也别把我们迁走。”

  人道主义组织无国界医生在上周四说,埃博拉在最初的爆发中心几内亚
的扩散已经放缓,关注的重心已经转移到了利比里亚和其他地区。该组织的
主席廖满嫦说,即使根据最乐观的估计,埃博拉危机也将持续至少六个月。
她是在疫区视察10天之后在几内亚说这番话的。

  廖满嫦说:“我真切地感觉到这是战争时期,无论你在哪里,你都能看
到恐惧,普遍的恐惧。没有人知道到底在发生什么。”

  廖满嫦说,世卫组织必须采取更多行动来维护地区稳定,特别是利比里
亚。

  她说: “世界卫生组织需要发挥领导作用,在各个操作层面上派去得力
人手。”

  恐惧使得一些国家暂停了飞往西非的航班。世界卫生组织说这是不必要
的。

  世卫组织全球紧急应急主任伊莎贝拉·努塔尔说:“空中飞行对埃博拉的
传播而言是低风险的,因为埃博拉不是空气传播的疾病。埃博拉通过与病患
接触传播,而传播是靠体液完成的。”

  埃博拉的爆发已经在今年造成了1000多人死亡和另外大约2000人患
病。该病的症状包括发热,肌肉疼痛,呕吐,腹泻以及重要器官受损引发的
出血。目前还没有治愈手段。

  专家说及早治疗是关键。

  疾病控制中心拉各斯应急组长约翰·维特福尔说:“当人们有症状的时候
立即前往医疗机构就医,这一点十分重要。”

  一些疫苗正处于研发初期。世界卫生组织已经宣布,在如此不同寻常的
严峻情况下,使用未经充分测试的药物和疫苗是合理的。
 
3   [dokknife 于 2014-08-18 11:40:04 提到] [FROM: 72.]
West Africa - Ebola virus disease

Update
Travel and transport

2014 Ebola Virus Disease (EVD) outbreak in West Africa

Travel and transport risk assessment: Recommendations
for public health authorities and transport sector

1. Summary of epidemiological facts and experience

The incubation period of Ebola virus disease (EVD)
varies from 2 to 21 days. Person-to-person
transmission by means of direct contact with infected
persons or their body fluids/secretions is considered
the principal mode of transmission. In a household
study, secondary transmission took place only if
direct physical contact occurred. No transmission was
reported without this direct contact. Airborne
transmission has not been documented during previous
EVD outbreaks.
There is no risk of transmission during the incubation
period and only low risk of transmission in the early
phase of symptomatic patients. The risk of infection
during transport of persons can be further reduced
through use of infection control precautions (see
paragraphs 3.2 and 3.3).
In the current outbreak, infected travellers have
crossed land borders with neighbouring countries and
there is a possibility that other cases might occur in
neighbouring countries.
Historically, several cases of haemorrhagic fever
(Ebola, Marburg, Lassa, Crimean Congo haemorrhagic
fever) disease were diagnosed after long distance
travel but none developed the symptoms during the
international travel. Long-distance travellers (e.g.
between continents) infected in affected areas could
arrive while incubating the disease and develop
symptoms compatible with EVD, after arrival.
2. Risk of EVD for different groups

2.1. Tourists and businessmen/women returning from
affected areas in a country

The risk of a tourist or businessman/woman becoming
infected with Ebola virus during a visit to the
affected areas and developing disease after returning
is extremely low, even if the visit included travel to
the local areas from which primary cases have been
reported. Transmission requires direct contact with
blood, secretions, organs or other body fluids of
infected living or dead persons or animal, all
unlikely exposures for the average traveller. Tourists
are in any event advised to avoid all such contacts.

2.2. Visiting families and relatives

The risk for travellers visiting friends and relatives
in affected countries is similarly low, unless the
traveller has direct physical contact with a sick or
dead person or animal infected with Ebola virus. In
such a case, contact tracing should confirm the
exposure and prevent further spread of the disease
through monitoring the exposed traveller.

2.3. Patients travelling with symptoms and fellow
travellers

There is a possibility that a person who had been
exposed to Ebola virus and developed symptoms may
board a commercial flight, or other mode of transport,
without informing the transport company of his status.
It is highly likely that such patients would seek
immediate medical attention upon arrival, especially
if well informed, and then should be isolated to
prevent further transmission. Although the risk to
fellow travellers in such a situation is very low,
contact tracing is recommended in such circumstances.

2.4. Risk for health care workers posted in affected
areas

There is a risk for healthcare workers and volunteers,
especially if involved in caring for EVD patients.
However, if the recommended level of precaution for
such settings is implemented, transmission of the
disease should be prevented. The risk level can be
considered very low to low unless these precautions
are not followed, e.g. no personal protective
equipment, needle stick injury etc.

3. Recommendations for public health authorities and
transport sectors

3.1. Recommendations for countries

3.1.1. Raise the awareness and knowledge of travellers
Travellers leaving for or arriving in an area where
EVD is occurring should be provided at points of entry
(e.g. in airports or ports on boarding or arrival
areas or at ground crossing points) with information
on the potential risk of EVD (see proposed template
below). Information should also be spread among
communities that may include cross-border travellers
and near all relevant international borders.

The information provided should emphasize that
travellers or residents in the affected areas of
countries can minimize any risk of getting infected if
they avoid:

Contact with blood or bodily fluids of a person or
corpse infected with the Ebola virus.
Contact with or handling of wild animals, alive or
dead or their raw or undercooked meat.
Having sexual intercourse with a sick person or a
person recovering from EVD for at least 7 weeks.
Having contact with any object, such as needles, that
has been contaminated with blood or bodily fluids.
Travellers should be informed where to obtain medical
assistance at the destination and who to inform (e.g.
through hotline telephone numbers).

Returning visitors from the affected areas should be
alerted that if they develop infectious disease
symptoms (such as fever, weakness, muscle pain,
headache, sore throat, vomiting, diarrhoea, rash, or
bleeding) within three weeks after return or if they
suspect that they have been exposed to Ebola virus
(e.g. volunteers who worked in healthcare settings) in
the affected areas, they should seek rapid medical
attention and mention their recent travel to the
attending physician.

Template message for travellers and EVD
Ebola Virus Disease is rare.
Infection is by contact with blood or body fluids of
an infected person or an animal infected or by contact
with contaminated objects.
Symptoms include fever, weakness, muscle pain,
headache and sore throat. This is followed by
vomiting, diarrhoea, rash, and in some cases,
bleeding.
Cases of Ebola have recently been confirmed in XXX and
YYY.
Persons who come into direct contact with body fluids
of an infected person or animal are at risk.
There is no licenced vaccine.
Practice careful hygiene.
Avoid all contact with blood and body fluids of
infected people or animals.
Do not handle items that may have come in contact with
an infected person’s blood or body fluids.
If you stayed in the areas where Ebola cases have been
recently reported seek medical attention if you feel
sick ( fever, headache, achiness, sore throat,
diarrhoea, vomiting, stomach pain, rash, or red eyes).
3.1.2. Raise the awareness and knowledge of health
care providers
Health care providers managing returning travellers
need to question them on travel history and consider
the possibility of EVD in person coming back from
affected areas. A person suspected of having been
exposed to Ebola virus should be evaluated regarding
the risk of exposure .

If the risk of exposure is considered very low, the
person should be reassured, asked to monitor his/her
temperature and symptoms for 21 days and seek
immediately care if developing symptoms. Other
pathologies (e.g. malaria) should be investigated and
the patient monitored regularly. Admission to hospital
in these observation phases is not necessary.

