Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis:lessons for the Global Health security agenda

作     者：Eduardo A.Undurraga Cristina Carias Martin I.Meltzer Emily B.Kahn Undurraga Eduardo A.;Carias Cristina;Meltzer Martin I.;Kahn Emily B.

作者机构：National Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA Present address:School of GovernmentPontificia Universidad Católica de ChileSantiagoRegión MetropolitanaChile 

出 版 物：《Infectious Diseases of Poverty》 (贫困所致传染病（英文）)

年 卷 期：2017年第6卷第1期

页      面：1419-1428页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 100401[医学-流行病与卫生统计学] 10[医学] 

基　　金：This work was funded by the Centers of Disease Control and Prevention US Government. 

主　　题：Ebola virus Global health Transmission Epidemics Viruses Communicable diseases Western Africa Guinea Liberia Sierra Leone 

摘      要：Background:The 2014-2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks.The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia,Sierra Leone,and Guinea,hinted at the possibility of broad-scale transmission of Ebola.Main text:Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak,we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission(based on late 2014 air travel patterns).We estimated Ebola cases in three scenarios:a delayed response,a Liberia-like response,and a fast response scenario.Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci,we emphasize the need for improved levels of preparedness and response to public health threats,which is the goal of the Global Health Security Agenda.Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci,had local and international health workers and organizations not committed to a major response effort.Our results underscore the importance of rapid detection and initiation of an effective,organized response,and the challenges faced by countries with limited public health systems.Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel,bolstering primary and critical healthcare facilities,developing public health infrastructure(e.***.laboratory capacity),and improving disease surveillance.With stronger local public health systems infectious disease outbreaks would still occur,but their rapid escalation would be considerably less likely,minimizing the impact of public health threats such as Ebola.Conclusions:The Ebola outbreak could have potentially spread to other countries,where limited public health surveillance and response capabilities may have resulted in additional foci.Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak.