International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Lancet Infect Dis. 2023 Jul;23(7):e240-e252. doi: 10.1016/S1473-3099(22)00874-X. Epub 2023 Feb 6.
The Sudan virus disease outbreak in Uganda in 2022 showed our vulnerability to viral haemorrhagic fevers (VHFs). Although there are regular outbreaks of VHFs with high morbidity and mortality, which disproportionally affect low-income settings, our understanding of how to treat them remains inadequate. In this systematic review, we aim to explore the availability, scope, standardisation, and quality of clinical management guidelines for VHFs. We identified 32 guidelines, 25 (78%) of which were low quality and did not have supporting evidence and eight (25%) of which had been produced or updated in the past 3 years. Guidance on supportive care and therapeutics had little detail and was sometimes contradictory. Guidelines based on uncertain evidence are a risk to patients, an ethical challenge for clinicians, and a challenge to implementing trials due to heterogeneous standards of care. We recommend a standard living guideline framework to improve the quality, scope, and applicability of guidelines. Furthermore, investments into trials should aim to identify optimal treatment strategies for VHFs and prioritise affordable and scalable interventions to improve outcomes globally.
2022 年乌干达爆发的苏丹病毒病显示了我们对病毒性出血热（VHFs）的脆弱性。尽管经常爆发高发病率和死亡率的 VHFs，而且不成比例地影响低收入环境，但我们对如何治疗它们的理解仍然不足。在本次系统评价中，我们旨在探讨 VHFs 临床管理指南的可用性、范围、标准化和质量。我们确定了 32 项指南，其中 25 项（78%）质量较低，没有支持证据，8 项（25%）是在过去 3 年内制定或更新的。关于支持性护理和治疗的指南细节很少，有时还相互矛盾。基于不确定证据的指南对患者构成风险，对临床医生构成伦理挑战，并由于护理标准的异质性而对实施试验构成挑战。我们建议采用标准的临床实践指南框架，以提高指南的质量、范围和适用性。此外，对试验的投资应旨在确定 VHFs 的最佳治疗策略，并优先考虑负担得起和可扩展的干预措施，以改善全球的结果。
