Schwartz David A
Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Vaccines (Basel). 2020 Jan 22;8(1):38. doi: 10.3390/vaccines8010038.
The Ebola virus disease (EVD) outbreak that began in Kivu province of the Democratic Republic of the Congo (DRC) in July 2018 is the second largest in history. It is also the largest and most deadly of the ten Ebola outbreaks to occur in DRC, the country where Ebola was first identified during the 1976 Yambuku outbreak. The Kivu region is one of the most challenging locations in which to organize humanitarian assistance. It is an active conflict zone in which numerous armed groups are conducting violent acts, often directed against the inhabitants, healthcare and relief workers and peacekeepers. EVD has been especially problematic in pregnancy-previous outbreaks both in DRC and other countries have resulted in very high mortality rates among pregnant women and especially their infants, with maternal mortality in some outbreaks reaching over 90% and perinatal mortality 100%. The development and implementation of the Merck rVSV-ZEBOV vaccine for Ebola infection has been a tremendous public health advance in preventing EVD, being used successfully in both the West Africa Ebola epidemic and the Équateur DRC Ebola outbreak. But from the start of the Kivu outbreak, policy decisions had resulted in excluding pregnant and lactating women and their infants from receiving it during extensive ring vaccination efforts. In June 2019, this policy was reversed, 10 months after the start of the outbreak. Pregnant and lactating women are now permitted not only the rVSV-ZEBOV vaccine in the continuing Kivu outbreak but also the newly implemented Ad26.ZEBOV/MVA-BN vaccine.
2018年7月在刚果民主共和国（DRC）基伍省爆发的埃博拉病毒病（EVD）疫情是历史上第二大疫情。它也是在刚果民主共和国发生的十次埃博拉疫情中规模最大、最致命的一次，该国在1976年扬布库疫情期间首次发现埃博拉病毒。基伍地区是组织人道主义援助最具挑战性的地点之一。它是一个活跃的冲突地区，众多武装组织在那里实施暴力行为，这些行为常常针对当地居民、医护人员、救援人员和维和人员。在以往的疫情中，埃博拉病毒病在孕期尤其成问题——在刚果民主共和国和其他国家的以往疫情中，孕妇及其婴儿的死亡率都非常高，在一些疫情中孕产妇死亡率超过90%，围产期死亡率达100%。默克公司研发的用于预防埃博拉感染的重组水疱性口炎病毒载体埃博拉疫苗（rVSV-ZEBOV）的开发和应用，是预防埃博拉病毒病在公共卫生领域取得的一项巨大进展，该疫苗已在西非埃博拉疫情和刚果民主共和国赤道省埃博拉疫情中成功使用。但从基伍疫情开始，政策决定导致在广泛的环状疫苗接种工作中，怀孕和哺乳期妇女及其婴儿被排除在接种范围之外。2019年6月，即在疫情开始10个月后，这一政策被扭转。现在，在基伍仍在持续的疫情中，怀孕和哺乳期妇女不仅可以接种rVSV-ZEBOV疫苗，还可以接种新投入使用的腺病毒26型载体埃博拉疫苗（Ad26.ZEBOV）/改良痘苗病毒安卡拉疫苗（MVA-BN）。
