Desclaux A, Ndione A G, Badji D, Sow K
IRD UMI 233, INSERM U 1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France.
Centre régional de recherche et de formation à la prise en charge de Fann, Dakar, Sénégal.
Bull Soc Pathol Exot. 2016 Oct;109(4):296-302. doi: 10.1007/s13149-016-0477-2. Epub 2016 Feb 5.
Quarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case's household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors' visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided-food and money-was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.
在西非埃博拉疫情爆发期间，隔离措施被广泛用于控制传播链。这一措施引发了伦理问题，需要记录实地隔离的方式及其对接触者的社会影响。在塞内加尔，2014年9月有74人与来自几内亚的埃博拉病例有接触。其中，该病例家庭的34名成员被集中在家中，并由工作人员进行监测。其余来自两个机构的40名医护人员分散在各自的家庭中，通过电话或医生家访进行监测。该研究基于对43名成年接触者关于他们的经历和看法的深入访谈，并通过额外观察进行解读和背景分析。对与零号病人生活在一起的接触者和专业医护接触者采取了不同的居家隔离方式。一开始没有使用强制手段，因为所有接触者都遵守监测规定，但其中一些人并未完全遵守行动限制。接触者认为生物安全预防措施带有污名化色彩，尤其是在最初几天，当时医护人员和接触者都对感染深感恐惧。提供的物质支持——食物和金钱——是必要的，因为接触者无法工作也无法获得资源，但支持过于有限且延迟。他们所得到的关系支持以及警察和后续工作人员对他们免受污名化的保护受到赞赏。但向接触者提供的信息不足，其中一些人，包括医护人员，对埃博拉病毒病和埃博拉传播知之甚少，这引发了焦虑和情感痛苦。一些接触者经历了失业和收入损失；有几个人难以轻易或完全恢复到以前的生活日常。除了关于加强支持措施的建议外，该研究还确定了塞内加尔隔离措施在知情同意和个人自主权、不伤害与仁爱以及公平和适应具体情况方面的伦理利害关系。然而，仍应从公共卫生角度评估隔离的预防益处与个人不便之间的平衡。
