Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA.
F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
J Infect Dis. 2020 Nov 13;222(12):2021-2029. doi: 10.1093/infdis/jiaa163.
Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited.
We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018-August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship.
Average Rt was 1.06 (95% confidence interval [CI], 1.02-1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05-.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30-1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21-1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02-1.35); among these, militia/political or ville morte events increased transmission.
Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.
我们对靶向和非靶向暴力对刚果民主共和国（刚果（金））埃博拉病毒（EBOV）传播的不同影响的理解有限。
我们使用 2018 年 4 月至 2019 年 8 月刚果（金）埃博拉疫区的病例数时间序列数据进行比较。暴露是每个卫生区的暴力事件数量，分为针对埃博拉的或非针对埃博拉的，以及平民引发的、（准）军事/政治的或抗议的。结果是按卫生区估计的每日繁殖数（Rt）。我们拟合线性时间序列回归模型来模拟这种关系。
平均 Rt 为 1.06（95%置信区间[CI]，1.02-1.11）。平均 2.92 起暴力事件导致 Rt 累计绝对增加 0.10（95%CI，0.05-.15）。更多的暴力事件增加了埃博拉病毒的传播（P = 0.03）。考虑到 21 天间隔内第 95 百分位的暴力事件及其对 Rt 的相对影响，针对埃博拉的事件对应于 Rt 为 1.52（95%CI，1.30-1.74），而平民引发的事件对应于 Rt 为 1.43（95%CI，1.21-1.35）。非靶向事件对应于 Rt 为 1.18（95%CI，1.02-1.35）；其中，民兵/政治或 Ville morte 事件增加了传播。
针对埃博拉的暴力事件，主要由平民引发，对埃博拉病毒的传播影响最大。
