(엠바고 없음/국내 코멘트 추가) 국내외 전문가의 감염병 과학 + 위험 소통 전문가 의견 26-058 Ver.2 콩고-우간다 에볼라 '국제 공중보건 비상사태'
2026.5.20. 18:10 추가 **엠바고 없음**
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- 배경
- 세계보건기구(WHO)는 17일, 콩고민주공화국과 우간다의 에볼라 발병에 대해 국제적 공중보건 비상사태(PHEIC)를 선포했습니다.
- 16일 기준, 콩고민주공화국 이투리 주에서는 부니아, 르밤파라, 몽그발루를 포함한 최소 3개 보건 구역에서 실험실 확진 사례 8건, 의심 사례 246건, 사망 의심 사례 80건이 보고됐습니다.
- 또, 콩고민주공화국에서 온 두 명의 여행객이 15일과 16일, 24시간 간격으로 우간다 캄팔라에서 확진 판정을 받는 등 이웃 국가에서도 확산이 이뤄지고 있습니다.
- WHO는 실제 감염자 수와 바이러스의 지리적 확산 범위에 불확실성이 크다고 밝혔습니다.
- 이번에 유행하고 있는 에볼라는 아직 허가 받은 백신이 없는 에볼라 변이주인 분디부교 에볼라바이러스(BDBV)에 의해 발생했습니다.
- 콩고민주공화국과 육로 국경을 접하는 국가들은 추가 확산 위험이 높을 것으로 추정됩니다.
- WHO는 "이 사건은 질병의 국제적 확산을 통해 다른 당사국에 공중 보건 위험을 초래한다"며 "이미 국제적 확산이 확인됐다"고 말했습니다.
- 다만, 현재로서는 이번 발병이 팬데믹 비상사태 기준에는 부합하지 않는다고 밝혔습니다.
- 참고: WHO 발표
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기자 여러분은 아래 주의사항을 참고해 활용해주시길 부탁드립니다.
- 엠바고는 없습니다. 자유롭게 활용 가능합니다.
- 되도록 원문을 그대로 활용해주시길 부탁드립니다.
- SMCK를 꼭 인용할 필요는 없습니다. 만약 인용 출처가 필요한 경우, 아래 형식을 따를 수 있습니다.
- "ㅇㅇㅇ(전문가)는 한국과학기술미디어센터에 ㅁㅁㅁ라고 말했다."
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류충민 한국생명공학연구원 감염병연구센터장
*2026.5.20. 18:10 추가
현재 WHO 보도자료 기준으로 131명이 사망했다. 이들 가운데 양성으로 판정된 사례는 30명으로, 기존 진단 방법으로 양성판정이 힘든다는 문제점이 있다. 현재 유행하는 에볼라는 분디부교 바이러스로 치명률이 약 30%이고 2007년과 2012년 두 번의 대규모 발생종과 동일한 종으로 판명된다. 보도자료에 따르면, 콩고에서 13명 가운데 8명이 양성으로 판정되어 그 비율이 지금까지 에볼라 확진율에 비해 높은 편이다.
영국 임페리얼대 예측으로는 1,000명 정도 확신 가능성이 있다. 국제적으로는 아직 대발생 초기 단계지만 급격한 확진자의 증가 양상으로 인하여 예의 주시할 필요가 있다.
현재 백신・치료제는 없다. 한국 질병관리청은 국내에서 발생활 확률은 낮을 것으로 예측한다.
cmryu@kribb.re.kr |
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김영욱 이화여대 커뮤니케이션·미디어 펠로우 교수
*2026.5.19.
에볼라 바이러스와 같은 고위험 감염병은 본질적으로 불확실성에 기초한 위험으로 이해할 수 있다. 이러한 불확실성은 첫째, 바이러스의 전파 경로, 감염 가능성, 치명률, 진단 정확성, 통제 가능성 등에 관한 과학적 지식이 충분하지 않다는 점에서 비롯되며, 둘째, 제한된 증거를 해석하는 과정에서 전문가들 사이에 위험 평가와 대응 방향에 대한 의견 불일치가 발생할 수 있다는 점에서 강화된다. 이러한 상황에서는 관계 기관이 최악의 시나리오를 상정하고 감시 체계 강화, 대응 자원 확보, 진단 및 격리 준비 등 선제적 대비를 수행하는 것이 필요하다. 그러나 이러한 대응이 공중의 과도한 공포나 패닉으로 이어지지 않도록 개방적이고 투명한 위험 커뮤니케이션이 병행되어야 한다. 즉, 현재 무엇이 알려져 있고 무엇이 아직 불확실한지, 왜 전문가들 사이에 판단 차이가 존재하는지, 그리고 새로운 과학적 증거가 축적될 경우 대응 지침이 변경될 수 있음을 사전에 명확히 설명함으로써 공중이 혼란이 아니라 이해를 바탕으로 대응 과정에 능동적으로 참여할 수 있도록 해야 한다.
kimyw@ewha.ac.kr |
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아래는 영국 사이언스미디어센터(UK SMC)에서 수집해 배포한 전문가 반응입니다. 영국 SMC 홈페이지에서도 확인할 수 있습니다. |
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Prof Emma Thompson, Clinical Professor of Infectious Diseases and Director of the MRC–University of Glasgow Centre for Virus Research, said:
“The current outbreak in DRC and Uganda is caused by the Bundibugyo virus, a member of the species Orthoebolavirus bundibugyoense, closely related to Ebola virus (species Orthoebolavirus zairense).
“There are several reasons for concern.
“First, reports that initial GeneXpert Ebola testing was negative suggest that the outbreak may have gone undetected for some time, with early diagnostic blind spots delaying recognition.
“Second, infections in healthcare workers are a serious warning sign in any filovirus outbreak, because they indicate unrecognised transmission in healthcare settings and gaps in infection prevention and control.
“Third, the identification of cases in Kinshasa and Kampala, hundreds of kilometres from Ituri province, shows that the virus has already moved through human mobility networks before full containment was in place.
“Bundibugyo virus has caused two previously recognised outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality proportion of 34–40%. The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports including probable and suspected cases gave higher totals. These figures are lower than the case fatality rates seen in many outbreaks caused by Ebola virus, but they are still extremely serious. Bundibugyo virus disease is not a mild infection.
“There is a licensed vaccine that targets Ebola virus from the species Orthoebolavirus zairense (rVSV-ZEBOV). Experimental non-human primate work suggests that rVSV-ZEBOV may provide partial heterologous protection against Bundibugyo virus, but this cannot be assumed to translate into reliable protection in people during an outbreak. Adenovirus- and MVA-vectored vaccine platforms may offer broader possibilities, particularly where multivalent constructs are used, but recent immunological data suggest that some licensed or advanced platforms still induce responses that are predominantly directed against Ebola virus rather than broadly cross-reactive across all ebolaviruses. In plain terms, we do not currently have a proven, licensed, Bundibugyo-virus-specific vaccine available for outbreak control and further urgent research is required.
“The same applies to therapeutics. Approved monoclonal antibody treatments such as Inmazeb and Ebanga were developed for disease caused by Ebola virus, not Bundibugyo virus, and their efficacy against other ebolaviruses has not been established. There are promising experimental broad-spectrum antibodies, but these are not yet a substitute for rapid detection, high-quality supportive care, infection prevention and control, and contact tracing.
“The immediate priorities are therefore practical and scientific: Bundibugyo-virus-capable diagnostics, rapid genomic sequencing, strong infection prevention in healthcare settings, safe clinical pathways, contact tracing, community engagement, and treatment centres able to deliver high-quality supportive care. Genomic sequencing is particularly important because it can confirm the virus species, identify whether cases are linked, reconstruct transmission chains, and detect whether the outbreak reflects sustained human-to-human transmission or multiple introductions.
“This outbreak also highlights a persistent weakness in epidemic preparedness. We tend to build tools around the best-known outbreak pathogens, but rarer viruses such as Bundibugyo virus can still cause severe disease and international spread. Sustained investment in high-containment laboratories, diagnostic development, genomic surveillance, vaccine platforms, therapeutics and international research partnerships is essential. These capacities cannot be assembled at speed once an outbreak is already moving.”
Dr Natsuko Imai, Research Lead in Epidemics and Epidemiology at Wellcome, said:
“While the global risk remains low, this evolving situation is concerning. The Bundibugyo ebolavirus is less common than other strains, with this marking only the third recorded outbreak. Unlike for the Zaire ebolavirus, there are no approved vaccines or therapeutics, and limited diagnostics relying on specialist labs, making it difficult to assess the true scale of its spread.
“Public health officials in the area have significant experience dealing with Ebola outbreaks, but rapid, coordinated response is essential. Global collaboration to strengthen active surveillance, contact tracing, infection prevention and control measures, as well as community engagement and safe and dignified burials are vital for containing the outbreak and protecting the communities at risk in the DRC, Uganda, and neighbouring countries.”
Dr Amanda Rojek, Associate Professor of Health Emergencies, Pandemic Sciences Institute, University of Oxford, said:
“The declaration of a PHEIC does not immediately change the reality on the ground. What it does do is signal to the international community the need to pay attention to this outbreak and support a well-coordinated response.
“It does not mean the outbreak is globally uncontrollable, but it does reflect that the situation is complex enough to require international coordination. There are already major challenges to controlling this outbreak. Some cases are in remote regions that are difficult for healthcare teams to access safely, while cases in capital cities create different risks. The simultaneous activity in DRC and Uganda also increases the importance of cross-border coordination and preparedness.
“Bundibugyo is a less commonly encountered strain of Ebola. There have been two previous outbreaks, one in Uganda and one in DRC, both more than a decade ago. Since then, we have significantly improved the quality of supportive care provided to patients with Ebola, and much of that experience will still be relevant here.
“Unfortunately, Bundibugyo has fewer proven countermeasures than Zaire ebolavirus, where vaccines have been highly effective in controlling outbreaks. Work is now urgently underway to determine which experimental treatments and vaccines should be prioritised for testing.
“Importantly, this declaration should also be seen as evidence that the international system is responding earlier and more proactively than in previous outbreaks. There are now much stronger surveillance systems, diagnostics, treatment trial networks, and regional preparedness mechanisms than existed a decade ago. Both DRC and Uganda also have substantial experience managing Ebola outbreaks.”
Prof Trudie Lang, Professor of Global Health Research, University of Oxford, said:
This latest Ebola outbreak, involving the Bundibugyo ebolavirus (BDBV) strain, presents several factors that together make it a significant public health concern and have driven the WHO’s decision to classify the situation as a Public Health Emergency of International Concern. The outbreak meets these criteria through its potential for cross-border spread, the operational challenges affecting detection and response, and the need for coordinated international support.
“Teams in the Democratic Republic of Congo are reporting serious challenges in the most vulnerable and affected areas, where access is difficult and laboratory confirmation of cases remains limited. As a result, detection and surveillance have been sporadic and complex, meaning cases may go undetected for periods of time before being identified and investigated.
“One of the most significant concerns is that this outbreak involves the Bundibugyo ebolavirus (BDBV) strain, a form of Ebola for which we do not currently have licensed vaccines available.
“The outbreak is occurring in a region that continues to experience the impacts of previous disease outbreaks. Many of the affected areas are mining towns with highly mobile and transient populations. This mobility increases risk as people move between communities and across borders. Ongoing local political instability and insecurity further complicate response efforts and access to affected populations.
“Importantly, many of the same public health and healthcare teams responding to this Ebola outbreak are also continuing to manage the ongoing mpox outbreak, which remains present and continues to transmit from person to person in parts of the region. This creates a layered emergency response environment, placing additional pressure on already stretched laboratory systems, surveillance networks and frontline health services. These overlapping outbreaks highlight the extraordinary challenges faced by teams working in these communities and border towns, where population movement, insecurity and competing health priorities can make outbreak detection, containment and continuity of response especially difficult.
“The immediate priorities are an urgent need for locally led and delivered community engagement effort to reduce transmission, strengthen trust and support early care-seeking and reporting. Second, laboratory systems and access to detection capabilities must be strengthened to enable faster case identification, more effective surveillance and improved outbreak monitoring.
“This response also depends upon strong cooperation, transparent information sharing and interoperable systems so that the situation can be understood and managed effectively across local, national and regional levels. There is strong local expertise and significant regional capacity already engaged in the response. Africa CDC and WHO have moved swiftly and are highly active, and response coordination and collaboration are robust and underway. Building and connecting these existing strengths and systems will be essential to bringing the outbreak under control.
“Beyond community engagement and strengthening detection capabilities, the immediate major challenge is to rapidly evaluate a vaccine candidate within the outbreak setting so that strategies such as ring vaccination can be considered and deployed if proven effective. Advancing this work quickly and safely may prove critical to limiting further spread and protecting vulnerable communities and health workers.”
Declared interests
Prof Emma Thompson: “Professor Thomson is Director of the MRC–University of Glasgow Centre for Virus Research and is involved in research collaborations in Uganda relating to viral surveillance, genomics and emerging infectious diseases. She has received research funding from UKRI, MRC, NIHR and other public and charitable funders. She has no relevant personal financial interests relating to Ebola vaccines or therapeutics.”
Dr Natsuko Imai: No COI
Dr Amanda Rojek: I’m the clinical lead for the WHO sponsored PARTNERS trial (the treatment trial in the region).
Prof Trudie Lang: No conflicts of interest
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아래는 호주 사이언스미디어센터(Aus SMC)에서 수집해 배포한 전문가 반응입니다. 호주 SMC 홈페이지에서도 확인할 수 있습니다. |
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"With respect to the Current Ebola outbreak in Africa, there are three things that deserve attention. Firstly, the two confirmed cases in Kampala have no known connection to each other. That is often a warning sign that the outbreak in the DRC is larger than health authorities can currently see. Secondly, at least four healthcare workers have died from Ebola virus. Previous Ebola epidemics have shown how easily health facilities can become major sites of transmission. The main problem is understaffed and under-resourced frontline care, combined with delayed presentation through informal clinics, pharmacies and traditional healers outside the formal health system. Finally, research into vaccines for Bundibugyo remains in pre-clinical stages. There is ongoing work on a pan-filo virus vaccine that could potentially have applications for Bundibugyo, but clinical-stage candidates do not yet exist. This underscores why preparedness planning and regulatory groundwork are essential now.This outbreak is also a reminder of why the WHO matters. Epidemics like Ebola do not stop at borders, and no single country can coordinate surveillance, diagnostics, regulatory approvals and cross-border preparedness alone. Much of that unglamorous but essential work sits quietly inside the WHO system until a crisis like this exposes how important it really is."
Comment correction: an earlier version of this comment incorrectly stated that "candidate vaccines and treatments for Bundibugyo exist; they are simply not licensed." The above comment has been corrected by the expert.
Adrian has not declared any conflicts of interest.
He is contactable on +61 401 124 613, +61 8 8302 2163 or adrian.esterman@adelaide.edu.au
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Professor Glenn Marsh is a Principal Research Scientist and Team Leader of Pathogen Research at CSIRO
"The World Health Organization (WHO) has declared an Ebolavirus outbreak in the Democratic Republic of the Congo (DRC) and Uganda a public health emergency of international concern. This outbreak is of concern due to the large number of suspected cases and deaths being reported. As of May 16, there are eight confirmed Bundibugyo virus cases, with an additional 246 suspected cases and 80 suspected deaths, including healthcare workers. Bundibugyo virus, first identified in 2007 in Uganda (37 cases, 25% fatality) and then again in 2012 in the DRC (57 cases, 51% fatality), currently has no approved vaccines or treatments, though some vaccine candidates are in development. This is due to the small number of outbreaks with the virus compared to other strains of Ebolavirus. Both Uganda and the DRC have experienced multiple Ebolavirus events previously. Testing and population movement restrictions will be implemented by health officials, along with WHO and other international partners, with the aim of containing the outbreak, identifying new cases, and providing emergency health care. The outbreak is geographically widespread in both countries, with most cases reported from the remote eastern region of the DRC. This area has poor road networks, which will make accessing it by response workers difficult."
Glenn has not declared any conflicts of interest.
He is contactable on 03 5227 5125 or glenn.marsh@csiro.au
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Associate Professor Vinod Balasubramaniam is a Molecular Virologist and the Leader of the Infection and Immunity Research Strength from the Jeffrey Cheah School of Medicine & Health Sciences at Monash University in Malaysia
"The WHO declaration is scientifically justified, but it should not be read as a reason for public panic. Ebola does not spread like COVID-19 or influenza. It usually requires direct contact with blood, body fluids, contaminated materials, or unsafe healthcare and burial practices. This means Ebola outbreaks can be controlled, but only if the response is early, coordinated and trusted by communities. What makes this outbreak important is that it involves Bundibugyo virus, a rarer member of the ebolavirus family. Most of the vaccines and antibody treatments we commonly associate with Ebola were developed for Zaire ebolavirus, not Bundibugyo virus. At best, a Zaire-based vaccine may provide limited or partial cross-reactive immunity, but in practical outbreak control, we should not assume reliable protection unless this is proven. This is why a Bundibugyo-specific vaccine, or ideally a broader pan-ebolavirus vaccine, is likely needed. The warning signs are clear. Suspected undetected transmission, spread across borders, and infections or deaths among healthcare workers. When healthcare workers are affected, the health system itself becomes vulnerable, and that can accelerate an outbreak. The priorities now are straightforward. This includes rapid diagnosis, safe isolation, contact tracing, strong infection prevention in hospitals, safe and dignified burials, and honest communication with communities. For countries outside the affected region, including Australia and Southeast Asia, the immediate risk remains low, but preparedness still matters. This is not about border closures or fear. It is about supporting affected countries quickly and using evidence-based public health before the outbreak becomes harder to contain."
Vinod has not declared any conflicts of interest.
He is contactable on +60 1 111 485 871 or vinod.balasubramaniam@monash.edu
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Associate Professor Jonathan Liberman is a Global Health Law Advisor at Burnet Institute and Associate Professor in Law and Global Health in Melbourne Law School at the University of Melbourne
"The Director-General of the World Health Organization has determined that the Ebola disease outbreak caused by the Bundibugyo virus in the Democratic Republic of Congo and Uganda constitutes a public health emergency of international concern, or PHEIC. This is a formal determination under the International Health Regulations, the legally binding international framework for preventing and responding to the international spread of disease. A PHEIC means the event is extraordinary, poses a public health risk to other countries through international spread, and may require a coordinated international response. Determining an event to be a PHEIC sends an important international alert, and enables the WHO to issue temporary recommendations to governments and others on how to prevent or reduce international spread, while minimising unnecessary interference with international travel and trade. The WHO has begun the process to do this. In the meantime, the WHO has issued advice to DRC and Uganda, to neighbouring countries with land borders adjoining affected states, and to all other states parties. It is also important that the Director-General has determined that the higher level of ‘pandemic emergency’ has not been met. This category was introduced through amendments to the International Health Regulations adopted in 2024, following lessons from COVID-19. A pandemic emergency requires additional criteria to be met, including high risk of wide geographical spread, pressure on health systems, and substantial social or economic disruption, and the need for rapid, equitable and enhanced international action across government and society."
Jonathan has not declared any conflicts of interest.
He is contactable via Tasha Wibawa on +61 425 922 892 or Tasha.wibawa@burnet.edu.au
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Professor Kirsten Spann is Associate Dean of Research in the Faculty of Health in the School of Biomedical Science at Queensland University of Technology (QUT)
"The most important action required at this stage is to stand-up large-scale Bundibugyo-specific diagnostics in DRC, Uganda, and all surrounding African nations so that cases can be identified in people with mild symptoms to reduce spread and enable early intervention to reduce the death rates. Effective diagnostics are essential to identify cases that can be isolated and treated. This outbreak is an example of the importance of maintaining global diagnostic capabilities, including public health units that can deliver diagnostics, and also utilising technology to ensure rapid design and production of tests. Globally, funding for diagnostic development is limited between outbreaks of disease, but then we are reminded each time situations like this arise that we need consistent efforts and funding for diagnostic development so that we can be prepared."
Kirsten has declared no conflicts of interest.
She is contactable on +61 409 620 110 or kirsten.spann@qut.edu.au
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Dr Abrar Chughtai is a Senior Lecturer and the Director of the Master of Infectious Diseases Intelligence Program at the School of Population Health, University of New South Wales
"The World Health Organization (WHO) has declared the Ebola outbreak in the Democratic Republic of Congo (DRC) a Public Health Emergency of International Concern (PHEIC). This decision was mainly driven by the high fatality rate associated with Ebola and the significant risk of further spread under the current conditions in the DRC. At least 88 deaths have been reported so far, and the number is likely to increase in the coming days. Ebola is one of the world’s deadliest infectious diseases, with several strains causing severe outbreaks, particularly the Zaire strain. Historically, most major Ebola outbreaks have been caused by the Zaire strain, which is associated with the highest fatality rates and was responsible for the largest outbreak in West Africa in 2014–2016. However, the current outbreak involves the Bundibugyo strain, raising major concerns because the widely used Ervebo vaccine is not effective against it. There are currently no approved vaccines or specific treatments for the Bundibugyo strain. Ebola spreads through direct contact with infected bodily fluids. It is highly infectious, but is not as easily transmissible as measles or other respiratory infections. However, the risk of further spread in the DRC remains high due to social, economic, and political instability in affected areas. By declaring a PHEIC, WHO aims to strengthen international coordination, accelerate emergency response measures, and mobilise additional healthcare resources and support for affected regions. Healthcare workers treating Ebola cases particularly require strict infection control protection, including adequate personal protective equipment (e.g. full-body suits, respirators, gloves, etc.), as they were disproportionately infected and killed during previous Ebola outbreaks. Community education and engagement are also necessary to control the outbreak early."
Abrar has not declared any conflicts of interest.
He is contactable on abrar.chughtai@unsw.edu.au, or +61 2 9385 1009
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Dr Matt Mason is Senior Lecturer in Nursing and Academic Lead for Work Integrated Learning for the School of Health at the University of the Sunshine Coast
"The WHO's declaration of the Bundibugyo virus disease outbreak in the Democratic Republic of the Congo and Uganda as a Public Health Emergency of International Concern demands an urgent, coordinated global response, one that places communities and their extensive local knowledge at its core. The healthcare worker deaths raise serious concerns about gaps in infection prevention and control (IPC) and the potential for amplification within health facilities, leading to the wider community. Strengthening IPC is critical, but cannot be achieved through top-down directives alone. Local health workers, traditional healers, and community caregivers carry deep contextual knowledge of how illness presents, spreads, and is understood within their communities. This knowledge is not supplementary; it is foundational. IPC guidance and outbreak response strategies must be co-designed with community leaders, not simply delivered to them. The international community must fund the response, ensure uninterrupted PPE supplies, and invest in local health systems and fair remuneration for health workers, professional and lay. Risk to Australia and International Travellers:Two confirmed cases have already been reported in Kampala following travel from the DRC, demonstrating the virus's capacity for international spread. While Australia's direct risk remains low, travellers to affected regions should monitor WHO advisories, avoid contact with suspected cases, and seek immediate medical attention if symptoms develop post-travel. The most effective protection is avoiding travel to active outbreak zones. Hand hygiene is one small component of a much broader, layered infection prevention strategy, including respiratory and mucous membrane protection."
