Ebola Outbreak Response in the DRC with rVSV-ZEBOV-GP Ring Vaccination.

IF 96.2 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jean-Jacques Muyembe, Hongchao Pan, Richard Peto, Abdourahamane Diallo, Alhassane Touré, Placide Mbala-Kingebene, Stéphane H Bateyi Mustafa, Ndjoloko Tambwe, Sabue Mulangu, Steve Ahuka-Mundeke, Elisabeth Mukamba Musenga, Godwin Enwere, Pierre-Stéphane Gsell, Ira M Longini, Ximena Riveros Balta, Chrissy H Roberts, Michael Marks, Michel N K Yao, Abdou Salam Gueye, Ibrahima-Soce Fall, Peter Salama, Michael J Ryan, Ana Maria Henao-Restrepo
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引用次数: 0

Abstract

Background: At the beginning of the 2018-2020 outbreak of Ebola virus disease (EVD) in eastern Democratic Republic of Congo (DRC), no vaccine had been licensed. However, cluster-randomized evidence from Guinea in 2015 had indicated that ring vaccination around new cases (targeting contacts and contacts-of-contacts) with the use of single-dose live-replicating rVSV-ZEBOV-GP vaccine reduced EVD rates starting 10 days after vaccination. Thus, ring vaccination was added to the standard control measures for that outbreak.

Methods: In this study, we evaluated the incidence of EVD within the first 9 days after vaccination (when little protection was expected from case isolation or ring vaccination), during days 10 to 29, and at later time periods. We established 1853 rings around new cases or clusters within 21 days after symptom onset in the index case and offered vaccination to the ring members. Vaccinees were monitored for EVD onset until the end of the outbreak in mid-2020.

Results: From August 8, 2018, to January 14, 2020, we vaccinated 265,183 participants. Of these vaccinees, 102,515 were monitored on days 0, 3, and 21 for safety. Among the contacts and contacts-of-contacts, 434 cases of EVD (0.2 per ring) were diagnosed, almost all within 0 to 9 days (380 cases) or 10 to 29 days (32 cases) after vaccination. An additional 22 cases were diagnosed after day 29 during an average of 170 more days of follow-up. The sooner that control measures (including ring vaccination) began after EVD onset in the index case, the sooner EVD rates fell among contacts. In each subgroup, EVD rates fell suddenly around day 10. Among the contacts and contacts-of-contacts who were still disease-free at day 10, the EVD onset rate during days 10 to 29 was 0.16 per 1000 (in 32 of 194,019 participants). This rate was much lower than the rate of 4.64 per 1000 (in 21 of 4528 participants) that had been seen among similarly defined ring members in Guinea, in whom standard control measures had been promptly initiated but vaccination was delayed until 21 days after ring formation (rate ratio, 0.04; 95% confidence interval, 0.02 to 0.06). No safety concerns with the vaccine were identified.

Conclusions: Nonrandomized evidence regarding standard EVD control measures plus ring vaccination in eastern DRC reinforces the earlier randomized evidence from Guinea of vaccine efficacy against EVD onset 10 or more days after vaccination.

使用rVSV-ZEBOV-GP环形疫苗在刚果民主共和国应对埃博拉疫情。
背景:在刚果民主共和国东部2018-2020年埃博拉病毒病(EVD)爆发之初,没有疫苗获得许可。然而,2015年来自几内亚的聚类随机证据表明,在新病例周围(针对接触者和接触者的接触者)使用单剂量活复制rVSV-ZEBOV-GP疫苗进行环接种,可在接种后10天开始降低EVD发病率。因此,在那次暴发的标准控制措施中增加了环形疫苗接种。方法:在本研究中,我们评估了EVD在疫苗接种后的前9天(此时病例隔离或环接种几乎没有保护作用)、第10天至第29天以及之后的时间段内的发病率。我们在指示病例出现症状后21天内围绕新发病例或聚集性病例建立了1853个圆环,并对圆环成员进行了疫苗接种。在2020年中期疫情结束之前,对接种疫苗者进行了EVD发病监测。结果:从2018年8月8日到2020年1月14日,我们接种了265183名参与者。在这些疫苗接种者中,102,515人在第0,3和21天进行了安全性监测。在接触者和接触者中的接触者中,诊断出EVD病例434例(每环0.2例),几乎全部在接种疫苗后0 ~ 9天(380例)或10 ~ 29天(32例)内。在平均170多天的随访中,另外22例在第29天之后被诊断出来。在指示病例出现埃博拉病毒病后越早采取控制措施(包括环形疫苗接种),接触者中埃博拉病毒病发病率下降越快。在每个亚组中,EVD发病率在第10天左右突然下降。在第10天仍无疾病的接触者和接触者中的接触者中,第10至29天的EVD发病率为0.16 / 1000(194,019名参与者中有32名)。这一比率远低于在几内亚类似定义的环成员中所见的每1000人中4.64人的比率(4528名参与者中的21人),在几内亚,标准控制措施已迅速启动,但疫苗接种延迟到环形成后21天(比率比,0.04;95%置信区间为0.02 ~ 0.06)。没有发现疫苗的安全问题。结论:刚果民主共和国东部关于标准埃博拉病毒病控制措施加环状疫苗接种的非随机证据加强了几内亚早期关于疫苗对接种后10天或更长时间埃博拉病毒病发病有效的随机证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
New England Journal of Medicine
New England Journal of Medicine 医学-医学:内科
CiteScore
145.40
自引率
0.60%
发文量
1839
审稿时长
1 months
期刊介绍: The New England Journal of Medicine (NEJM) stands as the foremost medical journal and website worldwide. With an impressive history spanning over two centuries, NEJM boasts a consistent publication of superb, peer-reviewed research and engaging clinical content. Our primary objective revolves around delivering high-caliber information and findings at the juncture of biomedical science and clinical practice. We strive to present this knowledge in formats that are not only comprehensible but also hold practical value, effectively influencing healthcare practices and ultimately enhancing patient outcomes.
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