Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China.
Infect Dis Poverty. 2016 Aug 5;5(1):74. doi: 10.1186/s40249-016-0167-0.
The Ebola virus disease spread rapidly in West Africa in 2014, leading to the loss of thousands of lives. Community engagement was one of the key strategies to interrupt Ebola transmission, and practical community level measures needed to be explored in the field and tailored to the specific context of communities.
First, community-level education on Ebola virus disease (EVD) prevention was launched for the community's social mobilizers in six districts in Sierra Leone beginning in November 2014. Then, from January to May of 2015, in three pilot communities, local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures, by involving them in alert case report, contact tracing, and social mobilization. The epidemiological indicators of transmission interruption in three study communities were evaluated.
A total of 6 016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts, and EVD message reached an estimated 631 680 residents. In three pilot communities, 72 EVD alert cases were reported, with 70.8 % of them detected by trained local community members, and 14 EVD cases were finally identified. Contact tracing detected 64.3 % of EVD cases. The median duration of community infectivity for the cases was 1 day. The secondary attack rate was 4.2 %, and no third generation of infection was triggered. No health worker was infected, and no unsafe burial and noncompliance to EVD control measures were recorded. The community-based measures were modeled to reduce 77 EVD cases, and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra Leone.
The community-based strategy of social mobilization and community engagement was effective in case detection and reducing the extent of Ebola transmission in a country with weak health system. The successfully practical experience to reduce the risk of Ebola transmission in the community with poor resources would potentially be helpful for the global community to fight against the EVD and the other diseases in the future.
2014 年，埃博拉病毒病在西非迅速蔓延，导致数千人死亡。社区参与是阻断埃博拉传播的关键策略之一，需要在实地探索切实可行的社区一级措施，并根据社区的具体情况进行调整。
2014 年 11 月开始，在塞拉利昂的六个地区，首先针对社区的社会动员者开展了关于埃博拉病毒病（埃博拉）预防的社区一级教育。然后，在 2015 年 1 月至 5 月期间，在三个试点社区，组织当地受过培训的社区成员参与实施埃博拉预防和传播中断措施，包括报告预警病例、接触者追踪和社会动员。评估了三个研究社区中传播中断的流行病学指标。
在六个地区共举办了 279 期讲习班，培训了来自 185 个区的 6 016 名社区社会动员者，使估计有 631 680 名居民了解了埃博拉信息。在三个试点社区，共报告了 72 例埃博拉预警病例，其中 70.8%由经过培训的当地社区成员发现，最终确诊了 14 例病例。接触者追踪发现了 64.3%的埃博拉病例。病例的社区传染性中位持续时间为 1 天。二代感染率为 4.2%，没有引发第三代感染。没有卫生工作者感染，也没有记录到不安全的埋葬和不遵守埃博拉控制措施的情况。所采用的社区措施模型减少了 77 例埃博拉病例，研究社区比塞拉利昂全国提前四个月实现了无埃博拉病例的目标。
在卫生系统薄弱的国家，以社会动员和社区参与为基础的社区战略在病例发现和减少埃博拉传播程度方面是有效的。在资源匮乏的社区降低埃博拉传播风险的成功实践经验，可能有助于全球社会今后抗击埃博拉和其他疾病。
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