Abstract

Background

Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited.

Methods

We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (R_t) by health zone. We fit linear time-series regression to model the relationship.

Results

Average R_t was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in R_t of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on R_t, Ebola-targeted events corresponded to R_t of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to R_t of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to R_t of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission.

Conclusions

Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.

中文翻译：

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2018-2020 年刚果民主共和国爆发期间不同类型的暴力对埃博拉病毒病传播的影响。

摘要

背景

我们对刚果民主共和国 (DRC) 的针对性暴力与非针对性暴力对埃博拉病毒 (EBOV) 传播的不同影响的了解有限。

方法

我们使用病例计数的时间序列数据来比较 2018 年 4 月至 2019 年 8 月刚果民主共和国受埃博拉影响的卫生区的个人。暴露是每个卫生区发生的暴力事件数量，分为埃博拉目标或非埃博拉目标，以及平民事件-引发的、（准）军事/政治的或抗议。结果是按卫生区估计的每日繁殖数（R _t）。我们拟合线性时间序列回归来模拟这种关系。

结果

平均R _t为 1.06（95% 置信区间 [CI]，1.02–1.11）。平均 2.92 起暴力事件导致R _t累积绝对值增加0.10（95% CI，0.05-0.15）。更多的暴力事件增加了 EBOV 传播 ( P  = .03)。考虑到 21 天间隔内第 95 个百分位数的暴力事件及其对R _t的相对影响，埃博拉目标事件对应的R _t为 1.52（95% CI，1.30-1.74），而平民引发的事件对应的R _t 1.43（95% CI，1.21-1.35）。非目标事件对应的R _t为 1.18（95% CI，1.02–1.35）；其中，民兵/政治或莫特城事件增加了传播。

结论

主要由平民引发的事件驱动的针对埃博拉的暴力对埃博拉病毒传播影响最大。