名家／無國界醫生在安哥拉和剛果協助控制黃熱病疫情

圖、文／無國界醫生（MSF Taiwan）

在剛果民主共和國（下簡稱剛果），無國界醫生（Doctors Without Borders/Médecins Sans Frontières，簡稱MSF）正在為馬塔迪（Matadi）全市人口接種疫苗，同時也在金夏沙（Kinshasa）和中剛果省（Kongo Central province）提供治療和開展控制黃熱病病媒的工作（消滅蚊子）。在安哥拉，無國界醫生正在協助衛生部治療病人。

▲在剛果民主共和國馬塔迪疫苗接種行動的第一天，一名無國界醫生的員工提著裝有黃熱病疫苗的冷藏箱。（圖／MSF）

去年12月黃熱病在安哥拉爆發，以及隨後在剛果民主共和國確認了幾十個病例，無國界醫生派出團隊到這兩個國家，協助控制疾病蔓延。5月19日，世界衛生組織認為儘管這場疫情的爆發需要給予嚴重關切，但目前並不構成「國際關注的突發公共衛生事件」。採用高效的預防黃熱病疫苗，是預防進一步傳播的關鍵，因此供應有限的疫苗必須被有效使用。

在剛果民主共和國，自2月底以來，共確認了48起病例。 病者大多數人是從安哥拉歸國，但是其中有三個本土案例（本地傳播的），分別在金夏沙、中剛果省及在安哥拉邊境的廣哥河省（Kwango）被發現。

在中剛果省首府馬塔迪，無國界醫生的團隊於5月26日為當地35萬名居民展開了疫苗接種活動，這是剛果衛生部針對200萬名目標人群開展項目的一部分。這一計劃覆蓋了金夏沙的兩個衛生區域和中剛果省九個衛生地區。無國界醫生也與衛生部合作，在金夏沙和中剛果地區開展了控制病媒的措施。這些工作的目標是對抗埃及斑蚊——即黃熱病的傳播媒介，包括向房屋噴灑或煙熏藥物以殺滅成年蚊子、 清理垃圾和藏有死水的物品等可供蚊子繁殖、產卵的地方。

▲在一所建造中的教堂，無國界醫生正在為人們注射黃熱病疫苗。（圖／MSF）

這些工作都在有確診病例的地區，以及醫院、學校和市場等有易感染人士或易生蚊患的地點進行。

無國界醫生也在當地治療病人、給有需要的醫療中心提供醫療物資，並培訓員工如何治療黃熱病。

無國界醫生緊急統籌法加 （Elisabetta Maria Faga）說：「為消除疾病蔓延的風險，至關重要的是時刻保持警惕及能夠隨時應對。黃熱病沒有針對的治療方法，通過有針對性的疫苗接種和媒介控制措施進行預防，目前仍然是對抗黃熱病的最佳武器。」

在安哥拉治療病人

自2月中旬以來，無國界醫生一直與安哥拉的衛生部合作，支援黃熱病病例管理。無國界醫生也在首都魯安達（Luanda）（Kapalanga醫院）、萬波（Huambo）、威拉（Huila）和本吉拉（Benguela）省，直接治療黃熱病病人。目前為止，無國界醫生已經治療了299名病人。

無國界醫生已派遣70人，分成多個隊伍前往安哥拉，提供診斷和治療，同時也幫助培訓該國醫療人員進行病例管理。無國界醫生也支援落實應對疾病的國家方案和疫苗接種預備工作。安哥拉截至目前已錄得2,420起疑似病例（其中298人死亡）和 736例確診病例， 其中僅在魯安達就多達459宗確診病例，其餘確診病例分布在其他13個省份。安哥拉衛生部正在各省開展大規模疫苗接種項目，也已在羅安達完成了一個接種項目。