Essential information to be provided to health care
providers should include the following:

The most common symptoms experienced by persons
infected with the virus are the sudden onset of fever,
intense weakness, muscle pain, headache and sore
throat. This is followed by vomiting, diarrhoea, rash,
impaired kidney and liver function, and at advanced
stage, both internal and external bleeding. Laboratory
findings include low white blood cells and platelet
counts and elevated liver enzymes.
The incubation period (interval from infection to
onset of symptoms) varies between 2 to 21 days.
People are infectious as long as their blood and
secretions contain the virus. Men who have recovered
from the disease can still transmit the virus through
their semen for up to seven weeks after recovery from
illness.
Malaria, typhoid fever, shigellosis, leptospirosis,
yellow fever, dengue and other viral haemorrhagic
fevers are differential diagnoses to consider in these
patients.
If the risk of exposure is deemed high, (e.g. a
healthcare worker having experienced a needle stick
injury with a potentially contaminated needle) a
transfer to a specialized centre should be considered.
More information can be obtained at:
• Disease Outbreak News (DON) on Ebola
• Ebola virus disease fact sheet
3.1.3. Prepare health system response
In anticipation of EVD introduction, public health
authorities need to:

Sensitise staff working at “points of entry”, in
healthcare settings or involved in first response
(emergency departments, ambulance services, GP
offices, fire department, civil defence, airport
operators, aircraft operators, port health authority)
for early and advanced symptoms of viral haemorrhagic
fever.
Emphasize systematic recording in health clinics of
travel history of those with relevant symptoms.
Establish a standard diagnostic procedure for EVD and
for common differential diagnoses at an early stage
(e.g. malaria, dengue, typhoid fever, shigellosis,
cholera, leptospirosis, plague, rickettsiosis,
relapsing fever, meningitis, hepatitis, yellow fever
and other viral haemorrhagic fevers).
Establish a protocol for notification to the competent
public health authorities at an early stage if an EVD
case is suspected.
Identify and establish laboratory procedures and
operational channels to perform Ebola virus diagnostic
testing in the country or refer to the closest WHO
Collaborating Centre or reference laboratories able to
perform viral haemorrhagic fever diagnostics if cases
are suspected.
Ensure basic training of health care workers on
principles of provisional barrier and use of personal
protective equipment.
Emphasize to personnel working in the travel sector
the importance of infection control methods.
Keep the regulatory authorities (e.g. national civil
aviation authority) informed and involved in decision-
making.
If a case of EVD is suspected in a traveller, health
care facilities attending the individual should apply
the same procedures as if the EVD has already been
confirmed. This includes:

Implementing contact tracing among staff and patients
who have been in direct contact with the suspected
patient.
Setting up medical monitoring of identified contacts
(fever and prodromal symptoms);
Notifying immediately to the competent public health
authorities.
Ensuring barrier management in all areas where the
suspected patient has been treated (contaminated zone,
transition or sluicing zone, “clean” zone).
Retaining waste and any type of body fluids from
patient’s side in the contaminated zone until
appropriate decontamination and disposal provisions
are in place.
Handling and shipping patient’s samples according to
the international procedures for “transport of
category A infectious substances”.
Suspect cases coming from areas affected (e.g.
returning travellers with symptoms) identified on an
aircraft) should immediately receive medical attention
and be isolated to prevent further transmission (see
3.2).

3.1.4. Screening passengers at points of entry ( ports
, airports or ground crossing) is not recommended
Screening of passengers at points of entry (arrival or
departure) is costly and expected to have very limited
impact because it is very unlikely to detect any
arriving person infected with EVD. This is
particularly true for EVD with its incubation period
of 2 to 21 days and symptoms that are not specific. As
part of this, the use of thermal scanners that rely on
the presence of ‘fever’ in arriving passengers is
costly, unlikely to detect any arriving person
infected with EVD and is not encouraged.

Travel restrictions, closure of borders at points of
entry are not recommended

3.2. Recommendations for international air
transport
In case of a passenger presenting with symptoms
compatible with EVD (fever, weakness, muscle pain,
headache, sore throat, vomiting, diarrhoea, bleeding)
on board of an aircraft, the following measures should
be immediately considered, in accordance with
operational procedures recommended by the
International Air Transport Association (IATA):

Distancing of other passengers if possible from the
symptomatic passenger (re-seating); with the ill
travellers preferably near a toilet, for his/her
exclusive use.
Covering nose and mouth of the patient with a surgical
facemask (if tolerated).
Limiting contacts to the passenger to the minimum
necessary. More specifically, only one or two (if ill
passenger requires more assistance) cabin crew should
be taking care of the ill passenger and preferably
only the cabin crew that have already been in contact
with that passenger. This cabin crew should be using
the Universal Precaution Kit (see below).
Hand washing with soap after any direct or indirect
contact with the passenger.
Immediate notification of authorities at the
destination airport in accordance with procedures
promulgated by the International Civil Aviation
Organization (ICAO).
Immediate isolation of passenger upon arrival.
Dedicated crew member to assist the ill traveller,
should be using suitable personal protection equipment
(PPE) such as that recommended by ICAO Universal
Precaution Kit (http://www.capsca.org/CAPSCARefs.html)
for dealing with the traveller and for cleaning
procedures on board as needed.

The possibility of transmission to other co-passengers
and crew on board the aircraft should be assessed by
health care providers on arrival. If the investigation
concludes that the passenger has symptoms compatible
with EVD and had a risk exposure in affected countries
in the past 21 days, passengers as well as crew
members may be at risk if they have been in direct
contact with body fluids or heavily contaminated
objects.

The following epidemiological measures based upon
proximity to the index patient should be considered:

Passengers and crew with reported direct contact
To gather this information, any records of significant
events on the flight should be obtained from the
airline. Co-travellers and crew members who report
direct body contact with the index case should undergo
contact tracing.
Passengers seated in an adjacent seat to the index
patient
As direct contact is the main route of transmission
for Ebola virus, only passengers who were seated in an
adjacent seat to the index case on the side, in front
or behind, including across an aisle, should be
included in contact tracing.
Cleaning staff of affected aircraft section
If the case is suspected or diagnosed after leaving
the aircraft, the staff who cleaned the section and
seat where the index case was seated should also
undergo contact tracing.
At the request of airport or port health authority,
airlines may also ask some or all passengers to
provide information on their itinerary and their
contact details where there is a particular reason to
believe they may have been exposed to infection on
board of aircraft (e.g. per the ICAO public health
passenger locator form)1. Additionally, countries may
consider requiring arriving aircraft to complete and
deliver the health part of the aircraft general
declaration (in those cases where the information is
not communicated to the airport of arrival while in
flight) concerning persons on board with communicable
diseases or sources of infection (IHR Annex 9).

Passengers, crew members and cleaning staff who have
been identified through contact tracing should be
assessed for their specific level of exposure. Passive
self-monitoring of temperature (e.g. monitoring
temperature only if feeling feverish) and symptoms or
active self-monitoring (e.g. by regular temperature
measurement twice a day) for those at higher risk
level should be continued for 21 days.

These measures should also be considered if an
individual, who experienced symptoms during the
flight, has been identified as a suspect of EVD after
arrival.

References

IATA guidelines for air crew to manage a suspected
communicable disease or other public health emergency
on board
IATA guideline for cleaning crew for an arriving
aircraft with a suspected case of communicable disease
ICAO Health related documents (1) Procedures for Air
Navigation Services; (2) Annex 6 – Medical Supplies
WHO Aviation Guide which includes information on
sanitizing of aircraft
3.3. Recommendations for ships

In case of a passenger presenting with symptoms
compatible with EVD (fever, weakness, muscle pain,
headache, sore throat, vomiting, diarrhoea, bleeding)
on board of a ship, the following precautions must be
applied:

Keep his/her cabin doors closed, if not placed in an
medical isolation room on board.
Provide information about the risk of Ebola
transmission to persons who will take care of the
patient or enter the isolation area.
A log listing all people entering the cabin should be
maintained.
Anyone who enters the cabin to provide care to the
person in isolation or to clean the cabin must wear
PPE with :
A surgical protection mask; and eye protection or a
face shield
Non-sterile examination gloves or surgical gloves;
Disposable impermeable gown to cover clothing and
exposed skin. A waterproof apron should be worn over a
non-impermeable gown or when coming in close contact
with the person in isolation
Before exiting the isolation the PPE should be removed
in such a way as to avoid contact with the soiled
items and any area of the face.
Limit the movement and transport of the patient from
the cabin for essential purposes only. If transport is
necessary, the patient should wear a surgical mask.
Clean and disinfect spills without spraying or
creating aerosol. Used linen, cloths, eating utensils
laundry and any other item in contact with a patient’s
body fluids should be collected separately and
disinfected in such a way as to avoid any creation of
aerosol or any contact with persons or contamination
of the environment. Effective disinfectant is a
dilution of sodium hypochlorite at 0.05 or 500 ppm
available chlorine, with a recommended contact time of
30 minutes.
All waste produced in the isolation cabin must be
handled according to the protocol of the ship for
clinical waste. If incinerator is available on board,
then waste must be incinerated. If waste must be
delivered ashore, then special precautions are needed
and the port authority should be informed before waste
delivery.
Start case investigation immediately. Protective
equipment is not required when interviewing
asymptomatic individuals, when a distance of one metre
is maintained.
Close contacts should be identified and asked to do
passive self-monitoring of temperature (e.g.
monitoring temperature only if feeling feverish) and
symptoms or active self-monitoring (e.g. by regular
temperature measurement twice a day and for 21 days.
In the event of a suspected diagnosis of EVD on a
ship, immediate expert medical opinion should be
sought and the event must be reported as soon as
possible to the next port of call by the Captain.

