【经验】埃博拉病毒的重要防控措施

威斯康星大学医学和公共卫生学院Jonathan Temte教授

我观察过埃博拉病毒病(EVD)缓慢进化的过程，其在西非失控后演变成一个全球性的噩梦。据官方统计，截止该报道，目前死亡人数为4300，发病人数为8399（病死率＞48%）。美国第1例死亡发生在2014年10月8号。病毒在非洲以外的二次传播首次报道发生在西班牙。随着埃博拉病毒在全球蔓延，人群里出现了更加广泛的担忧和恐慌，这种恐慌已导致商务班机受损，促使大量人群前往急诊就诊，引发公众为下一次发烧作好准备。非洲埃博拉病毒爆发持续扩大，将会与北半球的流感季节相遇，将有大量患者出现发烧和感冒相关的症状，而这些症状与早期埃博拉病毒的症状是相似的。所有内科医生都可以通过必要的准备而获益。

埃博拉病毒的传播遵循许多基本的规则：

1 埃博拉病毒在人与人之间传播。

2 通过直接接触感染的血液或者体液传播。

3 病毒入侵是通过粘膜表面或破损皮肤或针刺伤。

4 感染的血液和体液病毒含量较高。

5 感染剂量非常低。

6 埃博拉病毒可以在各种体液中发现，如尿液、唾液、汗液、排泄物、呕吐物、母乳、精液。

7释放的病毒可以很好的复原，能够在精液中存活84天。

鉴于以上认知，我们应采取以下措施：

1立即隔离患者，采取合适的感染控制措施将会破坏传播链。

2任何人在接触埃博拉患者时，为了防止传播，使用个人保护设施（隔离衣、手套、面罩或口罩、护目镜或护面罩）是基本的。

3避免双手接触面部。尽量减少接触面。当手套撕裂或严重污染时更换手套。用肥皂水清洗或酒精擦拭保持手部卫生。如果双手明显被污染，用肥皂水清洗，不要使用酒精。

因为没有人可以记得每一件事情，在此说明我个人抵御埃博拉病毒的黄金法则：如果你怀疑存在埃博拉病毒感染，即刻隔离患者，实施感染控制并采取公共卫生预防措施。埃博拉病毒的防控形势仍在恶化，我们当前须保持清醒的认识。我也建议使用如下资源：埃博拉病毒医疗护理准备清单（http://www.cdc.gov/vhf/ebola/pdf/healthcare-provider-checklist-for-ebola.pdf），美国患者埃博拉病毒评估表（http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf），可脱卸的个人防护设施（http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf）

I have watched the slowly evolving emergence of Ebola virus disease (EVD) in West Africa spiral out of control into a global nightmare. The official tally, as of this posting, is 4033 deaths and 8399 cases (case fatality rate, >48%). The first US death occurred on October 8, 2014; the first report of secondary spread outside of Africa has occurred in Spain. With globalization of EVD comes a much more widespread epidemic of fear and panic, which already has crippled commercial airliners, prompted emergency department visits, and primed the public for worry with the next fever. Continued expansion of Africa’s Ebola outbreak will coincide with the influenza season in the northern hemisphere and the accompanying upsurge in patients with fevers and associated symptoms, which mimic early EVD.

All physicians can benefit from a little preparation. There are some very basic rules for EVD.

1 Ebola is transmitted person to person.

2 Transmission is through direct contact with infected blood or bodily fluid.

3 The portal of entry is mucosal surfaces or broken skin or via needlestick injury.

4 Infected blood and bodily fluid have very high levels of virus.

5 The infective dose is extremely low.

6 Ebola virus can be found in a wide variety of bodily fluids: urine, saliva, sweat, feces, vomit, breast milk, and semen.

7 Shedding of virus can occur well into recovery, up to 84 days post onset in semen.

Because of #1–7:

8 Immediate isolation of patients and implementation of appropriate infection control will stop the chain of transmission.

9 Use of personal protective equipment (gown, gloves, mask/respirator, goggles/faceshield) is essential for anyone in contact with an EVD patient to prevent transmission.

10 Keep hands away from face. Limit surfaces touched. Change gloves when torn or heavily contaminated. Perform hand hygiene by washing with soap and water or using alcohol-based hand rubs. If hands are visibly soiled, use soap and water, not alcohol-based hand rubs.

Because no one can remember everything, here is my golden rule of EVD: If you suspect EVD, isolate the patient, call infection control, and call public health.

As this is an evolving situation, keep up to date on current trends. I also recommend use of the following resources:

Health Care Provider Preparedness Checklist for Ebola Virus Disease http://www.cdc.gov/vhf/ebola/pdf/healthcare-provider-checklist-for-ebola.pdf

Checklist for Patients Being Evaluated for Ebola Virus Disease (EVD) in the United States http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf

Donning and Removing Personal Protective Equipment http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf

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