早期预警、警报与应对的实施：2023年3月至5月坦桑尼亚卡盖拉马尔堡病毒病疫情应对经验
Implementation of early warning, alert and response: An experience from the Marburg virus disease outbreak response in Kagera, Tanzania, March to May 2023.
作者信息
Musyani Atuganile, Mwakapasa Emmanuel, Mponela Marcelina, Ngailo Lusungu, Rabiel Irene, Khama Mwanakombo, Mmbaga Eninka, Sindato Calvin, Noah Mololo, Solomon Werema, Mrema George, Ngenzi Danstan, Kauki George, Manasseh Gerald, Mahande Michael, Sarakikya Emmanuel, Mauka Wilhellmuss, Machumi Lameck, Mcharo Jonathan, Mtalika Mikidadi, Kanyankore Christer, Mukurasi Kokuhabwa, Beyanga Medard, Horumpende Pius, Kiremeji Michael, Kinyenje Erick, Mnkeni Emmanuel, Yango Missana, Kundy Faith Melchiory, Leonard Sibomana, Mwanahapa Patrick, Mutayoba Rita, Mayige Mary, Gatei Wangeci, Mmbaga Vida, Magembe Grace
机构信息
Amref Health Africa Tanzania, Dar es Salaam, Tanzania.
Ministry of Health (MoH), Dodoma, Tanzania.
出版信息
PLoS One. 2025 Jun 20;20(6):e0325823. doi: 10.1371/journal.pone.0325823. eCollection 2025.
INTRODUCTION
Tanzania declared a Marburg Virus Disease (MVD) outbreak on March 21, 2023, reporting nine cases and six deaths (case fatality rate (CFR) 66.7%). Detection began when a Community Health Worker (CHW) reported unexplained illness via the electronic EBS (e-EBS) system, triggering a national outbreak response. This study documents the Early Warning, Alert and Response (EWAR) interventions carried out during the MVD outbreak response in the Kagera region to identify strengths and bottlenecks for strengthening future outbreak preparedness and response efforts.
METHOD
We documented EWAR interventions using retrospective surveillance document review. MVD outbreak detection and reporting timeliness were compared with Tanzania's EBS indicators and the 7-1-7 target. Surveillance interventions included additional staff deployment, equipment addition, and tool adoption. Community sensitization efforts utilized Swahili-translated informational cards to facilitate early detection and reporting of signals through multiple channels, including the 199-hotline number, EBS desk numbers and via e-EBS and verified using the standard case definition (SCD). Signals were compiled in Microsoft Excel, where descriptive analysis using frequencies to show trends was conducted. Suspected MVD cases were sent for laboratory confirmation.
FINDINGS
On March 15, 2023, a CHW reported a signal in the e-EBS system within 24 hours. However, a community member and HCWs missed unusual signs of the MVD index case. Five additional members were deployed to support data management using the equipment provided, including three laptops, ten smartphones, and adapted tools. A total of 6,260 informational cards were distributed during community sensitization; 176 MVD signals were reported, where 48 (27.3%) met the SCD, and 37 were sent for laboratory confirmation, of which 2.7% tested positive for the virus. Most signals, 107 (60.8%), were reported in April.
CONCLUSIONS AND RECOMMENDATIONS
The government should adopt the 7-1-7 target and strengthen community and health facility EBS through ongoing mentorship for EWAR.
引言
坦桑尼亚于2023年3月21日宣布爆发马尔堡病毒病（MVD），报告了9例病例和6例死亡（病死率（CFR）66.7%）。检测始于一名社区卫生工作者（CHW）通过电子疫情监测系统（e-EBS）报告不明原因疾病，从而引发了全国范围的疫情应对行动。本研究记录了在卡盖拉地区马尔堡病毒病疫情应对期间开展的早期预警、警报和应对（EWAR）干预措施，以确定加强未来疫情防范和应对工作的优势与瓶颈。
方法
我们通过回顾性监测文件审查记录了EWAR干预措施。将马尔堡病毒病疫情的检测和报告及时性与坦桑尼亚的疫情监测系统指标及7-1-7目标进行了比较。监测干预措施包括增派工作人员、增加设备和采用工具。社区宣传工作利用了斯瓦希里语翻译的信息卡，以促进通过多种渠道（包括199热线号码、疫情监测系统服务台号码以及通过e-EBS）早期发现和报告信号，并使用标准病例定义（SCD）进行核实。信号在Microsoft Excel中进行汇总，在其中进行了使用频率的描述性分析以显示趋势。疑似马尔堡病毒病病例被送去进行实验室确认。
结果
2023年3月15日，一名社区卫生工作者在24小时内在e-EBS系统中报告了一个信号。然而，一名社区成员和医护人员忽略了马尔堡病毒病首例病例的异常症状。另外部署了五名成员，以使用提供的设备（包括三台笔记本电脑、十部智能手机以及适配工具）支持数据管理。在社区宣传期间共分发了6260张信息卡；报告了176个马尔堡病毒病信号，其中48个（27.3%）符合SCD，37个被送去进行实验室确认，其中2.7%的病毒检测呈阳性。大多数信号（107个（60.8%））在4月份报告。
结论与建议
政府应采用7-1-7目标，并通过对EWAR进行持续指导来加强社区和卫生机构的疫情监测系统。
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