The patient should disembark in such a way as to avoid
any contact with healthy travellers and wearing a
surgical mask. Personnel in contact with the patient
during the medical evacuation should wear a surgical
protection mask and PPE.

The competent authority at port may need to arrange
depending on the situation: medical evacuation or
special arrangements for disembarkation and
hospitalization of the patient and laboratory
diagnosis.

Passengers, crew members and cleaning staff who have
been identified through contact tracing should be
assessed for their specific level of exposure. Passive
self-monitoring of temperature (e.g. monitoring
temperature only if feeling feverish) and symptoms or
active self-monitoring (e.g. by regular temperature
measurement twice a day) for those at higher risk
level should be continued for 21 days.

At the request of a governmental port health
authority, ship operators shall also facilitate
obtaining, from some or all passengers, to provide
information on their itinerary and their contact
details (should they need to be contacted) when there
is a particular reason to believe they may have been
exposed to infection on board of the ship.
Additionally, countries may consider requiring
arriving ships to complete and deliver the Maritime
Declaration of Health (IHR Annex 8). Measures taken on
board should also be noted on the IHR Ship sanitation
control certificate (IHR Annex 3)


Frequently asked questions on Ebola virus disease

Updated 8 August 2014

Download the FAQ on Ebola in pdf
pdf, 204kb
1. What is Ebola virus disease?

Ebola virus disease (formerly known as Ebola
haemorrhagic fever) is a severe, often fatal illness,
with a death rate of up to 90%. The illness affects
humans and nonhuman primates (monkeys, gorillas, and
chimpanzees).

Ebola first appeared in 1976 in two simultaneous
outbreaks, one in a village near the Ebola River in
the Democratic Republic of Congo, and the other in a
remote area of Sudan.

The origin of the virus is unknown but fruit bats
(Pteropodidae) are considered the likely host of the
Ebola virus, based on available evidence.

2. How do people become infected with the virus?

In the current outbreak in West Africa, the majority
of cases in humans have occurred as a result of human-
to-human transmission.

Infection occurs from direct contact through broken
skin or mucous membranes with the blood, or other
bodily fluids or secretions (stool, urine, saliva,
semen) of infected people. Infection can also occur if
broken skin or mucous membranes of a healthy person
come into contact with environments that have become
contaminated with an Ebola patient’s infectious fluids
such as soiled clothing, bed linen, or used needles.

More than 100 health-care workers have been exposed to
the virus while caring for Ebola patients. This
happens because they may not have been wearing
personal protection equipment or were not properly
applying infection prevention and control measures
when caring for the patients. Health-care providers at
all levels of the health system – hospitals, clinics,
and health posts – should be briefed on the nature of
the disease and how it is transmitted, and strictly
follow recommended infection control precautions.

WHO does not advise families or communities to care
for individuals who may present with symptoms of Ebola
virus disease in their homes. Rather, seek treatment
in a hospital or treatment centre staffed by doctors
and nurses qualified and equipped to treat Ebola virus
victims. If you do choose to care for your loved one
at home, WHO strongly advises you to notify your local
public health authority and receive appropriate
training, equipment (gloves and personal protective
equipment [PPE]) for treatment, instructions on proper
removal and disposal of PPE, and information on how to
prevent further infection and transmission of the
disease to yourself, other family members, or the
community.

Additional transmission has occurred in communities
during funerals and burial rituals. Burial ceremonies
in which mourners have direct contact with the body of
the deceased person have played a role in the
transmission of Ebola. Persons who have died of Ebola
must be handled using strong protective clothing and
gloves and must be buried immediately. WHO advises
that the deceased be handled and buried by trained
case management professionals, who are equipped to
properly bury the dead.

People are infectious as long as their blood and
secretions contain the virus. For this reason,
infected patients receive close monitoring from
medical professionals and receive laboratory tests to
ensure the virus is no longer circulating in their
systems before they return home. When the medical
professionals determine it is okay for the patient to
return home, they are no longer infectious and cannot
infect anyone else in their communities. Men who have
recovered from the illness can still spread the virus
to their partner through their semen for up to 7 weeks
after recovery. For this reason, it is important for
men to avoid sexual intercourse for at least 7 weeks
after recovery or to wear condoms if having sexual
intercourse during 7 weeks after recovery.

Generally, a person must come into contact with an
animal that has Ebola and it can then spread within
the community from human to human.

3. Who is most at risk?

During an outbreak, those at higher risk of infection
are:

health workers;
family members or others in close contact with
infected people;
mourners who have direct contact with the bodies of
the deceased as part of burial ceremonies.
More research is needed to understand if some groups,
such as immuno-compromised people or those with other
underlying health conditions, are more susceptible
than others to contracting the virus.

Exposure to the virus can be controlled through the
use of protective measures in clinics and hospitals,
at community gatherings, or at home.

4. What are typical signs and symptoms of
infection?

Sudden onset of fever, intense weakness, muscle pain,
headache and sore throat are typical signs and
symptoms. This is followed by vomiting, diarrhoea,
rash, impaired kidney and liver function, and in some
cases, both internal and external bleeding.

Laboratory findings include low white blood cell and
platelet counts, and elevated liver enzymes.

The incubation period, or the time interval from
infection to onset of symptoms, is from 2 to 21 days.
The patients become contagious once they begin to show
symptoms. They are not contagious during the
incubation period.

Ebola virus disease infections can only be confirmed
through laboratory testing.

5. When should someone seek medical care?

If a person has been in an area known to have Ebola
virus disease or in contact with a person known or
suspected to have Ebola and they begin to have
symptoms, they should seek medical care immediately.

Any cases of persons who are suspected to have the
disease should be reported to the nearest health unit
without delay. Prompt medical care is essential to
improving the rate of survival from the disease. It is
also important to control spread of the disease and
infection control procedures need to be started
immediately.

6. What is the treatment?

Severely ill patients require intensive supportive
care. They are frequently dehydrated and need
intravenous fluids or oral rehydration with solutions
that contain electrolytes. There is currently no
specific treatment to cure the disease.

Some patients will recover with the appropriate
medical care.

To help control further spread of the virus, people
that are suspected or confirmed to have the disease
should be isolated from other patients and treated by
health workers using strict infection control
precautions.

7. What can I do? Can it be prevented? Is there a
vaccine?

Currently, there is no licensed medicine or vaccine
for Ebola virus disease, but several products are
under development.

Ways to prevent infection and transmission
While initial cases of Ebola virus disease are
contracted by handling infected animals or carcasses,
secondary cases occur by direct contact with the
bodily fluids of an ill person, either through unsafe
case management or unsafe burial practices. During
this outbreak, most of the disease has spread through
human-to-human transmission. Several steps can be
taken to help in preventing infection and limiting or
stopping transmission.

Understand the nature of the disease, how it is
transmitted, and how to prevent it from spreading
further. (For additional information, please see the
previous questions about Ebola virus disease in this
FAQ.)
Listen to and follow directives issued by your
country’s respective Ministry of Health.
If you suspect someone close to you or in your
community of having Ebola virus disease, encourage and
support them in seeking appropriate medical treatment
in a health-care facility.
If you choose to care for an ill person in your home,
notify public health officials of your intentions so
they can train you and provide appropriate gloves and
personal protective equipment (PPE) (gloves,
impermeable gown, boots/closed shoes with overshoes,
mask and eye protection for splashes), as well as
instructions as a reminder on how to properly care for
the patient, protect yourself and your family, and
properly dispose of the PPE after use. N.B. WHO does
not recommend home care and strongly advises
individuals and their family members to seek
professional care in a treatment centre.
When visiting patients in the hospital or caring for
someone at home, hand washing with soap and water is
recommended after touching a patient, being in contact
with their bodily fluids, or touching his/her
surroundings.
People who have died from Ebola should only be handled
using appropriate protective equipment and should be
buried immediately by public health professionals who
are trained in safe burial procedures.
Additionally, individuals should reduce contact with
high-risk infected animals (i.e. fruit bats, monkeys
or apes) in the affected rainforest areas. If you
suspect an animal is infected, do not handle it.
Animal products (blood and meat) should be thoroughly
cooked before eating.

8. What about health workers? How should they
protect themselves while caring for patients?

Health workers treating patients with suspected or
confirmed illness are at higher risk of infection than
other groups. During an outbreak a number of important
actions will reduce or stop the spread of the virus
and protect health workers and others in the health-
care setting. These actions are called “standard and
other additional precautions” and are evidence-based
recommendations known to prevent the spread of
infections. The following questions and answers
describe the precautions in detail.

Should patients with suspected or confirmed Ebola
virus be separated from other patients?
Isolating patients with suspected or confirmed Ebola
virus disease in single isolation rooms is
recommended. Where isolation rooms are not available,
it is important to assign designated areas, separate
from other patients, for suspected and confirmed
cases. In these designated areas, suspect and
confirmed cases should also be separate. Access to
these areas should be restricted, needed equipment
should be dedicated strictly to suspected and
confirmed EVD treatment areas, and clinical and non-
clinical personnel should be exclusively assigned to
isolation rooms and dedicated areas.

Are visitors allowed in areas where patients suspected
or confirmed Ebola virus disease are admitted?
Stopping visitor access to patients infected with EVD
is preferred. If this is not possible, access should
be given only to those individuals who are necessary
for the patient’s well-being and care, such as a
child’s parent.

Is protective equipment required when caring for these
patients?
In addition to standard health-care precautions,
health-care workers should strictly apply recommended
infection control measures to avoid exposure to
infected blood, fluids, or contaminated environments
or objects – such as a patient’s soiled linen or used
needles.
All visitors and health-care workers should rigorously
use what is known as personal protective equipment
(PPE). PPE should include at least: gloves, an
impermeable gown, boots/closed shoes with overshoes, a
mask, and eye protection for splashes (goggles or face
shields).
Is hand hygiene important?
Hand hygiene is essential and should be performed:

before donning gloves and wearing PPE on entry to the
isolation room/area;
before any clean or aseptic procedures is being
performed on a patient;
after any exposure risk or actual exposure with a
patient’s blood or body fluids;
after touching (even potentially) contaminated
surfaces, items, or equipment in the patient’s
surroundings; and
after removal of PPE, upon leaving the isolation area.
It is important to note that neglecting to perform
hand hygiene after removing PPE will reduce or negate
any benefits of the PPE.

Either an alcohol-based hand rub or soap and running
water can be used for hand hygiene, applying the
correct technique recommended by WHO. It is important
to always perform hand hygiene with soap and running
water when hands are visibly soiled. Alcohol-based
hand rubs should be made available at every point of
care (at the entrance and within the isolation rooms
and areas); running water, soap, and single use towels
should also be always available.

What other precautions are necessary in the health-
care setting?
Other key precautions are safe injection and
phlebotomy procedures, including safe management of
sharps, regular and rigorous environmental cleaning,
decontamination of surfaces and equipment, and
management of soiled linen and of waste.

In addition, it is important to ensure safe processing
of laboratory samples from suspected or confirmed
patients with EDV and safe handling of dead bodies or
human remains for post-mortem examination and burial
preparation. Any health-care workers and other
professionals undertaking these tasks in connection
with suspected or confirmed patients with Ebola virus
disease should wear appropriate PPE and follow
precautions and procedures recommended by WHO.

9. What about rumours that some foods can prevent
or treat the infection?

WHO strongly recommends that people seek credible
health advice about Ebola virus disease from their
public health authority.

While there is no specific drug against Ebola, the
best treatment is intensive supportive treatment
provided in the hospital by health workers using
strict infection control procedures. The infection can
be controlled through recommended protective measures.

10. How does WHO protect health during outbreaks?

WHO provides technical advice to countries and
communities to prepare for and respond to Ebola
outbreaks.

WHO actions include:

disease surveillance and information-sharing across
regions to watch for outbreaks;
technical assistance to investigate and contain health
threats when they occur – such as on-site help to
identify sick people and track disease patterns;
advice on prevention and treatment options;
deployments of experts and the distribution of health
supplies (such as personal protection gear for health
workers) when they are requested by the country;
communications to raise awareness of the nature of the
disease and protective health measures to control
transmission of the virus; and
activation of regional and global networks of experts
to provide assistance, if requested, and mitigate
potential international health effects and disruptions
of travel and trade.
11. During an outbreak, numbers of cases reported
by health officials can go up and down? Why?

During an Ebola outbreak, the affected country’s
public health authority reports its disease case
numbers and deaths. Figures can change daily. Case
numbers reflect both suspected cases and laboratory-
confirmed cases of Ebola. Sometimes numbers of
suspected and confirmed cases are reported together.
Sometimes they are reported separately. Thus, numbers
can shift between suspected and confirmed cases.

Analyzing case data trends, over time, and with
additional information, is generally more helpful to
assess the public health situation and determine the
appropriate response.

12. Is it safe to travel during an outbreak? What
is WHO’s travel advice?

During an outbreak, WHO reviews the public health
situation regularly and recommends any travel or trade
restrictions, if necessary, and may inform national
authorities to implement it. WHO is currently
reviewing its recommendations for travel and expects
to issue advice in the coming days.

While travellers should always be vigilant with regard
to their health and those around them, the risk of
infection for travellers is very low since person-to-
person transmission results from direct contact with
the body fluids or secretions of an infected patient.

Is it safe to travel with persons who have Ebola?
As with any illness or disease, it is always possible
that a person who has been exposed to Ebola virus may
choose to travel. If the individual has not developed
symptoms (see FAQ #4), they cannot transmit EVD to
those around them. If the individual does have
symptoms, they should seek immediate medical attention
at the first sign they are feeling unwell. This may
require either notifying the flight crew or ship crew
or, upon arrival at a destination, seeking immediate
medical attention. Travellers who show initial
symptoms of EVD should be isolated to prevent further
transmission. Although the risk to fellow travellers
in such a situation is very low, contact tracing is
recommended under these circumstances.

Is it safe to travel to West Africa on business or to
visit family and friends?
The risk of a tourist or businessman/woman becoming
infected with Ebola virus during a visit to the
affected areas and developing disease after returning
is extremely low, even if the visit included travel to
the local areas from which primary cases have been
reported. Transmission requires direct contact with
blood, secretions, organs or other body fluids of
infected living or dead persons or animal, all of
which are unlikely exposures for the average
traveller. In any event, tourists are advised to avoid
all such contacts.

If you are visiting family or friends in the affected
areas, the risk is similarly low, unless you have
direct physical contact with a person who is ill or
who has died. If this is the case, it is important to
notify public health authorities and engage in contact
tracing. Contact tracing is used to confirm you have
not been exposed to EVD and to prevent further spread
of the disease through monitoring.

WHO’s general travel advice

Travelers should avoid all contact with infected
patients.
Health workers traveling to affected areas should
strictly follow WHO-recommended infection control
guidance.
Anyone who has stayed in areas where cases were
recently reported should be aware of the symptoms of
infection and seek medical attention at the first sign
of illness.
Clinicians caring for travelers returning from
affected areas with compatible symptoms are advised to
consider the possibility of Ebola virus disease.
For additional travel advice, please read the Travel
and transport risk assessment: Recommendations for
public health authorities and transport sector at
http://who.int/ith/updates/20140421/en/.
 
4   [dokknife 于 2014-08-18 11:34:37 提到] [FROM: 72.]
WHO Ebola news

15 August 2014

The scale, duration, and lethality of the Ebola
outbreak have generated a high level of public fear
and anxiety, which extends well beyond west Africa.
Such reactions are understandable, given the high
fatality rate and the absence of a vaccine or cure.

Recent intense media coverage of experimental
medicines and vaccines is creating some unrealistic
expectations, especially in an emotional climate of
intense fear. The public needs to understand that
these medical products are under investigation. They
have not yet been tested in humans and are not
approved by regulatory authorities, beyond use for
compassionate care.

Evidence of their effectiveness is suggestive, but not
based on solid scientific data from clinical trials.
Safety is also unknown, raising the possibility of
adverse side effects when administered to humans. For
most, administration is difficult and demanding. Safe
administration of some requires facilities for
intensive care, which are rare in west Africa.

WHO has advised that the use of experimental medicines
and vaccines under the exceptional circumstances of
this outbreak is ethically acceptable. However,
existing supplies of all experimental medicines are
either extremely limited or exhausted.

While many efforts are under way to accelerate
production, supplies will not be augmented for several
months to come. Even then, supplies will be too small
to have a significant impact on the outbreak.

WHO welcomes the decision by the Canadian government
to donate several hundred doses of an experimental
vaccine to support the outbreak response. A fully
tested and licensed vaccine is not expected before
2015.

Another source of public misunderstanding, especially
in affected areas, comes from rumours on social media
claiming that certain products or practices can
prevent or cure Ebola virus disease.

Decades of scientific research have failed to find a
curative or preventive agent of proven safety and
effectiveness in humans, though a number of promising
products are currently under development.

All rumours of any other effective products or
practices are false. Their use can be dangerous. In
Nigeria, for example, at least two people have died
after drinking salt water, rumoured to be protective.

The most effective personal behaviours are avoiding
well-known high-risk situations, knowing the symptoms
of infection, and reporting early for testing and
care. Evidence suggests that early supportive care
improves the prospects of survival.

The Ebola virus is highly contagious but only under
very specific conditions involving close contact with
the bodily fluids of an infected person or corpse.
Most infections have been linked to traditional
funeral practices or the unprotected care, in homes or
health facilities, of an infected person showing
symptoms.

Apart from these specific opportunities for exposure
to the virus, the general public is not at high risk
of infection.

WHO media contacts:
Gregory Hartl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
Email: [email protected]

Tarik Jasarevic
Telephone: +41 22 791 50 99
Mobile: +41 79 367 62 14
Email: [email protected]

Fadéla Chaib
Telephone: + 41 22 791 3228
Mobile:+ 41 79 475 55 56
Email: [email protected]
 
5   [dokknife 于 2014-08-18 11:33:13 提到] [FROM: 72.]
埃博拉疫区 首都变“鬼城”
2014-08-18 07:05:20 凤凰网

  埃博拉病毒带来的毁灭性影响已经悄然来到了塞拉利昂土地上。原先熙
熙攘攘的首都弗里敦,现状一塌煳涂。一名高档社区的咖啡馆经营者
Abdalla El-Ali说:“经济影响已经显现出来,但一定会变得更糟的。”


  变成“鬼城”的首都
  “我从来没见过这样的城市。” Abdalla说:“以前还会有些移民人群
来消费,现在全都看不见人影了。”每个人都在抱怨,生意不仅是变得缓慢
了,更是快要濒临“被废弃”。

  在弗里敦,所有银行都限制了营业时间,下午1点必须关门。街边卖香
烟、口香糖、蔬菜等小贩,也被规定必须在晚上6点之前关门。根据规定,
夜总会被停止营业,连市场区域都被清空。当地人和外国人平时都喜欢来的
拉姆莱海滩(Lumley Beach)总是很热闹,现在已经完全失去了活力。
以前每逢周末,赌场、酒吧和夜店都会营业到天亮,要再赶上法定假日,成
千上万的人都会来这里休闲玩耍。

  有传言说,弗里敦将被隔离,就像凯内马和凯拉洪一样。但目前只是驻
军的增加。毕竟对于一个人口超百万的城市,不像只有13万人的凯内马容易
隔离。我们不知道,军事检疫点是不是真正对人民有保护作用。本周早些时
候,两名在检疫点工作的士兵确认感染了埃博拉,一人正在接受治疗,另一
人已逃走,不知去向。

  宁可死在别处,也要逃离医院

  不仅在首都,塞拉利昂第三大城市凯内马,现在也成为埃博拉疫情的中
心地带,变成一个“死亡陷阱”。

  在抗击病毒一线的医院里,病房空空如也。这是一个埃博拉病毒随处潜
伏的城市,病人们却在试图逃离医院,几乎没有人想要来到这里。

  “别摸那墙!” 一个医师大喊道,“摸了就百分百被感染!”

  每天有大约4名感染埃博拉病人死于这家医院。但威胁社会安全、加重
他人感染危险并枉费国际社会控制疫情心血的,则是那些在城市和附近村庄
中垂死挣扎的人。由于不去医院,他们给别人带来的传染危险是极大的。医
院负责埋葬尸体的Albert J. Mattia说,“社区里一天就会有五、六个
人死亡。”

  利比里亚一个救治中心日前被袭击,17名埃博拉感染者逃离了医院。袭
击者大多数是持有棍棒的年轻男子,他们大喊:“埃博拉疫情并不存在!”
目击者称,“他们打破了房门并洗劫了整个地区,病人们全部逃走了。”当
然,救助中心的护士也逃走了。

  一个被死亡和恐惧笼罩的村庄

  致命威胁的痕迹随处可见:房屋周围凌乱的尸体,使用过的口服补液盐
(这些药看起来并没起到什么作用)。很多人就是这样死在了去医院的路
上。

  房屋挨着房屋,每家都有因埃博拉死亡的人。这里有十个,那里的四个
(其中三个是孩子),另外一间房子的七个人全部死亡,还有一间平房里一
家十六口全部死亡。

  在塞拉利昂这个叫Njala Ngiema小村里,一名35岁老师握着女儿的
小手说:“我们失去了太多生命。”


  Njala Ngiema的小女孩,双亲均死于埃博拉。图片来源The New
York Times

  这里的确还有人,但整个村子就像被冻住了一样。在那些昏暗的房屋
里,埃博拉死者的遗物,包括褴褛的衣衫、凉拖鞋和罕见的一部收音机,都
原封不动地“冻结”了几周之久,没人敢碰那些东西。尽管没有新发病例,但
人们对这些遗物,仍抱有极大恐惧。

  上周在凯拉洪城外参与治疗工作的无国界医生Anja Wolz说道,“每周
我们都会发现一到两个新的疫情村,这是个灾难。”

  政府的全面检疫隔离来的太晚了。在泥泞的道路上,疫情的痕迹随处可
见。在一栋死了5人的房屋前,挂着一条蓝裤子,没人敢碰。房子里还住着
两名活着的老妇,放置衣物的塑料袋上写着“看看这个世界”。在另一户家
庭,浴巾、裤子和内衣仍挂在房梁上,但家中的三名成员已离开人世。

  还有一名不肯去医院的埃博拉感染者,几天后,人们发现他以坐姿死在
自家床边,头低了下来。

  幸存者的悲剧

  在利比里亚北部Boya小城,Joseph Gbembo作为感染埃博拉的幸存
者,本应因被治愈而享受美好生活。但现在的他,面临抚养10个不到五岁的
孩子——他的家族有9人感染埃博拉去世,产生了5个寡妇。Joseph今年只有
三十岁,邻居们都拒绝与他交谈,并谴责他给这个小城带来了疾病。

  “我真的很孤独,”他说。“没有人跟我讲话,人们看到我就躲。”政府
部门没能给他或他的孩子提供任何食物或医疗照顾。

  老年人在屋门前的过道上坐着,凝望着空荡荡的肮脏街道,偶尔有几只
山羊和瘦得脱相的鸡走过。埃博拉就像是一个袭击并掠夺了人们财产的游击
队,扫过整片城。

  没有充足的食物和水资源,新一轮的危机即将到来。

  另一位26岁的埃博拉幸存者Kadiatou Fanta,则有着虽然不同却同
样令人痛心的遭遇。她被男友抛弃,每天一个人吃饭,一个人睡觉。在病愈
数月后,她的家人都不敢碰她。

  “尽管我表面上被治愈了,可埃博拉已经毁了我的生活。”她说,“没有
人愿意和我待上哪怕一分钟,因为他们怕被我传染。”

  埃博拉病毒只会通过体液的直接接触而传染,比如血液,唾液,汗液
等。可他们的生活,究竟何时能回归正常?

  经济急速衰退下一个致命挑战:饥饿

  在疫情爆发的早些时候,即使确诊病例被公开后,塞拉利昂首都弗里敦
的情况也还不太糟。真正引发大规模恐慌的,是经济方面的混乱:美元比任
何时候上涨得都快,不管是在银行还是在黑市里。

  英国航空公司取消往来弗里敦的航班。这里虽然还有飞出去的航班,但
价格却在原先的三倍,而且前提条件是,八月底前预定。

  人们都在想办法逃离,但大部分人连逃都逃不走。他们享受不起那个奢
侈的待遇。弗里敦的咖啡馆店主Abdalla说,“穷人是受经济混乱影响最深
重的人群,接下来的几周,他们将面对最严重的遭遇。”

  由于食物价格在塞拉利昂的城市和村庄中飞涨,饥饿即将来袭。

  “埃博拉吓退了很多人的订单,”一位来自尼日利亚最大城市拉各斯的酒
店经理Darren Julyse抱怨道。“很多大公司都在对旅行计划加以限制。”

  很多跨国界的生意也被勒令停止,农民们离开了自己的农场,留下了没
人管理的庄稼在地里腐烂。

  政府和援助机构竭尽所能地提供上亿美元控制疫情并照顾感染者,但这
笔开销远远超过了正常的医疗开销,严重地影响了经济发展。

  世界银行修正了对几内亚经济增速的估值。利比里亚财政部长也认为,
国际货币基金组织对于该国5.9%的增速估计,现在看来已经不那么现实。

  英国航空公司、阿联酋航空公司和两个非洲的航空公司已经暂停了通往
一些疫情国家的航班。如果对航班和旅游的限制继续,这些国家的经济面临
的压力将更大。(编译:张娇杨)
 
6   [dokknife 于 2014-08-18 11:32:34 提到] [FROM: 72.]
可怕的埃博拉病毒跨越国界 传到亚洲

2014-08-18 08:16:29 俄罗斯之声

  可怕的埃博拉病毒传播到了亚洲。一名从尼日里亚到达印度甘地国际机
场的男子已受隔离住院,而昨天从尼日利亚飞往印度的一个有埃博拉病症的
女病患已在阿布扎比机场中转区死亡。

  各国机场都紧急设置热像仪和防治队,特别注意来自非洲的航班和非洲
国家公民。世界卫生组织已经限制了感染埃博拉病毒者的行动权利,包括对
疑似病毒感染者:可以取消他们的飞行,让他们住院治疗,实行隔离,直到
得到分析结果。此种疾病无法医治,隔离是防止其流行的唯一办法。
  伊万诺夫斯基病毒科研所主要科学工作者拉里切夫强调说:“病毒通过
人的所有体液传播。相应地,所有与人接触的物品都可能携带病毒,所有与
之接触者也可能受到传染。因此需要全面的隔离。在俄罗斯这是封闭隔离
室,医生只能穿上密封的服装进入。非洲的防疫卫生水平很低,因此,那里
需要半军事化措施”。

  在利比里亚,对埃博拉病毒感染者住房周围实行武装防护。匪帮的行动
迫使当地政府采取这种决定。昨天,一批人袭击了利比里亚首都医疗隔离
室。他们砸开大门,放出里面的20个病人并抢走了被褥。结果,地区的疾病
流行风险大大增大了。

  使问题激化的是:今天这种疾病最流行的几内亚、利比里亚、尼日利
亚、塞拉利昂等西非洲国家的许多居民拒绝服从医生们提出的要求:留在家
里,在家里死亡,避免传染周围人。某些人相信病毒并非通过和病人接触传
播,而是诸如上帝、鬼神愤怒等宗教原因或西方文件明的阴谋等等。因此,
难于防止疾病的蔓延 。

  流行病学家罗曼丘克指出:“这并非新闻。例如,海地发生霍乱流行
时,当地居民说是白人给他们带来的疾病。他们袭击了世卫组织工作者和医
生们。海地的文化环境和利比里亚大致相同,那里文化水平很低。战胜疾病
流行毕竟是可能的。问题在于需要作出多大的努力。如果需要全面隔离整个
国家,代价将高得多”。

  到上周末埃博拉病的牺牲者已达到1145人,但已登记的病人数量要多
一倍。其中幸存的可能性为1:10.

 
7   [dokknife 于 2014-08-13 17:47:04 提到] [FROM: 72.]
伊波拉病毒试剂 深圳研制成功

2014-08-13 13:32:48 东方日报

  伊波拉病毒在西非持续肆虐,各国加紧研制疫苗。加拿大表示将捐出自
制实验性疫苗予西非疫国,中国亦已研发出伊波拉病毒试剂。尼日利亚有第
三人感染伊波拉病毒死亡,塞拉利昂则再有一名医生死亡。

  加拿大公共衞生署前日表示,加拿大自制的伊波拉实验疫苗属于全球资
源,但它尚未于人体临床实验,不知应注射多少才能发挥效果。这疫苗可能
只有不到一千五百剂,每人的注射剂量只是根据对灵长类动物的研究推算出
来。当局将向世界衞生组织捐出八百至一千剂伊波拉疫苗,供受影响国家使
用,另有十剂被送往瑞士日内瓦一间医院,部分疫苗则留在国内进行毒性研
究。
  世衞前日表示,使用未经临床实验的伊波拉药物合乎道德。

  深圳华大基因联合军事医学科学院微生物流行病研究所表示,已研制出
伊波拉病毒核酸检测试剂,并向国家食品药品监管总局申请了应急审批。华
大基因多次参与国家突发公共衞生事件的应急处理,曾协助完成了中国首例
SARS病毒的基因组序列,并成功研制了人类H7N9禽流感诊断试剂。

  西非国家经济共同体(ECOWAS)前日发表声明指,职员阿卜杜库迪亚
感染伊波拉,上月廿五日在尼日利亚拉各斯一间医院离世,令尼国感染伊波
拉不治的人数增至三人。塞拉利昂继抗疫英雄乌马尔之后,日前再失去多一
名医生科尔。畿内亚比绍总理佩雷拉表示,由于邻国畿内亚的疫情严重,决
定关闭接壤畿内亚的边境。德国呼吁国民离开畿内亚、利比里亚和塞拉利昂
三大疫国。

  今次爆发伊波拉疫情的西非地区,人民教育水平较低,面对突如其来的
恐怖病毒,即使非常亲近的邻居甚至亲人,只要对方感染伊波拉,他们亦会
敬而远之。不少患者瞬间被社会遗弃,部分更因孤独缺粮,无声无息地死
去。
 
8   [dokknife 于 2014-08-12 15:14:36 提到] [FROM: 72.]
8名中国医务人员因在非洲治疗埃博拉病人被隔离(图)
文章来源: 法新社 于 2014-08-12 09:32:52 -

2014年8月9日塞拉利昂医务工作者在凯内马一所政府医院等待为人们探测
埃博拉病毒。

据法新社援引中国驻塞拉利昂大使赵彦博透露的消息报道,在塞拉利昂参与
救治埃博拉病毒感染者的8名中国医务人员,其中包括7名医生和1名护士被
安置于一处隔离区内接受隔离观察。但是他没有说明这些中国医务人员是否
出现埃博拉症状。

据悉,6名中方医务人员和5名当地医务人员工作的医院出现死亡病例,在医
院进行内部消毒时,接触过病人的工作人员都被隔离观察2周。1名在另一家
医院工作的中国医生之前也被隔离。还有24名塞拉利昂当地的护士也被隔
离。

由于应对热带疾病埃博拉疫情而陷入恐慌的西非国家,被迫采取一些极端措
施,结果导致交通混乱,物价飞涨和食品短缺。

这场历史上最为严重的埃博拉疫情已导致近千人死亡。
 
9   [dokknife 于 2014-08-12 15:11:11 提到] [FROM: 72.]
欧洲出现首位感染埃博拉死亡者 曾使用美国新药(图)
文章来源: 凤凰卫视 于 2014-08-12 05:08:25 -

图说:西班牙牧师米格尔·帕拉斯(资料图)

西班牙卫生部发言人周二表示,感染埃博拉病毒的75岁牧师帕哈雷斯死亡,
这使全球死亡人数增至1014人,不过卫生部并没有透露他的死亡时间,帕
哈雷斯在隔离期间接受了美国生产的试验性药物治疗。世卫组织表示,为防
止埃博拉病毒传播,使用这类药物不违反道德标准。而美国当局11号已经同
意,将可能对抗埃博拉病毒的药物于本周内送抵利比里亚。

美国当局11号表示,因应利比里亚请求,已经同意把药物ZMapp的样品送
至利比里亚,协助治疗感染埃博拉的医生;而利比里亚总统网站也发表声
明,药品剂量预计在本周内,由一名美国政府代表送达。

与此同时,世界卫生组织医学伦理委员会11号在日内瓦开会,讨论使用实验
性药物对抗埃博拉病毒的可能性。

而早前到利比里亚首都蒙罗维亚埃博拉治疗中心当义工的英国防疫专家韦尔
德女士,回到英国后向媒体表示,自己经常目睹到一晚就有五、六名护士染
病身亡,患者遗体也被遗弃在街头,情势危险;她认为,官方公布的死亡数
字,并不能反映出病毒的真实肆虐情况。

另外,为了加强埃博拉防护措施防止疫情蔓延,机场的健康检查,暂停所有
往来埃博拉疫区国家航班等,成为西非多国的首要选择,当中就包括了尚未
出现疑似病例的科特迪瓦、布基纳法索等国。
 
