伊波拉病毒。资料来源：维基百科

这ongoing Ebola outbreakin the Democratic Republic of Congo that started in August 2018, and has since been largely forgotten amid the flurry of everything else happening throughout the world. However, recent developments, such as the宣布公共卫生紧急国际关注，，，，have attracted renewed attention to the outbreak.

What is the现在的情况在刚果民主共和国中的埃博拉疫情？在这一点上，这是第二最长的埃博拉疫情，仅超过2014-2016 outbreak in West Africa。到目前为止，据报道有2592例病例，其中1743例死亡，死亡率（CFR）为67％，这也使其成为迄今为止第二大埃博拉病毒疫情。如上所述，爆发已经集中在北基沃和伊图里省，尤其是在贝尼，丁博，丁博，卡特瓦，马巴拉科和曼迪玛健康区。在过去的21天中，大多数病例都在北基沃省的贝尼健康区报告。从今年3月左右开始，每周的新案例数量从约40个增加到90个，并且没有显示出减少的迹象（见下文）。

Last Thursday, on the 17^Thof July 2019, the Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, declared this outbreak aPublic Health Emergency of International Concern (PHEIC)，，，，following the recommendation of the International Health Regulations Emergency Committee. What does this mean? According to the国际卫生法规，国际关注的公共卫生紧急情况被定义为“如本法规所规定的一个非凡事件：

• 通过国际疾病传播对其他州构成公共卫生风险；和
• 有可能需要协调的国际反应”。这个定义意味着：严重，不寻常或意外的情况；对受影响州的国家边界以外的公共卫生产生了影响；并可能需要立即采取国际行动。

那么，为什么委员会建议现在宣布刚刚开始爆发的一年后，立即宣布在刚果民主共和国的爆发呢？此时需要这样的声明发生了什么变化？许多公共卫生专家提倡该声明应该早些时候做。但是，如果一个人读国际卫生法规应急委员会声明，它确实为声明目前提供了理由。他们列出了可能扩展流行病的令人担忧的迹象，以及潜在地理传播的担忧。

这一点由introduction of the disease into Goma，，，，a200万人的城市in the DRC. Goma is very close to Rwanda, and there are 15,000 people traveling to and from Rwanda through Goma per day. While the fatal case of Ebola did not lead to secondary cases in Goma, this could happen at other occasions. Previously, a family that was infected by Ebola virus travelled from the DRC to乌干达，几个家庭成员屈服于这种疾病，进一步说明了这种疾病传播到邻国的潜力。戈马的这一简介显然动员了当局，以确保该疾病在进一步传播之前得到控制，尤其是因为戈马有一个international airport，，，，with direct flights to Ethiopia.

在他们的决定宣布国际关注的突发公共卫生事件,提交tee further cited the ongoing transmission in Beni, challenges in community acceptance and the continued risk for health care workers due to violence. Importantly, they stressed a lack of sustainable and adequate technical assistance, human or financial resources from the global community for outbreak response. The committee recommended that affected countries (such as the DRC) continue to strengthen community awareness, screen potential cases and trace contacts, strengthen surveillance, strengthen measures to prevent nosocomial infections, optimize vaccine strategies and enhance coordination between partners. For neighboring countries, they recommended to improve preparedness for detecting and managing imported cases, predict disease spread, and increase risk communication and community engagement. For all other states, they recommended not to place any travel and trade restrictions, nor implement entry screening at ports of entry outside of the region, as the harm caused by such strategies exceeds the benefits.

这是第一次埃博拉病毒爆发埃博拉疫苗作为响应的一部分包括在内（在临床试验和紧急towards the end of the 2014-16 West African outbreak).初步数据indicates that the VSV-EBOV vaccine is highly efficacious, protecting 97.5% of those vaccinated. Only 71 people out of 94,000 people vaccinated developed Ebola virus disease. 57 of these patients developed disease only 9 days after being vaccinated, potentially indicating that the vaccine did not have enough time to develop protective immunity before exposure. 54 of the 71 cases were high-risk contacts, and only 9 people died, which shows that the vaccine reduced the case fatality rate even if it was administered too late to protect from disease altogether.

So if we have such an effective vaccine, why don’t they just vaccinate everybody? The problem here is supply. So far, 171,052 people have been vaccinated. The manufacturer of theRVSV Zebov GP，这家德国公司默克公司在2020年已经翻了一番，但有8134万人居住在DRC，根本没有足够的疫苗给每个人。此外，实际上可能没有必要为所有人接种疫苗。当前的策略是环接种疫苗，与感染患者（或其身体）接触的人接种疫苗。第二枚戒指将包括所有联系人的邻居和家人。这World Health Organization’s Strategic Advisory Group of Experts on Immunization（Sage）建议Third ring接种疫苗的接触，但只有1/5^Thdose, which would confer protection after 28 days, according to clinical trials. However, all of these strategies rely on contact tracing, finding those contacts, and their cooperation, which is not straightforward at all.

这declaration of the PHEIC for the Ebola outbreak at the DRC has initiated a series of events since last Thursday. The global health community has pledged more financial and technical support, with theWorld Bank announcing再增加3亿美元，以扩大对刚果民主共和国爆发的反应。在刚果民主共和国总统费利克斯·托西克迪（Felix Tshisekedi）took over the Ebola response来自卫生部，任命Jean-Jacques Muyembe刚果生物医学研究所负责人在以前的埃博拉病毒爆发方面拥有丰富的经验，以协调政府的反应。作为回应，卫生部长Oly Ilunga有辞职从他的帖子。在辞职信中，他提到他承受着批准第二种疫苗的压力，该疫苗开发了约翰逊和约翰逊，，，，和supported by the WHO, and incorporate it into the ongoing response. Apparently, Dr. Ilyunga had预订关于这种疫苗，并担心有两种不同的疫苗会使公众和卫生工作者感到困惑。约翰逊和约翰逊在一份声明中坚持了疫苗的质量。随着他的离开，很有趣的是，第二次疫苗是否确实会纳入回应中。最后，自从总统办公室接管了卫生部的埃博拉病毒回应以来daily reportscoming out of the Ministry will停止。这些报告为全球卫生社区提供了宝贵的资源，如果不再公开可用，那将是一个不利的资源。因此，我希望他们将由Muyembe博士领导的团队继续。

那么这将离开我们的地方呢？看起来DRC中的埃博拉疫情正处于关键时刻。随着Pheic的宣布，已经投入了其他资源。希望这将在Muyembe博士的领导下加剧重组的国家反应，这将导致传播减少和当前爆发的结束。但是，如果承诺的资源没有实现，并且反应会使我们在时间和潜在地理上的流行病进行延伸。这可能会为埃博拉病毒提供在人口中流行的机会，并发展成为真正的人类病原体，维持在人们之间的传播。即使是恢复和疫苗接种的结合，我们也离当地人口具有足够的群豁免权。关于接种疫苗的人在一个过程中脱离病毒的能力也有开放的问题asymptomatic infection，以及此类人对感染的出现和持久性的影响。

我们都希望这些新发展将有助于控制爆发而且，大多数人会忘记这种可怕的病毒，直到下一次爆发再次回来！