黃熱病是一種由被感染的蚊子傳播的急性病毒出血性疾病。名稱中的「黃」指的是在一些病人身上會出現的黃疸。埃及斑蚊是黃熱病的主要傳播媒介，它同時也會傳播登革熱、屈公病和茲卡。目前對黃熱病還沒有治療方法，接種疫苗是最有效的預防方法。黃熱病的癥狀包括發燒、頭痛和肌肉疼痛，一些病人還會進入更嚴重的階段，出現高燒和內臟出血。根據世界衛生組織的數據，高達50%的嚴重感染者將會在14天之內死亡。

▲無國界醫生的成員正在為一處社區噴藥，以殺死傳播黃熱病的病媒蚊。（圖／MSF）

MSF teams help curb yellow fever in Angola and DRC

In the DRC, MSF is vaccinating the entire population of the city of Matadi, while treatment and yellow fever vector control activities (destruction of the mosquitos) are under way in Kinshasa and in Kongo Central province. In Angola, MSF is supporting the Ministry of Health in treating patients.

Following the outbreak of yellow fever in Angola in December and the subsequent confirmation of dozens of cases in the DRC, MSF teams were deployed in both countries to help contain the spread of the disease. On May 19, the World Health Organization found that the outbreak, though serious and of grave concern, does not currently constitute a public health emergency of international concern. Deploying the highly effective yellow fever vaccine is key to prevent further spread, and the limited supply of the vaccine must be used efficiently.

In the DRC, 48 cases have been confirmed since the end of February. The majority are among people arriving from Angola, but three indigenous cases (locally transmitted ) were also identified in Kinshasa and in Kongo Central and Kwango provinces, on the Angolan border.

In Matadi, the capital of Kongo Central, MSF teams on 26 May launched a vaccination campaign intended for its 350,000 residents, as part of the Congolese Ministry of Health (MoH) programme aimed at a target population of two million people. This single programme covers two health districts in Kinshasa and nine health districts in Kongo Central. Also in cooperation with the Health Ministry, MSF has launched vector control measures in Kinshasa and Kongo Central.

These activities are intended to combat the Aedes aegypti mosquito, the carriers of yellow fever. Homes are being sprayed or fumigated to kill adult mosquitoes and destroy breeding sites such as refuse or items containing stagnant water, where the mosquito lays its eggs. These activities are being carried out in locations where cases have been confirmed and in vulnerable locations such as hospitals, schools and markets.

MSF is also treating patients, providing medical supplies to identified health centres and training staff in yellow fever treatment.

“To eliminate any risk of the disease spreading, it is vital to be vigilant and responsive,” says Elisabetta Maria Faga, MSF emergency coordinator. “There is no specific treatment for yellow fever. Prevention through targeted vaccination and vector control measures therefore remains the best weapon against the disease.”

Treating people in Angola

Since mid-February MSF has been working in collaboration with Angola’s MoH, supporting yellow fever case management. MSF teams are also directly treating yellow fever patients in the capital, Luanda (Kapalanga hospital), as well as in Huambo, Huila and Benguela provinces. To date, MSF has treated 299 patients.

MSF has deployed 70 people in different teams in Angola to provide diagnostics and treatment, as well as training national medical staff in case management. MSF is also supporting the implementation of the national protocol responding to the disease and vaccination preparedness.  Angola has so far reported 2,420 suspected cases (including 298 deaths), with 736 confirmed cases. Of the confirmed cases, 459 were in Luanda alone, with the rest in 13 other provinces. Angola’s MoH is conducting a mass vaccination campaign in the provinces, having already concluded a campaign in Luanda.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The ‘yellow’ in the name refers to the jaundice that affects some patients. The Aedes aegypti mosquito is the principal vector of yellow fever, which also transmits dengue, chikungunya and Zika. There is no treatment for yellow fever and vaccination is the most effective method of prevention. Symptoms include fever, headache and muscle pain, with some patients experiencing a more severe phase of high fever and internal bleeding. Up to 50% of severely affected patients die within 14 days, according to the World Health Organization.