Department of Zoology, University of Oxford, Oxford, UK.
Harvard Medical School, Harvard University, Boston, USA.
BMC Med. 2020 Apr 27;18(1):113. doi: 10.1186/s12916-020-01574-1.
The 2018-2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC) is the largest ever recorded in the DRC. It has been declared a Public Health Emergency of International Concern. The outbreak emerged in a region of chronic conflict and insecurity, and directed attacks against health care workers may have interfered with disease response activities. Our study characterizes and quantifies the broader conflict dynamics over the course of the outbreak by pairing epidemiological and all available spatial conflict data.
We build a set of conflict variables by mapping the spatial locations of all conflict events and their associated deaths in each of the affected health zones in North Kivu and Ituri, eastern DRC, before and during the outbreak. Using these data, we compare patterns of conflict before and during the outbreak in affected health zones and those not affected. We then test whether conflict is correlated with increased EVD transmission at the health zone level.
The incidence of conflict events per capita is ~ 600 times more likely in Ituri and North Kivu than for the rest of the DRC. We identified 15 time periods of substantial uninterrupted transmission across 11 health zones and a total of 120 bi-weeks. We do not find significant short-term associations between the bi-week reproduction numbers and the number of conflicts. However, we do find that the incidence of conflict per capita was correlated with the incidence of EVD per capita at the health zone level for the entire outbreak (Pearson's r = 0.33, 95% CI 0.05-0.57). In the two provinces, the monthly number of conflict events also increased by a factor of 2.7 in Ebola-affected health zones (p value < 0.05) compared to 2.0 where no transmission was reported and 1.3 in the rest of the DRC, in the period between February 2019 and July 2019.
We characterized the association between variables documenting broad conflict levels and EVD transmission. Such assessment is important to understand if and how such conflict variables could be used to inform the outbreak response. We found that while these variables can help characterize long-term challenges and susceptibilities of the different regions they provide little insight on the short-term dynamics of EVD transmission.
2018-2019 年刚果民主共和国（DRC）北基伍省和伊图里省爆发的埃博拉病毒病（EVD）是 DRC 有史以来规模最大的一次。它已被宣布为国际关注的突发公共卫生事件。疫情发生在一个长期存在冲突和不安全的地区，对医护人员的定向攻击可能干扰了疾病应对活动。我们的研究通过将流行病学和所有可用的空间冲突数据配对，来描述和量化疫情期间更广泛的冲突动态。
我们通过在北基伍省和伊图里省、DRC 东部受影响的每个卫生区之前和期间，对所有冲突事件及其相关死亡的空间位置进行映射，构建了一组冲突变量。利用这些数据，我们比较了受影响和不受影响的卫生区在疫情前后的冲突模式。然后，我们测试了冲突是否与卫生区一级的埃博拉病毒传播增加相关。
伊图里省和北基伍省的人均冲突事件发生率比 DRC 其他地区高出约 600 倍。我们确定了在 11 个卫生区跨越 120 个双周的 15 个连续传播的时间段。我们没有发现双周繁殖数与冲突数量之间存在显著的短期关联。然而，我们确实发现，整个疫情期间，人均冲突发生率与人均埃博拉病毒发病率在卫生区一级呈正相关（Pearson's r=0.33，95%CI 0.05-0.57）。在这两个省，与没有报告传播的地区相比，埃博拉疫情期间，受影响卫生区的每月冲突事件数量增加了 2.7 倍（p 值<0.05），而在没有报告传播的地区，每月冲突事件数量增加了 2.0 倍，在 DRC 其他地区，每月冲突事件数量增加了 1.3 倍，这一时间段是 2019 年 2 月至 2019 年 7 月。
我们描述了记录广泛冲突水平和埃博拉病毒传播的变量之间的关联。这种评估对于了解这些冲突变量是否以及如何用于指导疫情应对非常重要。我们发现，虽然这些变量可以帮助描述不同地区的长期挑战和脆弱性，但它们对埃博拉病毒传播的短期动态几乎没有洞察力。