10   [dokknife 于 2014-08-12 13:52:55 提到] [FROM: 72.]
埃博拉疫情源头找到:一名2岁已故婴儿

2014-08-12 08:23:08 CNN

  研究称导致1000余人死亡的此轮埃博拉疫情的源头可能是一名2岁的已
故婴儿。

  据美国有线电视新闻网(CNN)报道,研究人员最新成果显示,此轮在西
非爆发的埃博拉疫情很可能源于一名生活在几内亚,已经去世的2岁小病
人。

  报道援引近期刊发在《新英格兰医学杂志》上的一篇研究报告称,大约
8个月前,这名2岁的婴儿开始发烧,排出黑色的粪便并且呕吐,研究人员认
为其是“零号”病人,此名婴儿在发病4天后,于2013年12月6日死亡。
  报道称,科学研究者们不清楚这名婴儿如何接触到了埃博拉病毒。据世
卫组织称,埃博拉病毒通过人与动物之间的液体或组织传染。

  这篇文章称,研究人员在2014年内追溯了这名婴儿的家族,发现了一
系列埃博拉感染疾病的连锁反应。

  据悉,在这名婴儿死去后,孩子的母亲出现出血症状,在2013年12月
13日死亡。然后婴儿的3岁姐姐也在12月29日死亡,并且症状表现为发
热、呕吐等。婴儿的祖母后来也有同样症状,并于2014年1月1日死亡。

  据悉,婴儿一家所在的村庄位于几内亚南部靠近塞拉利昂与利比里亚的
边境地区。而就在几名村庄外部的人员参加了婴儿祖母的丧礼后,陆续出现
了感染症状。

  直到今年3月,几内亚的卫生部确诊了埃博拉病毒,人们才发现已经有
多人因感染已经死亡。据世卫组织统计,截至11日,在几内亚、利比里亚、
塞拉利昂和尼日利亚等国爆发的埃博拉疫情已经导致1013人死亡。

 
11   [dokknife 于 2014-08-11 13:35:03 提到] [FROM: 72.]
埃博拉救命药厂:9人小公司没前台

2014-08-10 15:52:27 第一财经

  一个连前台都没有的“小微企业”,现在却成为抗击埃博拉的救命稻草。
美国马普生物制药公司(Mapp)已经抢占了媒体的头条。

  上周末,《第一财经日报》记者探访了这家位于美国西部的企业。一名
戴着手套的科学家从神秘实验室中走出和本报记者握手。但他不愿多谈公司
的研发进展。Mapp研发的药物刚刚挽救了两名在非感染埃博拉的美国医护
人员,但其仍处于实验阶段,安全性依然没有完全得到认定。

  埃博拉狙击者

  世界卫生组织8日拉响埃博拉疫情“全球警报”。

  世卫组织总干事陈冯富珍说,西非地区埃博拉疫情“严重且反常”,是近
40年来这类疫情最复杂的一次暴发。

  据世卫组织统计,截至8月6日,西非地区累计出现埃博拉出血热确诊和
疑似病例1779例,其中961例死亡。

  而当两名美国医疗援助人员因感染埃博拉病毒命悬一线时,三支名
为“ZMapp”的冷冻药剂从美国飞抵利比里亚,使用药剂后两位患者病情好
转。

  其中一位患者肯特·布兰特利认定自己肯定“扛不过去”,已向妻子做了
最后的道别。但是患者所在的撒玛利亚救援会向美国国家卫生研究院的一个
科学家提出救援请求,最终获得了这三支从未在人体上进行过试验的药剂。

  用药一个小时后,布兰特利呼吸变得顺畅,身上皮疹渐渐消退。在场医
生用“奇迹”形容这一变化。另外一位患者在注射第一剂“ZMapp”治疗后并
没有改观,但第二次接受治疗后也有了明显的好转。

  在埃博拉肆虐已造成近千人死亡的西非,上述场景简直如一部典型美国
大片那样激动人心,即使这种被称为“秘密血清”的“ZMapp”依然笼罩在若
干谜团中。

  日前,《第一财经日报》记者造访了“ZMapp”的制造公司Mapp。

  在美国加州圣迭戈科技园区的一栋二层楼房里,外墙皆是黑色玻璃门窗
的Mapp只占据了一楼的一小间。旁边许多这样的单元门口还贴着“FOR
RENT”(招租)的字样。

  就是这个连前台都没有的九人小公司,现在是全球埃博拉患者的希望。

  Mapp看上去和这附近所有最普通的生物制药公司没什么两样,从里间
实验室到外面大门之间只隔了一个摆满杂物的小房间。

  在全世界都将目光投向这种新型药品时,Mapp公司气氛显得十分平
静。“真是想不到我们现在被放到了聚光灯下。”Mapp的一个科学家告诉
《第一财经日报》记者。

  Mapp在2003年由拉里·塞特林和凯文·威利创办,从在霍普金斯大学
起,两人就一直尝试如何用农作物来生产治疗疾病的免疫系统蛋白。

  自从Mapp在上周开始名声大噪后,两人一直努力躲避镁光灯,极少再
在公开场合发言。Mapp公司研究人员的工作状态也并没有发生太大的改
变,“因为我们只是做研究,不做制造,所以用不着加班加点。”上述科学家
说。

  同样简陋的Mapp官网上有一则公示,称两名美国患者使用的药
剂“ZMapp”,在今年1月就进入了治疗埃博拉的候选药物名单,但是从未在
人体身上进行过临床试验。因此,目前世界上“ZMapp”药剂存量极少。

  Mapp的研究团队从埃博拉病毒中幸存的小鼠体内提取抗体,然后将小
鼠抗体进行基因改造后使之成为更适合人类的抗体。

  而“ZMapp”此前只在8只猴子身上试过。试验结果证明,如果在猴子感
染埃博拉一天后就注射药物,猴子的存活率达到100%;如果在感染两天后
再注射,猴子存活率为50%。

  Mapp此前仅仅还在准备进一步扩大动物试验阶段,这是展开人体临床
试验前必须做的准备。根据目前有限的动物试验,“ZMapp”的药效已经远
远超越此前的同类药物。

  伦理之争

  围绕新型药物,尤其是实验性药物的那些古老的伦理问题再次降临
到“ZMapp”之上:是否应该将尚未经过检测也未证明对人类安全的药物用
于此次疫情?考虑到可获得药物数量极为有限,如果使用该药,应该把药给
谁用?

  由于尚未进行过人体临床试验,所以原则上医生不能使用“ZMapp”这
种未经批准的药物。之所以“ZMapp”最后还是送到了两个美国患者手上,
一来是美国联邦食药监局(FDA)有“同情使用”原则。

  二来也是因为Mapp公司一直和美国政府有着紧密联系。根据公司网站
介绍,Mapp曾与美国国立卫生研究院及美国国防威胁降低局合作,多年负
责开发埃博拉病毒治疗方法研究。

  伴随着严峻疫情和新药风险之间的博弈,科学家和公共卫生决策者们之
间的争论也在日渐发酵。

  谨慎的意见暂时占了上风。美国总统奥巴马在上周美非峰会闭幕时表态
称,由于缺乏足够信息证实这种药的有效性,给西非国家提供这种试验性药
物的时机仍“不成熟”。

  许多科学家也认为,仅靠八只猴子和两名患者无法判断这种疗法的利
弊,唯有严格控制的临床试验才能做出正确评估。

  世卫组织也发表声明称:任何新药的使用指导原则是不会造成伤害,安
全才是最重要的。世卫组织已经召集了一批医学伦理专家,来研究到底如何
才是负责任的做法。

  但疫情蔓延让西非当局认为已经威胁“国家存亡”了,尼日利亚卫生部长
称已经向美方提出提供这种药物的可能性。

  处于漩涡中心的Mapp公司则称,还在和FDA商讨中,最后的一切决定
都掌握在政府决策者手中。

  “散兵游勇”

  实际上就算FDA紧急批准在非常状况下可以使用“ZMapp”,产量能否跟
上还是个问题。

  这些药物能够以多快速度投入大规模生产,目前都取决于美国雷诺烟草
公司。这家公司在肯塔基州拥有将“ZMapp”所需原料从烟草中提取出来的
设施,该公司发言人戴维·霍华德说,想要扩大生产最起码需要几个月的时
间。生产“ZMapp”需要让烟草感染经过改造后的抗体,然后让烟草生长大
约一周后,才能生产出足够的原料。

