Tambo Ernest, Xiao-Nong Zhou
Sydney Brenner Institute for Molecular Bioscience, School of Medical Sciences & School of Public Health, University of the Witwatersrand, Johannesburg, South Africa ; Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, 200025 People's Republic of China ; WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 People's Republic of China ; Département de Biochimie et Science Pharmaceutiques, Université des Montagnes, Bagangté, République du Cameroun.
Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, 200025 People's Republic of China ; WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 People's Republic of China.
Infect Dis Poverty. 2014 Oct 29;3:41. doi: 10.1186/2049-9957-3-41. eCollection 2014.
The number of surveillance networks for infectious disease diagnosis and response has been growing. In 2000, the World Health Organization (WHO) established the Global Outbreak Alert and Response Network, which has been endorsed by each of the 46 WHO African members since then. Yet, taming the dynamics and plague of the vicious Ebola virus disease (EVD) in African countries has been patchy and erratic due to inadequate surveillance and contact tracing, community defiance and resistance, a lack of detection and response systems, meager/weak knowledge and information on the disease, inadequacies in protective materials protocols, contact tracing nightmare and differing priorities at various levels of the public health system. Despite the widespread acceptance of syndromic surveillance (SS) systems, their ability to provide early warning alerts and notifications of outbreaks is still unverified. Information is often too limited for any outbreak, or emerging or otherwise unexpected disease, to be recognized at either the community or the national level. Indeed, little is known about the role and the interactions between the Ebola infection and exposure to other syndemics and the development of acquired immunity, asymptomatic reservoir, and Ebola seroconversion. Can lessons be learnt from smallpox, polio, and influenza immunity, and can immunization against these serve as a guide? In most endemic countries, community health centers and disease control and prevention at airports solely relies on passive routine immunization control and reactive syndromic response. The frontline and airport Ebola SS systems in West Africa have shown deficiencies in terms of responding with an alarming number of case fatalities, and suggest that more detailed insights into Ebola, and proactive actions, are needed. The quest for effective early indicators (EEE) in shifting the public and global health paradigm requires the development and implementation of a comprehensive and effective community or regional integrated pandemic preparedness and surveillance response systems tailored to local contexts. These systems must have mechanisms for early identification, rapid contact tracing and tracking, confirmation, and communication with the local population and the global community, and must endeavor to respond in a timely manner.
用于传染病诊断和应对的监测网络数量一直在增加。2000年，世界卫生组织（WHO）建立了全球疫情警报和反应网络，自那时起已得到46个WHO非洲成员国的认可。然而，由于监测和接触者追踪不足、社区违抗和抵制、缺乏检测和应对系统、对该疾病的知识和信息匮乏、防护材料协议不完善、接触者追踪困难以及公共卫生系统各级的优先事项不同，非洲国家在控制恶性埃博拉病毒病（EVD）的动态和疫情方面一直参差不齐且不稳定。尽管症状监测（SS）系统已被广泛接受，但其提供疫情早期预警警报和通知的能力仍未得到验证。对于任何疫情、新出现的或其他意外疾病，在社区或国家层面往往因信息过于有限而无法识别。事实上，对于埃博拉感染与接触其他共病之间的作用和相互作用以及获得性免疫、无症状储存库和埃博拉血清转化的发展知之甚少。能否从小天花、脊髓灰质炎和流感免疫中吸取教训，以及针对这些疾病的免疫接种能否作为指导？在大多数流行国家，社区卫生中心和机场的疾病控制与预防仅依靠被动的常规免疫控制和反应性症状应对。西非的前线和机场埃博拉SS系统在应对大量病例死亡方面存在不足，这表明需要对埃博拉有更详细的了解并采取积极行动。在转变公共和全球卫生范式方面寻求有效的早期指标（EEE）需要制定和实施一个全面有效的、因地制宜的社区或区域综合大流行防范和监测应对系统。这些系统必须具备早期识别、快速接触者追踪和跟踪、确认以及与当地居民和全球社区沟通的机制，并且必须努力及时做出反应。
