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平成26年11月27日
エボラ出血熱対応緊急セミナー
宮城県庁行政庁舎2階講堂
エボラ出血熱のアウトブレイク
西アフリカの現状
独立行政法人 国立国際医療研究センター 国際感染症センター 国際感染症対策室
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Situa5on Reports 21 November 2014
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brief report
diarrhea, vomiting, and an apparent
rate. (Médecins sans Frontières had
g on a malaria project in Guéckédou
In Guéckédou, eight patients were
three of them died, and additional
reported among the families of the
everal deaths were reported in
luding deaths among hospital staff
team sent by the health ministry
outbreak region on March 14 (Fig. 1).
ns Frontières in Europe was notified
am, which arrived in Guéckédou on
Epidemiologic investigation was
d blood samples were collected and
iosafety level 4 laboratories in Lyon,
Hamburg, Germany, for virologic
Senegal
& 100 km
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Mali
Guinea
Bissau
首都モンロビアの患者発生数
Guinea
Mamou
Faranah
Kindia
Conakry
Kissidougou
Sierra Leone
Guéckédou
Macenta
Nzérékoré
ivory
coast
Liberia
Bayze et al.N Engl J Med. 2014;371:1418-1425
Me thods
Figure 1. Map of Guinea Showing Initial Locations of the Outbreak of Ebola
Virus Disease.
The area of the outbreak is highlighted in red. The main road between the
outbreak area and Conakry, the capital of Guinea, is also shown. The map
was modified from a United Nations map.
s were obtained from 20 patients who
ized in Guéckédou, Macenta, and Kisause of fever, diarrhea, vomiting, or
Demographic and clinical data for the
provided on the laboratory request
al data were not collected in a systemThis work was performed as part of
alth response to contain the outbreak
formed consent was not obtained.
fied in overlapping fragments with the use of
EBOV-specific primers. The fragments were sequenced from both ends with the use of conventional Sanger techniques. The sequence of the
contigs was verified by visual inspection of the
electropherograms.
Assays
Viral Isolation
was extracted from 50 to 100 µl of
asma and 1:10 diluted plasma with
he QIAmp viral RNA kit (Qiagen).
amplification tests for detection of
and arenaviruses were performed
of commercially available kits and
imers and probes5-11 (Table S1 in the
ry Appendix, available with the full
rticle at NEJM.org).
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About 100 µl of all serum samples was used to
inoculate Vero E6 cells maintained in 25-cm2
flasks in Dulbecco’s modified Eagle’s medium
containing 2 to 5% fetal-calf serum and penicillin–streptomycin. Cells and supernatant were
passaged several times. Virus growth in the cells
was verified on immunofluorescence with the
use of polyclonal mouse anti-EBOV–specific antibodies in the serum of!"#$%&'%()&*#+(,#+(&-.&/#.+()00%1#&'#2.+3&
mice challenged with
EBOV or on the basis of an increase in viral levels
ncing
in the cell-culture supernatant over several orders
mplified by filovirus L gene–specific of magnitude, as measured on real-time RT-PCR.
e sequenced with the use of polyカルドウェル
フリーポート
Microscopy
n-reaction (PCR) primers. Complete Electron
mes were sequenced directly with the Specimens from two patients were prepared for
extracted from serum obtained from electron microscopy with the use of a conventions with high levels of viral RNA, as al negative-staining procedure. In brief, a drop of
n real-time reverse-transcriptase– 1:10 diluted serum was adsorbed to a glow-disR) analysis. The genome was ampli- charged carbon-coated copper grid and stained
n engl j med 371;15
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nejm.org
首都モンロビアにおける流行地
october 9, 2014
WHO: Ebola Response Roadmap Situa6on Report 5 November 2014 ! !
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医療機関の閉鎖
1419
The New England Journal of Medicine
ownloaded from nejm.org on November 10, 2014. For personal use only. No other uses without permission.
Copyright © 2014 Massachusetts Medical Society. All rights reserved.
ウエストポイント
1
14/11/27
WHO リベリア事務所の組織
エボラ出血熱対策の組織
リベリア
保健省
臨床管理
住民教育・
広報
サーベイラン
ス・検査診断
リベリア
代表
ジュネーブ本部
心理支援
臨床管理・
感染防止
検査診断 住民教育・
広報
疫学
ロジスティ
クス
•  ジュネーブ本部 •  ウガンダ保健省 •  アフリカ・米州・欧州地域事務局 •  厚生労働省(国立国際医療研究センター) •  欧州CDC 個人防護具
支援活動の内容
•  WHO
•  国境なき医師団
•  感染防止 –  主要病院(4 ヶ所)・大学
の医療従事者に研修を実
施 •  治療 –  新しいユニットの運営,レ
イアウトの助言,保健省と
の折衝など
A 病院 3月16日夜勤帯
2014年 西アフリカにおけるアウトブレイクにおける 症状と所見(1,415名のまとめ) WHO Ebola Response Team. N Engl J Med. 2014
•  看護助手(40歳代男性) –  検温,吐物や便に素手で触
れた可能性あり –  3月28日発症 •  看護師(40歳代男性) –  静脈路確保の際に顔面に
血液を浴びた –  4月1日発症 死亡例 (%)
生存例 (%)
オッズ比
嘔吐
69.4
62.8
1.19
下痢
68.3
58.0
1.42
頭痛
53.8
52.5
1.03
腹痛
43.5
46.2
0.85
咳嗽
32.5
22.8
1.74
嚥下困難
36.8
22.3
2.22
結膜炎
23.4
14.5
2.03
咽頭痛
24.2
15.6
1.94
吃逆
13.0
6.9
2.15
黄疸
11.7
7.1
1.83
皮疹
6.6
3.7
1.90
昏睡
7.6
1.6
4.59
2
14/11/27
2014年西アフリカにおけるアウトブレイクにおける 症状と所見(1,415名のまとめ) エボラ出血熱の臨床経過
WHO Ebola Response Team. N Engl J Med. 2014
第10病日
原因不明の出血
吐血
下血
歯肉出血
鼻出血
血痰
注射部位の出血
性器出血
血尿
死亡例 (%)
20.2
4.0
5.7
3.0
2.5
2.6
3.1
4.5
1.5
生存例 (%)
11.7
3.6
5.7
0.4
0.4
1.8
0.4
0.8
0.4
オッズ比
1.83
1.07
0.98
6.69
8.02
1.63
6.51
6.0
5.14
潜伏期 約10日間
早期発熱
消化器
症状
ショック・
回復
後期合
併症
エボラ治療ユニット(35床)の一例
患者の治療
•  抗マラリア薬・抗菌薬投与,点滴などの基本的治療のみ
勤務体制
•  3交代(8時間毎)
•  一勤務帯あたり医師,医師助手,看護師,消毒係,清掃係など約25名
職員の健康管理
•  勤務前後の体温管理
•  心理面のケア
研修
•  勤務前に個人防護具の脱着トレーニング
•  最初の1週間は経験者と一緒に勤務
3