  接下来还要对原料进行纯化,整个过程极为缓慢。安东尼·福西也称,
即使少量生产也需要2~3个月时间。

  此外,其他疫苗计划也正在推进。

  由于埃博拉疫苗的市场很小,不足以刺激大型药企启动疫苗的研发,而
人体临床试验又耗费巨大,因此美国许多疫苗研发都由小型科研团队担纲,
背后则是政府出资。

  政府还允许这些科研团队共同使用一些级别极高的生物实验室,这也是
为什么Mapp这家名不见经传的小公司可以生产需要使用生物安全四级实验
室的药剂。
 
12   [dokknife 于 2014-08-11 13:33:46 提到] [FROM: 72.]
搏击死神埃博拉 中国经验值得借鉴

2014-08-11 10:15:08 多维

  连日来的埃博拉(以往称为“埃博拉病毒性出血热”)疫情引发全球性恐
慌,世界卫生组织(WHO)宣布,当前埃博拉病毒的爆发已上升至国际性突
发公共卫生事件。一时间,埃博拉病毒俨然成为死神的代名词,将不少人的
记忆一下子拉回到多年前的中国抗击非典型肺炎(简称非典,SARS)和
H7N9禽流感的时期。相较非典等病毒,埃博拉的杀伤性有过之而无不及,
然而中国抗击非典的经验无疑带给各国难得的借鉴,在新一轮人类同死神的
搏击中多一份冷静、力量和斗志。


  致命埃博拉令世界闻风丧胆
  世界卫生组织资料显示,埃博拉病毒病是一种急性出血性传染病,病死
率高达50%至90%,是世界上最凶猛的疾病之一。世界卫生组织将其列为对
人类危害最严重的病毒之一,即“第四级病毒”(艾滋病为2级,SARS为3
级,级数越大防护越严格)。临床症状为突然发病,表现有发热、极度虚
弱、头痛、肌痛、咽痛、结膜充血等,数天后可出现呕吐、腹痛、腹泻、皮
疹。严重病例可出现无黄疸型肝炎和胰腺炎,及轻重不一的出血倾向。病毒
潜伏期可达2至21天,但通常只有5天至10天。1976年在苏丹南部和扎伊尔
即现在的刚果(金)的埃博拉河地区被发现它的存在后,引起医学界的广泛
关注和重视,“埃博拉”由此而得名。病毒的起源尚不得而知。但基于现有证
据,人们认为果蝠(狐蝠科)可能是埃博拉病毒的自然宿主。目前对该病尚
无有效治疗药物和预防疫苗,主要对症治疗。

  自今年2月初几内亚暴发埃博拉病毒以来,疫情迅速蔓延至周边西非国
家,目前,早已扩散到北美、亚洲多地。据世卫组织8日数据,本轮埃博拉
疫情共感染1,779人,致死961人,是该病毒自40年前在非洲首次被发现以
来,最为严峻的一次疫情。卢旺达卫生部10日晚上发表声明称,当局已经将
一名疑似产生埃博拉病状的德国学生隔离,目前正在等待最终诊断结果。越
南总理阮晋勇日前主持有关埃博拉疫情的紧急会议时,指示相关单位做好防
疫准备。香港埃博拉病毒疑似个案被排除,港府吁社会各界提高警觉。印度
尼西亚政府全面备战,除通告各地方卫生局防范,观光胜地巴厘岛的医院也
备妥隔离治疗室及穿戴防护措施的医疗人员。

  中国责任意识和经验助力搏击

  据悉,埃博拉病毒号称史上最致命,却并非新生事物,早在1976年就
已经逞凶于世人眼前,近40年来发生过多次疫情。在这一方面,美国、欧盟
等发达国家的确具有先发经验。比如说,美国政府敢于冒着国内舆论压力,
接回两名感染埃博拉病毒的美国人,“美非峰会”如期举行,这些举措都有着
相应的底气:一是掌握抗埃博拉病毒的新药,两名感染者已经接受这一处于
试验阶段的新药治疗;二是基于强大的检疫和防控能力,美国目前已经启动
最高疫情响应级别。目前,中国虽然还没有遭遇与美国相似的问题,但类似
风险同样无法回避,国内民众对埃博拉病毒疫情也高度关注。

  中国国家卫计委上周宣布已做好阻击疫情入境的防控措施,中国已具备
应对埃博拉疫情的科技储备,包括检测、诊断试剂、抗体生产能力,以及疫
苗的研发。另外,从非典出现到应对H7N9禽流感,中国通过了一次次的疫
情“大考”,积累了应对公共卫生突发事件的丰富经验。此次埃博拉疫情,中
国在严防疫情进入同时,也愿与他国分享抗疫经验。世卫组织助理总干事福
田敬二认为,中国在公共卫生领域投入巨大,在疾病监控监测、信息传递等
方面的投入收到显著红利,最终促成对H7N9禽流感疫情的快速全面反应,
这是可适用于世界的经验。目前,中国已经向疫情发生地派去了多名医生和
相关专家,可以说,埃博拉肆虐至今,中国医生的坚守为深受疾疫之苦的当
地人们筑起了一道疫情“防波堤”。

  有媒体指出,中国防控非典积累的知识与办法,以及中国医疗队几十年
来坚持在非洲行医施药打下的坚实基础,都在为抗击埃博拉病毒提供中国经
验和中国模式。同时,在疫区第一线对抗埃博拉的经验,反过来也为中国的
病毒防治研究提供了第一手素材。另外,作为全球新兴大国的重要一员,中
国不仅在经济发展上与世界相联系,中国人民的利益更是与世界各国人民的
利益攸关。地球任何一个地方的危机,都可能影响到中国。在本次埃博拉疫
情爆发的西非四国,就有近2万名中国同胞在当地工作生活,更加深中国同
当地休戚与共的天然使命感。

  埃博拉疫情失控但可遏制

  世界卫生组织总干事陈冯富珍日前表示:“本次疫情爆发的速度比我们
努力实施控制的速度要快。如果情况持续恶化,后果将会是灾难性的:不仅
会造成大量人员死亡,而且会造成严重的社会经济影响,并极有可能扩散到
其他国家。”她同时指出,“病毒疫情已经失控,但能够被遏制住。”

  目前,各国正加紧各项行动搏击埃博拉。欧盟以及美国国际开发署于上
周五表态称,将分别增资1,070万美元和1,200万美元给予非洲国家,以遏
制埃博拉疫情。美国疾病控制中心认为,埃博拉不会在美国大规模爆发。虽
然其他传染病死亡率低得多,但因其感染数量众多,所以它们造成的患者希
望数量巨大。与此同时,各国投入控制埃博拉的资源太少,也是造成这种病
恐慌的原因。

  据法国媒体报道,世界卫生组织副总干事基尼9日表示,目前还没有成
熟的埃博拉病毒疫苗产品,但很多机构都在加紧研制,明年疫苗有望投入使
用。世卫组织疫苗研发部门负责人称,在埃博拉疫情紧急的情况下,他们将
为疫苗的审查、试验开通“快速通道”,使疫苗产品更快面世。由于受试人群
样本数量可能会比较少,研究人员仍将对可能的副作用进行密切监视。

  目前,美国科学家研发的一种疫苗已经在灵长类动物体测试中取得了积
极的效果。该疫苗计划最早今年9月进入人体测试阶段。如果一切顺利,明
年年底,人类就有希望研制出第一款针对埃博拉病毒的疫苗。此外,英国一
家公司也宣布,下月将对他们的埃博拉疫苗产品展开临床试验。
 
13   [USMedEdu 于 2014-08-07 16:56:20 提到] [FROM: 72.]
美国伊波拉实验用药 引发道德矛盾

2014-08-07 11:48:30 明镜网

  在非洲肆虐的伊波拉病毒,已导致将近千人死亡,两名受感染的美国人
接受实验用药,却引发道德矛盾。

  对抗伊波拉的药物ZMapp,由美国的制药公司马普(Mapp)所研发,
仍在动物实验阶段,尚未获得美国食品药物管理局的批准,但在赖比瑞亚行
医的美国医师布兰特利(Kent Brantly)和志工瑞特波(Nancy
Writebol)仍愿意试用,两人用药后出现好转迹象。
  消息一出,增加此药产量的要求也随之而来,奈及利亚已表示将与美国
疾病管制中心讨论取得ZMapp的可能性,但世界卫生组织(WHO)和专家都
表示,使用此药物仍有风险,而且还无法证明两人的好转跟药物有关。

  药物离正式上市还有一大段距离,即使需求呼声大,仍无法略过必要的
程序大量产制。法新社指出,在目前的阶段,专家认为只在美国人身上用药
有其道理,首先是两人的医学背景能让他们更瞭解新药的风险,其次是他们
一开始就愿意投入风险中,医治伊波拉病患。不过更应该做的,是加倍努力
预防病情传播。

  WHO已宣布下週将召开特别会议,讨论实验用药的使用。
 
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