Ehlkes Lutz, George Maja, Samosny Gerhard, Burckhardt Florian, Vogt Manfred, Bent Stefan, Jahn Klaus, Zanger Philipp
These authors contributed equally to this article and share first authorship.
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
Euro Surveill. 2017 Sep;22(39). doi: 10.2807/1560-7917.ES.2017.22.39.16-00728.
Due to rapid diagnosis and isolation of imported cases, community outbreaks of viral haemorrhagic fevers (VHF) are considered unlikely in industrialised countries. In March 2016, the first documented locally acquired case of Lassa fever (LF) outside Africa occurred, demonstrating the disease's potential as a cross-border health threat. We describe the management surrounding this case of LF in Rhineland-Palatinate - the German federal state where secondary transmission occurred. Twelve days after having been exposed to the corpse of a LF case imported from Togo, a symptomatic undertaker tested positive for Lassa virus RNA. Potential contacts were traced, categorised based on exposure risk, and monitored. Overall, we identified 21 contact persons with legal residency in Rhineland-Palatinate: seven related to the index case, 13 to the secondary case, and one related to both. The secondary case received treatment and recovered. Five contacts were quarantined and one was temporarily banned from work. No further transmission occurred. Based on the experience gained during the outbreak and a review of national and international guidelines, we conclude that exposure risk attributable to corpses may currently be underestimated, and we present suggestions that may help to improve the anti-epidemic response to imported VHF cases in industrialised countries.
由于对输入性病例的快速诊断和隔离，在工业化国家，病毒性出血热（VHF）的社区暴发被认为不太可能发生。2016年3月，非洲以外首次记录到本地感染拉沙热（LF）的病例，这表明该疾病有可能成为跨境健康威胁。我们描述了在莱茵兰-普法尔茨州（发生二代传播的德国联邦州）对该例拉沙热病例的管理情况。一名有症状的殡仪馆工作人员在接触了从多哥输入的拉沙热病例尸体12天后，拉沙病毒RNA检测呈阳性。对潜在接触者进行了追踪，根据接触风险进行分类，并进行了监测。总体而言，我们确定了21名在莱茵兰-普法尔茨州拥有合法居留权的接触者：7人与首例病例有关，13人与二代病例有关，1人同时与两者有关。二代病例接受了治疗并康复。5名接触者被隔离，1人被暂时禁止工作。未发生进一步传播。根据疫情暴发期间获得的经验以及对国家和国际指南的审查，我们得出结论，目前可能低估了尸体造成的接触风险，并且我们提出了一些建议，可能有助于改善工业化国家对输入性病毒性出血热病例的抗疫应对措施。
