Pittalis Silvia, Fusco Francesco Maria, Lanini Simone, Nisii Carla, Puro Vincenzo, Lauria Francesco Nicola, Ippolito Giuseppe
Epidemiological and Pre-clinical Research Department, National Institute for Infectious Diseases (INMI) "L. Spallanzani", Rome, Italy.
New Microbiol. 2009 Oct;32(4):359-67.
Viral haemorrhagic fevers (VHFs) represent a challenge for public health because of their epidemic potential, and their possible use as bioterrorism agents poses particular concern. In 1999 the World Health Organization (WHO) proposed a case definition for VHFs, subsequently adopted by other international institutions with the aim of early detection of initial cases/outbreaks in western countries. We applied this case definition to reports of Ebola and Marburg virus infections to estimate its sensitivity to detect cases of the disease. We analyzed clinical descriptions of 795 reported cases of Ebola haemorrhagic fever: only 58.5% of patients met the proposed case definition. A similar figure was obtained reviewing 169 cases of Marburg diseases, of which only 64.5% were in accordance with the case definition. In conclusion, the WHO case definition for hemorrhagic fevers is too specific and has poor sensitivity both for case finding during Ebola or Marburg outbreaks, and for early detection of suspected cases in western countries. It can lead to a hazardous number of false negatives and its use should be discouraged for early detection of cases.
病毒性出血热（VHFs）因其具有流行潜力，对公共卫生构成挑战，且其可能被用作生物恐怖主义制剂，这引发了特别关注。1999年，世界卫生组织（WHO）提出了病毒性出血热的病例定义，随后被其他国际机构采用，目的是在西方国家早期发现首例病例/疫情。我们将此病例定义应用于埃博拉和马尔堡病毒感染报告，以评估其检测该病病例的敏感性。我们分析了795例报告的埃博拉出血热病例的临床描述：只有58.5%的患者符合提议的病例定义。回顾169例马尔堡病病例也得到了类似数字，其中只有64.5%符合病例定义。总之，WHO关于出血热的病例定义过于具体，在埃博拉或马尔堡疫情期间用于病例发现以及在西方国家早期发现疑似病例时敏感性都很差。它可能导致大量危险的假阴性结果，不应鼓励使用该定义进行病例的早期发现。