Declared conflicts of interest: Board member of the Australasian College of Infection Prevention and Control, and the Pacific Region Infectious Diseases Association
Matt is contactable on +61 7 5456 5191 (office), +61 498 188 039 (mobile) or mmason1@usc.edu.au
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Dr Peter Bai James is from the Faculty of Health at Southern Cross University
"The declaration by the World Health Organization (WHO) of the current Ebola outbreak in DR Congo and Uganda as a public health emergency of international concern suggests the potential of the virus to be a global health threat. What makes it more serious is that the current outbreak is fuelled by an uncommon, but lethal strain of the virus (Bundibugyo) that has no approved vaccines or therapeutics. The Africa CDC and WHO have reported more than 246 suspected cases, 80 suspected deaths, and eight laboratory confirmed cases in the DRC conflict, Ituri province. This underscores a lag in detection: the virus has been spreading undetected for weeks, and given the high levels of people movement in that region due to mining activity and insecurity, this would explain the rapid spread. Despite DR Congo having grappled with Ebola outbreaks in past, standard containment measures, such as contact tracing, isolation and proper burial practices, are currently hampered by regional insecurity. The current public health priority should focus on ensuring the immediate deployment of infection control supplies to frontline health facilities and to kick-start research into Bundibugyo-strain-specific interventions before the outbreak reaches a point at which it can no longer be contained. Also, regional collaboration among the affected countries and donor agencies is critical at this stage. This outbreak continues to highlight that in the Ebola-endemic region, continuous surveillance is critical for early detection and containment, and at the same time, non-biological factors, such as insecurity, can undermine the gains made in previous outbreaks."
Peter has declared no conflicts of interest. Dr Peter Bai James was a front-line health worker during the 2013-2016 Ebola outbreak in Sierra Leone, West Africa. His doctoral research investigated the health-seeking behaviour of Ebola survivors with post-Ebola sequelae in Sierra Leone. His current research looks at post-infectious sequelae rehabilitation as it relates to COVID -19.
He is contactable on +61 2 6620 3143, +61 416 175 256, or peter.james@scu.edu.au
Alternative contact: Sharlene King, media office at Southern Cross University - +61 429 661 349
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Professor Paul Griffin is the Director of Infectious Diseases at Mater Health Services and the Head of the Mater Clinical Unit for the University of Queensland School of Medicine
"The current situation with Ebola, caused by the Bundibugyo strain of ebolavirus predominantly in the Democratic Republic of Congo, is certainly one that warrants careful attention and makes the declaration of a public health emergency of international concern (PHEIC) very reasonable. However there are important points of clarification. Firstly, a public health emergency of international concern is not at all related to there being concern of pandemic potential. Ebola is not a new virus, discovered in the late 1970’s and requires close contact or contact with blood or body fluid to be transmitted. The mortality is much greater than that of respiratory viruses such as COVID-19, typically with the mortality of the Bundibugyo strain often quoted as between 25 to 50%. While this is bad for those infected and makes the current situation very significant, it does mean cases are more likely to be displaying significant symptoms and therefore be identified and ideally managed accordingly to limit onward spread. Provided, of course, that there are appropriate resources to do so, which hopefully the declaration of the PHEIC will help ensure is the case. Concerning elements of the current situation include the high numbers of suspected cases and deaths have already been reported at approximately 250 to 300 and at least 88, respectively. It is thought, however, that the true numbers may already be far greater. While there are vaccines for Ebola, unfortunately, these are for a different strain, namely, for Zaire ebolavirus. This means there are no vaccines or treatments for the Bundibugyo strain. Suspected cases have been found in densely populated areas; there have also been suspected healthcare worker cases and spread across borders to Uganda. It is for these, and many other reasons, that the PHEIC has been declared. Hopefully, this will facilitate international coordination and cooperation to understand the true extent of the current outbreak, to coordinate surveillance as well as prevention and response efforts. With a coordinated response that can be facilitated by the declaration of the PHEIC, it is very reasonable to expect this current outbreak will be able to be geographically restricted, hence the global risk outside the region remains low."
Paul has not declared any conflicts of interest.
Additional notes: "I am also Director and Scientific Advisory Board Member of the Immunisation Coalition and Director of AMA Queensland. I have been the principal investigator on trials of Ebola vaccines. I am very available and happy to discuss as needed."
Paul is contactable on +61 402 077 302 or paul.griffin@uq.edu.au
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Professor Justine Smith is a Strategic Professor in Eye and Vision Health/Matthew Flinders Distinguished Professor at Flinders University and a Senior Consultant Ophthalmologist at Flinders Medical Centre
"I was professionally distressed to learn of this development over the weekend, because it means more eye inflammation and potential blindness down the track. I am an ophthalmologist (=eye surgeon) who works in the area of eye inflammation and infection. From the 2014-2016 West African outbreak, we know that up to one-third of Ebola survivors develop severe inflammation inside the eye (the condition ophthalmologists call ‘uveitis’), because the virus persists inside the eye after the infected person recovers from acute Ebola. This severe inflammation can be complicated by cataract. Eyes are frequently blinded by uveitis or its complications. It is the eye’s unique cellular and immune environment that facilitates the persistence of the virus and inflammation inside."
Justine's COI statement: "No conflicts outside grant funding to study mechanisms of Ebola eye disease."
She is contactable on +61 408 445 666, +61 8 8204 4300 or justine.smith@flinders.edu.au
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아래는 스페인 사이언스미디어센터(SMC Spain)에서 수집해 배포한 전문가 반응입니다. 스페인 SMC 홈페이지에서도 확인할 수 있습니다. |
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Daniela Manno, profesora clínica adjunta en la Escuela de Higiene y Medicina Tropical de Londres (Reino Unido), dice:
¿Cómo de preocupante es este brote?
“Este es un brote preocupante por varias razones. En primer lugar, el número de casos sospechosos notificados antes de la confirmación sugiere que la transmisión podría haber estado ocurriendo durante varias semanas antes de que el brote fuera reconocido oficialmente. En segundo lugar, el brote se está produciendo en una región afectada por la inseguridad, el desplazamiento de población y una alta movilidad de personas, todo lo cual puede complicar la vigilancia, el rastreo de contactos y la prestación de servicios sanitarios.
Un brote previo de ébola que afectó a las provincias de Kivu Norte e Ituri entre 2018 y 2020 duró casi dos años, con la inseguridad y la desconfianza comunitaria interrumpiendo repetidamente el rastreo de contactos, la vacunación y las actividades de respuesta.
Además, ahora se cree que el brote está causado por el virus del Ébola de Bundibugyo, un virus raro causante de ébola para el cual actualmente no existen vacunas ni tratamientos autorizados. Tampoco hay vacunas en fases avanzadas de desarrollo clínico que puedan desplegarse rápidamente durante el brote.
Sin embargo, es importante subrayar que la República Democrática del Congo tiene una amplia experiencia en la respuesta a brotes de ébola y la capacidad de respuesta es significativamente mayor hoy que hace una década”.
¿Qué es una Emergencia de Salud Pública de Importancia Internacional (PHEIC, por sus siglas en inglés)? ¿Cómo cambia esto nuestra comprensión de la situación o la respuesta de salud pública?
“Una PHEIC es el nivel más alto de alerta de salud pública internacional que la Organización Mundial de la Salud puede declarar bajo el Reglamento Sanitario Internacional.
Una PHEIC no significa que el brote se haya convertido en una pandemia global. Más bien, refleja que el evento se considera lo suficientemente grave como para requerir acción internacional coordinada, vigilancia reforzada, movilización de recursos y colaboración transfronteriza.
En términos prácticos, la declaración ayuda a movilizar la atención internacional, la financiación, el apoyo técnico y la coordinación entre países y agencias de salud pública”.
¿Cómo de preocupante es esa declaración de emergencia? ¿Cuándo fue la última vez que se declaró una PHEIC por ébola?
“La Organización Mundial de la Salud declaró previamente una PHEIC durante el gran brote de ébola en las provincias de Kivu Norte e Ituri en la República Democrática del Congo entre 2018 y 2020, y antes de eso durante la epidemia de ébola en África Occidental de 2014–2016.
La declaración actual refleja la preocupación por la complejidad operativa del brote, incluida la inseguridad, el movimiento de la población, la detección tardía y la implicación del virus del ébola de Bundibugyo, para el cual actualmente no existen vacunas ni tratamientos autorizados, ni vacunas en desarrollo avanzado que puedan desplegarse rápidamente”.
La OMS dice que no cumple los criterios de una emergencia pandémica. ¿Cuál es la diferencia entre una PHEIC y una emergencia pandémica?
“Una PHEIC es un mecanismo legal formal bajo el Reglamento Sanitario Internacional diseñado para activar la coordinación internacional y el apoyo ante eventos de salud pública graves.
Una pandemia se refiere a la propagación global sostenida de una enfermedad a través de múltiples países o continentes.
Los brotes de ébola pueden ser extremadamente graves y devastadores a nivel local y regional, pero el ébola no se propaga de la misma manera que los virus respiratorios como la gripe o la covid-19, y en general es mucho menos transmisible. La transmisión normalmente requiere contacto directo con fluidos corporales o materiales contaminados de una persona infectada, lo que hace que la propagación global sostenida sea mucho menos probable”.
¿Sabemos más sobre la cepa que está causando este brote y eso afecta a la respuesta?
“La evidencia actual sugiere que el brote está causado por el ébolavirus Bundibugyo, un virus raro del ébola identificado previamente solo en dos brotes documentados, en Uganda en 2007 y en la República Democrática del Congo en 2012.
Esto es importante porque las vacunas y tratamientos actualmente autorizados desarrollados para el virus del Ébola (anteriormente ébolavirus Zaire) no se espera que proporcionen protección contra la enfermedad causada por el virus de Bundibugyo.
Como resultado, la respuesta depende en gran medida de medidas clásicas de salud pública como la detección rápida de casos, el aislamiento, el rastreo de contactos, la prevención y control de infecciones, los entierros seguros y la participación comunitaria. Estas medidas fueron fundamentales para controlar finalmente la epidemia de ébola de África Occidental de 2014–2016, la mayor registrada hasta la fecha, y si se implementan de forma rápida y eficaz también pueden ayudar a controlar este brote”.
¿Algún otro comentario?
“Este brote pone de relieve tanto los avances como las lagunas que aún existen en la preparación global frente a epidemias. En la última década se han logrado avances considerables en vigilancia del ébola, diagnóstico, sistemas de respuesta a brotes, vacunas y tratamientos. Sin embargo, la preparación sigue siendo desigual entre diferentes filovirus, especialmente en el caso de virus del Ébola más raros como el ébolavirus Bundibugyo.
También pone de relieve cómo la inseguridad, el desplazamiento y la fragilidad de los sistemas sanitarios pueden seguir complicando la respuesta a brotes, incluso cuando existen herramientas científicas y experiencia en salud pública disponibles.”
Conflicto de interés: Daniela Manno ha trabajado anteriormente en ensayos clínicos de vacunas contra el ébola y en investigaciones sobre preparación ante brotes en Sierra Leone, Tanzania y la República Democrática del Congo.
Emma Thompson, profesora clínica de Enfermedades Infecciosas y directora del MRC–University of Glasgow Centre for Virus Research, Universidad de Glasgow (Reino Unido), dice:
El actual brote en la República Democrática del Congo y Uganda está causado por el virus Bundibugyo, un miembro de la especie Orthoebolavirus bundibugyoense, estrechamente relacionado con el virus del Ébola (especie Orthoebolavirus zairense).
Hay varias razones de preocupación.
En primer lugar, los informes de que las pruebas iniciales de ébola realizadas con GeneXpert fueron negativas sugieren que el brote podría haber pasado desapercibido durante algún tiempo, con puntos ciegos diagnósticos tempranos que retrasaron su detección.
En segundo lugar, las infecciones en trabajadores sanitarios son una señal de alarma en cualquier brote por filovirus, ya que indican transmisión no detectada en entornos sanitarios y fallos en las medidas de prevención y control de infecciones.
En tercer lugar, la identificación de casos en Kinshasa y Kampala, a cientos de kilómetros de la provincia de Ituri, muestra que el virus ya se ha desplazado a través de redes de movilidad humana antes de que se lograra una contención completa.
El virus Bundibugyo ha causado dos brotes previamente reconocidos. El primero fue en el distrito de Bundibugyo, en Uganda, en 2007–2008, con 131 casos notificados y 42 muertes, y una letalidad del 34–40%. El segundo fue en Isiro, en la República Democrática del Congo, en 2012, con 38 casos confirmados en laboratorio y 13 muertes, aunque los informes más amplios que incluyen casos probables y sospechosos elevan las cifras totales. Estas tasas son inferiores a las observadas en muchos brotes causados por el virus del Ébola, pero siguen siendo extremadamente graves. La enfermedad por el virus Bundibugyo no es una infección leve.
Existe una vacuna autorizada dirigida al virus del Ébola de la especie Orthoebolavirus zairense (rVSV-ZEBOV). Estudios experimentales en primates no humanos sugieren que rVSV-ZEBOV podría ofrecer cierta protección cruzada parcial frente al virus Bundibugyo, pero no puede asumirse que esto se traduzca en una protección fiable en humanos durante un brote. Las plataformas de vacunas basadas en adenovirus y MVA pueden ofrecer posibilidades más amplias, especialmente en formulaciones multivalentes, pero datos inmunológicos recientes sugieren que algunas plataformas autorizadas o en fases avanzadas siguen generando respuestas principalmente dirigidas contra el virus del Ébola, más que respuestas amplias frente a todos los ebolavirus. En términos sencillos, actualmente no disponemos de una vacuna específica contra el virus Bundibugyo aprobada y lista para el control de brotes, por lo que se necesita investigación urgente adicional.
Lo mismo ocurre con los tratamientos. Las terapias aprobadas basadas en anticuerpos monoclonales como Inmazeb y Ebanga se desarrollaron para la enfermedad causada por el virus del Ébola, no por el virus Bundibugyo, y su eficacia frente a otros ebolavirus no está establecida. Existen anticuerpos experimentales de amplio espectro prometedores, pero aún no sustituyen la detección rápida, la atención de soporte de alta calidad, la prevención y control de infecciones y el rastreo de contactos.
Las prioridades inmediatas son, por tanto, prácticas y científicas: diagnósticos capaces de detectar el virus Bundibugyo, secuenciación genómica rápida, fuerte control de infecciones en entornos sanitarios, circuitos clínicos seguros, rastreo de contactos, participación comunitaria y centros de tratamiento capaces de ofrecer cuidados de soporte de alta calidad. La secuenciación genómica es especialmente importante porque permite confirmar la especie viral, determinar si los casos están relacionados, reconstruir cadenas de transmisión y detectar si el brote se debe a transmisión sostenida entre humanos o a múltiples introducciones.
Este brote también pone de relieve una debilidad persistente en la preparación frente a epidemias. Tendemos a desarrollar herramientas en torno a los patógenos de brote más conocidos, pero los virus más raros como el Bundibugyo también pueden causar enfermedad grave y propagación internacional. Es esencial una inversión sostenida en laboratorios de alta contención, desarrollo de diagnósticos, vigilancia genómica, plataformas de vacunas, terapias y colaboraciones internacionales de investigación. Estas capacidades no pueden improvisarse rápidamente una vez que un brote ya está en marcha”.
Conflicto de interés: Emma Thomson es directora del Centro de Investigación Viral del MRC-Universidad de Glasgow y participa en colaboraciones de investigación en Uganda relacionadas con la vigilancia viral, la genómica y las enfermedades infecciosas emergentes. Ha recibido financiación para investigación de UKRI, MRC, NIHR y otras entidades públicas y benéficas financiadoras. No tiene intereses financieros personales relevantes relacionados con vacunas o tratamientos contra el ébola.
La siguiente reacción procede de nuestras compañeras del SMC Australia:
Vinod Balasubramaniam es virólogo molecular y director del Grupo de Investigación en Infecciones e Inmunidad de la facultad de Medicina y Ciencias de la Salud Jeffrey Cheah de la Universidad Monash en Malasia, dice:
“La declaración de la OMS está científicamente justificada, pero no debe interpretarse como un motivo para que cunda el pánico entre la población. El ébola no se propaga como la covid-19 o la gripe. Por lo general, requiere contacto directo con sangre, fluidos corporales, materiales contaminados o prácticas sanitarias y funerarias inseguras. Esto significa que los brotes de ébola pueden controlarse, pero solo si la respuesta es temprana, coordinada y cuenta con la confianza de las comunidades.
Lo que hace que este brote sea importante es que se trata del virus Bundibugyo, un miembro menos común de la familia de los ébolavirus. La mayoría de las vacunas y tratamientos con anticuerpos que solemos asociar con el ébola se desarrollaron para el virus del Ébola de Zaire, no para el virus de Bundibugyo. En el mejor de los casos, una vacuna basada en el virus de Zaire podría proporcionar una inmunidad cruzada limitada o parcial, pero en la práctica del control de brotes, no debemos dar por sentada una protección fiable a menos que se demuestre. Por eso es probable que se necesite una vacuna específica contra el virus de Bundibugyo o, idealmente, una vacuna más amplia contra todos los virus del Ébola.
Las señales de alerta son claras. Sospecha de transmisión no detectada, propagación transfronteriza e infecciones o muertes entre el personal sanitario. Cuando el personal sanitario se ve afectado, el propio sistema sanitario se vuelve vulnerable, y eso puede acelerar un brote.
Las prioridades ahora son claras. Esto incluye el diagnóstico rápido, el aislamiento seguro, el rastreo de contactos, una prevención rigurosa de la infección en los hospitales, entierros seguros y dignos, y una comunicación honesta con las comunidades. Para los países fuera de la región afectada, incluidos Australia y el Sudeste Asiático, el riesgo inmediato sigue siendo bajo, pero la preparación sigue siendo importante. No se trata de cerrar fronteras ni de miedo. Se trata de apoyar rápidamente a los países afectados y de aplicar medidas de salud pública basadas en la evidencia antes de que el brote sea más difícil de contener”.
No declara conflictos de interés.
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아래는 독일 사이언스미디어센터(SMC Germany)에서 수집해 배포한 전문가 반응입니다. 독일 SMC 홈페이지에서도 확인할 수 있습니다. |
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► PD Dr. Torsten Feldt AKTUALISIERT
Bereichsleiter Tropenmedizin, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, und Zweiter Vorsitzender der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit
Bundibugyo-Variante
„Das Bundibugyo-Virus gehört zu der Familie der Filoviren und hat viele Gemeinsamkeiten mit den anderen Ebolaviren, die auch die vorherigen Ausbrüche in Afrika verursacht haben. Es wurde erst 2007 entdeckt und ist daher für uns ein relativ neues Virus. Vor dem aktuellen Ausbruch waren erst zwei Ausbrüche mit etwa 200 Fällen bekannt. Daher ist die Datenlage wesentlich schlechter als zum Beispiel für das Zaire-Ebolavirus, das in der Vergangenheit für die meisten und die größten Ausbrüche verantwortlich war, insbesondere für den großen Westafrika-Ausbruch in den Jahren 2013 bis 2016 mit über 28.000 Fällen und über 11.000 Toten. Die Sterblichkeitsrate ist mit 25 bis 50 Prozent immer noch sehr hoch, scheint aber im Vergleich zu bisherigen Ausbrüchen mit dem Zaire-Ebolavirus deutlich geringer zu sein. Hier wurden in der Vergangenheit Letalitätsraten von bis zu 90 Prozent beschrieben. Problematisch ist, dass es gegen Bundibugyo derzeit noch keinen zugelassenen spezifischen Impfstoff und keine zugelassene spezifische Therapie gibt. Sowohl Impfungen als auch Therapieansätze sind in Entwicklung, die Evidenz beschränkt sich jedoch überwiegend auf präklinische Daten. Die WHO prüft derzeit die einsetzbaren Optionen, um die Wirksamkeit in klinischen Studien zu untersuchen. Hier könnte auch das Medikament Remdesivir eine Rolle spielen, das als unspezifische Therapie bei vorherigen Ausbrüchen zum Einsatz kam.“
Ausbreitung und Eindämmung
„Der Ausbruch wurde definitiv sehr spät erkannt. Die WHO beschreibt hier eine kritische Zeit von rund vier Wochen zwischen Symptombeginn beim mutmaßlichen Indexfall am 25. April 2026 und der Laborbestätigung des Ausbruchs Mitte Mai. Hier ist zu berücksichtigen, dass die ersten Fälle sich häufig in kleineren Gesundheitszentren mit geringen diagnostischen Möglichkeiten und ohne Erfahrung in Bezug auf Ebolavirus-Infektionen vorstellen. Das Verdachtsmoment war daher vermutlich gering und zugleich gibt es zahlreiche andere und wesentlich häufigere Ursachen für schwere fieberhafte Erkrankungen: zum Beispiel Malaria und gleichzeitig zirkulierende Arboviren. Für das Containment bedeutet dies, dass das epidemiologische Bild große Lücken aufweist und die Identifizierung von Fällen und Kontaktpersonen eine immense Herausforderung darstellt. Wir wissen, dass Fälle bereits in angrenzende Regionen und mindestens in ein Nachbarland eingeschleppt wurden. Angesichts der hohen Mobilität der Bevölkerung in der Region und der unklaren Übertragungsketten ist mit weiteren Fällen außerhalb des ursprünglichen Ausbruchsgebiets zu rechnen. Eine zum Teil mangelhafte Gesundheits- und Verkehrsinfrastruktur sowie bewaffnete Konflikte in der Ausbruchsregion erschweren die Aufklärung und Eindämmung.“
Akute Behandlungsmöglichkeiten
„Auch wenn es keine zugelassenen Therapieoptionen gibt, ist die frühe Erkennung und Behandlung in einem spezialisierten Behandlungszentrum entscheidend für die Prognose. Wir wissen, dass sich die Sterblichkeit durch eine gute supportive Therapie erheblich senken lässt. Dazu gehören zum Beispiel Flüssigkeits- und Elektrolytmanagement, Behandlung von Schock, Blutungen und Organfunktionsstörungen, die Gabe von Sauerstoff sowie die Behandlung von Koinfektionen. Im Verlauf kann der Einsatz von experimentellen Therapieoptionen im Rahmen von Studien die Prognose wahrscheinlich weiter verbessern.“
Schutzausrüstung vor Ort
„Mangelnde Schutzausrüstung ist nicht nur ein logistisches Problem. Es ist ein epidemiologisches Risiko und daher ein zentrales Problem. Wenn Gesundheitseinrichtungen zu Verstärkern der Übertragung werden, verliert man Zeit, Vertrauen in die Behandlungszentren und das Personal – also die Ressourcen, die für Containment entscheidend sind. Wichtig ist aber auch, dass die persönliche Schutzausrüstung nur wirksam ist, wenn sie korrekt getragen, abgelegt und entsorgt wird. Die WHO berichtet bereits über mehrere Infektionen bei Mitarbeitenden der Gesundheitszentren, was auf relevante Lücken in der frühen Erkennung, Isolation und Infektionsprävention schließen lässt. Die Verbesserung ist gerade in dieser Phase ein entscheidender Aspekt für die Eindämmung des Ausbruchs, stellt aber eine enorme Herausforderung dar.“
Behandlung von Ebola-Patient:innen in Deutschland NEU
„Bei Ebola handelt es sich um einen Erreger der höchsten Risikokategorie (Risikogruppe 4). Infizierte Personen müssen daher unter den höchsten Sicherheitsstandards transportiert und behandelt werden. Der Transport ist extrem aufwendig, und die medizinische Versorgung während des Transports stellt eine große Herausforderung dar, da jederzeit mit einer dynamischen Verschlechterung des Zustands des Patienten gerechnet werden muss.“
„Aufgrund der kürzeren Flugzeiten bietet sich daher eine Versorgung in Deutschland an. Die Behandlung muss auf einer Sonderisolierstation erfolgen. Hier sind wir in Deutschland sehr gut vorbereitet: Es gibt sieben solcher Behandlungszentren, die auf die Versorgung dieser Fälle unter höchsten Sicherheitsstandards spezialisiert sind. Zu den technischen Schutzmaßnahmen gehören Gebläse-Schutzanzüge, Raumluftanlagen mit Unterdruck und Hochleistungs-Filteranlagen sowie Abfall- und Abwasserdekontamination. Alle Untersuchungen – zum Beispiel Labor, Röntgen und Endoskopie – müssen bis auf ganz wenige Ausnahmen in der Regel in der Einheit stattfinden.“
„Am wichtigsten sind aber die gut ausgebildeten Teams, die ständig in Bereitschaft sind und regelmäßig für den Ernstfall trainieren. Die Teams der Sonderisolierstationen sind sehr gut vernetzt (im STAKOB). Durch gute internationale Zusammenarbeit hat sich Deutschland in der Vergangenheit eine sehr gute Reputation erarbeitet. Einige Zentren haben bereits Erfahrung in der Behandlung von Ebola-Patienten, da beim großen Ebola-Ausbruch in Westafrika schon drei Fälle zur Behandlung nach Deutschland gebracht wurden.“
„Wichtig ist die internationale Vernetzung, um mögliche experimentelle Therapieoptionen zu diskutieren und gegebenenfalls zu beschaffen. Entscheidend ist aber erst einmal, dass eine optimale supportive Therapie erfolgt, durch die sich die Sterblichkeit erheblich senken lässt. Diese Therapie ist in den Einheiten gewährleistet – bis hin zur vollwertigen intensivmedizinischen Behandlung.“
► Dr. Maximilian Gertler
Facharzt für Innere Medizin, Tropenmedizinische Ambulanz, und Leiter der Arbeitsgruppe Infection Prevention and Control in Health Care Settings/Epidemic Preparedness, Charité – Universitätsmedizin Berlin
Bundibugyo-Variante
„Die Bundibugyo-Variante kennen wir hauptsächlich aus zwei Ausbrüchen mit etwas über 200 Fällen – wir kennen sie also nicht besonders gut. Vermutlich ist die Variante etwas weniger virulent als der Ebola-Zaire-Typ, das heißt, weniger häufig tödlich – circa 40 bis 50 Prozent, aber wirklich gute belastbare Daten dazu gibt es wenige. Auch sind die Nachweismethoden weniger gut etabliert. Und wesentlich relevanter: Es gibt keinen zugelassenen Impfstoff dagegen.“
Eindämmung
„Die weiteren Schutz- und Eindämmungsmaßnahmen, die jetzt dringend und massiv gestartet werden müssen, sind aber im Wesentlichen die gleichen wie bei den anderen Ebolaviren. Gegenwärtig werden Notfallmaßnahmen in der gesamten Provinz Ituri und in der Nachbarprovinz sowie den angrenzenden Ländern, unter anderem Südsudan, Uganda, und Ruanda, ergriffen, die ihre entsprechenden nationalen Notfallzentren alarmiert haben. Das heißt, dass aber auch konkrete Maßnahmen zur Isolierung und Behandlung der Erkrankten sowie zur Eindämmung der Epidemie ergriffen werden müssen. Das ist in der instabilen Region nicht einfach und wird aufwendig.“
„Von ,Ärzte ohne Grenzen‘ weiß ich aus erster Hand, dass bereits in diesen Tagen Teams zusammengestellt werden, um solche Maßnahmen vor Ort umzusetzen. Einige waren bereits seit über einer Woche mit Verdachtsfällen aktiv. Mit der Bestätigung des Ausbruchs benötigt dieses Personal und natürlich auch jenes anderer Partner nun rasch erhebliche Mengen an Schutzausrüstung und Gerät, um effektiv zu werden und zu bleiben.“
„Infektionsausbrüche wie durch Ebola profitieren erheblich von der rudimentären Gesundheitsversorgung und den prekären Lebensverhältnissen, wie sie für viele Menschen im Ostkongo leider seit Jahren Realität sind. Die Erkrankung beginnt unspezifisch und das Gesundheitspersonal ist gewissermaßen daran gewöhnt, dass (allgemein) schwere Erkrankungen häufig tödlich verlaufen, ohne dass eine abschließende Ursache identifiziert wurde, weil schlicht die diagnostischen Mittel fehlen. Oft kommt es auch gar nicht zu einer Vorstellung im Krankenhaus – aus Angst vor Kosten oder weil es nichts in erreichbarer Entfernung gibt.“
„Darüber hinaus erleben die Menschen in dieser Region so viel Gewalt und Kriminalität, dass eine möglicherweise ansteckende Erkrankung ihnen nicht immer als das Bedrohlichste erscheint.“
„Das Containment oder die Eindämmung ist natürlich auch schwieriger, wenn es wenig qualifiziertes Personal gibt und die Bevölkerung wenig Vertrauen in die oft als schwach und kostenträchtig erlebte Gesundheitsversorgung hat.“
Grenzüberschreitende Ausbreitung
„Dadurch, dass einmal erkrankte Personen sich effektivere medizinische Hilfe außerhalb ihrer Lebensregion erhoffen, versuchen sie alles ihnen Mögliche. Das kann hinter den beiden in Kampala, Uganda, nachgewiesenen Fällen stecken. Der am 17. Mai bestätigte Fall in der Großstadt Goma ist ähnlich besorgniserregend. Goma liegt an der Grenze zu Ruanda und vom Schlagbaum (Grenzposten; Anm. d. Red.) fährt man in drei Stunden über eine sehr gute Straße direkt in die Hauptstadt Kigali.“
Akute Behandlungsmöglichkeiten
„Es gibt kein Medikament, das direkt gegen dieses Virus wirkt. Es gibt aber harte Daten dafür, dass je früher und je besser eine unterstützende Behandlung eingesetzt wird, desto geringer die Sterblichkeit ist. Unterstützende Behandlungen sind zum Beispiel Flüssigkeitsinfusionen oder intensivmedizinische Maßnahmen.“
Schutzausrüstung vor Ort
„Es gibt begrenzte Vorräte in den Nachbarländern und in der Demokratischen Republik Kongo, aber dieses Ausmaß, die Vielzahl betroffener Bezirke und angrenzender Länder wird logistische und finanzielle Herausforderungen bedeuten – dies sind allerdings prinzipiell lösbare Aufgaben. Da gibt es keine Ausrede.“
► Prof. Dr. Stephan Becker
Leiter des Instituts für Virologie, Philipps-Universität Marburg
Bundibugyo-Variante
„Das Bundibugyo-Virus (BDBV) ist ein Virus der Orthoebolaviren. Es ist hochpathogen, wie auch das Sudanvirus und das Ebolavirus. Die Sterblichkeitsrate liegt je nach Ausbruch zwischen 30 und 40 Prozent und kann sehr schwanken. Einen zugelassenen Impfstoff gibt es nur für den Zaire-Stamm. Die Sequenz der Viren ist aber einfach zu unterschiedlich, sodass es nicht zu einer vollständigen Kreuzprotektion kommt. Das findet man nur bei sehr nah verwandten Viren, wie den unterschiedlichen Marburgvirus-Subtypen. Es gibt aber präklinische Studien, die zeigen, dass ein multivalenter ,Pan‘-Ebola- und Marburgvirus-Impstoff gegen BDBV im Affenmodell schützt. Wie nahe dessen Einsatz ist, weiß ich nicht.“
Ausbreitung
„Dass solche Ebola-Ausbrüche zunächst nicht schnell erkannt werden, passiert leider häufig in Gebieten, in denen die Sicherheitslage schlecht ist und die Gesundheitssysteme dementsprechend ebenfalls schlecht sind. Das Problem ist, dass es aktuell schon sehr viele bekannte Kontaktpersonen gibt und man befürchten muss, dass es noch mehr nicht identifizierte Kontaktpersonen gibt – das ist eine schlechte Prognose für eine schnelle Eindämmung des Ausbruchs. In Uganda gab es bereits einen Fall, der aus der Demokratischen Republik Kongo kam. Also: Das Risiko ist groß. Allerdings haben sowohl die Demokratische Republik Kongo als auch Uganda Erfahrung im Umgang mit Filovirus-Epidemien. Aber grundsätzlich gilt: Der Verlauf eines Ausbruchs in einem Bürgerkriegsgebiet, wie im Osten der Demokratischen Republik Kongo, ist unvorhersagbar.“
Akute Behandlungsmöglichkeiten
„Es gibt keine spezifischen zugelassenen Impfungen oder Behandlungen, wie therapeutische monoklonale Antikörper. Aber auch hier gibt es Antikörper, die im Tier vor BDBV geschützt haben, allerdings nicht klinisch getestet sind. Dass diese in Mengen vorhanden sind, die einen Einsatz am menschlichen Patienten erlauben, halte ich für unwahrscheinlich.“
► Prof. Dr. Clara Schoeder
Juniorprofessorin für die Entwicklung von immuntherapeutischen Wirkstoffen, Institut für Wirkstoffentwicklung, Universität Leipzig
Erforschung eines Pan-Ebola-Marburg-Impfstoffs
„Die Pan-Ebola-Impfstoffentwicklung befindet sich noch in sehr frühen Entwicklungsphasen. Die heute zugelassenen Ebola-Impfstoffe sind basierend auf dem häufigsten Vertreter der Ebolaviren entwickelt worden. Zwischen dem Ebolavirus und dem Bundibugyo-Virus besteht aber eine enge Verwandtschaft. So wissen wir von der Untersuchung der Antikörperantwort von Überlebenden von Ebola- oder Bundibugyo-Virus-Infektionen, dass Antikörper gebildet werden können, die beide Viren neutralisieren. Die präferenzielle Bildung solcher breit neutralisierenden Antikörper ist auch die Hoffnung beim multivalenten Impfstoffdesign.“
Immunologische Breite versus Wirksamkeit
„Eine Immunantwort gegen einen Impfstoff ist immer heterogen. Es gibt Teile der Immunantwort, die ganz spezifisch den Impfstoff erkennen, aber keine breit neutralisierende Wirkung haben. Wenn multivalente Impfstoffe entwickelt werden, hofft man, den Anteil an breit neutralisierender Immunantwort zu erhöhen. Um dies festzustellen, muss man die Immunantwort auf die Impfstoffkandidaten genau untersuchen, und zum Beispiel den Anteil an diesen breit neutralisierenden Antikörpern bestimmen. Man kann aber nicht genau vorhersagen, was im Gegenzug passiert: Ist ein multivalenter Impfstoff genauso potent gegen die einzelnen Virusinfektionen wie ein monovalenter Impfstoff? Ist die Immunantwort gegen einen Kandidaten stärker (immunodominant)? Das ist vielleicht auch abhängig vom Virus und der strukturellen Zusammensetzung des Antigens. Erst die weitere Erforschung solcher multivalenter Kandidaten wird uns darauf Antwort geben können.“
KI-generierte Impfstoffdesigns
„Die Impfstoffentwicklung durch computergestützte Verfahren ist zurzeit in der Erprobung. Man erhofft sich durch computergestützte Methoden – auch unter der Verwendung von KI – schnellere Entwicklungszyklen, die Zeit und Geld einsparen – vor allem wenn ein Notfall auftritt. Computergestützte Methoden werden verwendet, um das Antigen, gegen das die Immunantwort gerichtet wird, zu stabilisieren. An der Universität Leipzig am Institut für Wirkstoffentwicklung untersuchen wir mit Förderung durch CEPI, Coalition for Epidemic Preparedness Innovations, wie zuverlässig diese Methoden bereits Vorhersagen für diese Stabilisierung generieren, und testen dies experimentell bei uns im Labor. Basierend auf diesen Erkenntnissen passen wir die computergestützten Methoden an und trainieren neue Modelle, damit diese dann erneut im Labor überprüft werden. Die Impfstoffe, die wir entwickeln, zum Beispiel für Filoviren wie das Ebolavirus, werden dann von Partnern an der Universität Oxford oder an der Universität Kopenhagen weiter untersucht.“
Interessenkonflikte
Dr. Maximilian Gertler: „Keine Interessenkonflikte. Ich habe aber zwei Hüte auf (Ärzte ohne Grenzen und die Charité). Da gibt es aber keine grundsätzlich unterschiedlichen Ansichten zur Epidemie und deren Bekämpfung vor Ort.“
Prof. Dr. Stephan Becker: „Ich habe hier keinen Interessenkonflikt.“
Anm. d. Red.: Stephan Becker ist Mitglied im Aufsichtsrat des Science Media Center Germany.
Prof. Dr. Clara Schoeder: „Die Universität Leipzig, mein Labor und ich werden von CEPI, der Coalition für Epidemic Preparedness Innovations, gefördert, um eine computergestützte Impfstoffentwicklungs-Pipeline zu entwickeln und zu erproben. Mit Partnern an der Universität Oxford und an der Universität Kopenhagen werden dabei unter anderem Pan-Filovirus-Impfstoffe untersucht.“
Alle anderen: Keine Angaben erhalten.
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아래는 대만 사이언스미디어센터(SMC Taiwan)에서 수집해 배포한 전문가 반응입니다. 대만 SMC 홈페이지에서도 확인할 수 있습니다. |
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國立臺灣大學公共衛生學院助理教授 吳亞克（Andrei R. Akhmetzhanov）
吳亞克指出，當前剛果民主共和國與烏干達的伊波拉疫情，是由較少見但已知可造成高死亡率的本迪布焦型病毒引起。由於疫情偵測較晚、已有醫護人員死亡，並出現不安全喪葬行為與跨行政區、跨國境傳播，因此WHO宣布構成「國際關注公共衛生緊急事件」。
吳亞克說明，台灣過去未曾發生伊波拉疫情，目前傳入台灣的風險極低但並非為零，主要風險仍是旅遊移入。而伊波拉病毒的傳播主要透過直接接觸感染者體液，並非經由空氣傳播，因此傳播風險在患者出現症狀後更高，尤其是嘔吐、腹瀉、出血等「濕性症狀」。
吳亞克認為，此次疫情在國際間如流感或COVID-19般大規模擴散的風險仍低，目前主要是區域內擴散風險。對民眾而言，重點仍是避免前往疫情熱區、避免接觸疑似病例，返國後做好健康監測，有症狀時儘速就醫。
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한국과학기술미디어센터(SMCK) 소개
한국과학기술미디어센터는 근거 기반의 과학 정보를 언론에 제공하는, 과학계와 미디어 사이의 다리 역할을 하는 독립 비영리 조직입니다. 잘못된 정보와 가짜 뉴스가 넘쳐나는 세상에서, 제대로 된 전문가의 해설과 의견을 빠르고 다양하게 기자들에게 제시하고 이를 체계적으로 아카이빙하는 역할을 합니다.
2025년 7월 이사회를 구성하고(이사장 노정혜 전 한국연구재단 이사장) 센터장(이근영 전 한겨레 과학전문기자)을 선임했으며, 같은해 9월 개소식을 열며 활동을 시작했습니다.
*참고 기사:
SMCK 역할
SMCK는 세 분야 전문가인 과학자, 기관 커뮤니케이터(홍보팀), 기자에게 구체적인 도움을 드리고자 설립됐습니다. 각각 아래와 같습니다.
- 과학자, 연구자에게는 의견과 해설이 온전한 맥락과 함께 제공되는 안전한 발언 공간이 돼줍니다. 선의를 위해 한 논평이 기사화 과정에서 왜곡되거나 부정확하게 변질될 우려를 줄이는 완충 작용을 합니다.
- 기관 홍보 담당자에게는 기관의 성과를 기자들에게 보다 객관적이고 정교하게 알리고, SMC 글로벌 네트워크를 통해 영향력을 높일 기회를 제공합니다.
- 기자에게는 사안을 해석하는 데 도움이 될 치우침 없는 종합적인 정보를 빠르고 풍성하게 제공하고, 이를 통해 기사에서 과학과 기술을 보다 자유롭고 편리하게 활용하도록 돕습니다.
SMCK는 이를 통해, 궁극적으로 근거에 기반해 사안을 합리적으로 판단하고 이것이 정책에까지 반영되는 사회를 만드는 데 기여하고자 합니다.
해외 협력
사이언스미디어센터(SMC)는 2002년 영국에서 최초로 설립됐고 현재 호주와 뉴질랜드, 독일, 스페인, 대만, 아일랜드 등으로 확장됐습니다. 한국은 2025년 12월, 7번째 센터로 합류했습니다. 글로벌 네트워크에 포함된 8개 조직은 엄격한 독립성과 신뢰성이라는 가치를 공유하고 있으며 협력을 통해 주요한 국제 과학 이슈에 공동 대응하고 있습니다.
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* 지난 의견은 '지난 의견 다시 보기'를 선택해주세요. |
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내용문의: 윤신영 미디어국장 yoonsy@smck.or.kr
비상 연락(당직 전화): 010-4440-5450
한국과학기술미디어센터(SMCK)
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