本迪布焦病毒病证据图：快速研究需求评估

文献信息

中文摘要

背景： 2026年刚果民主共和国和乌干达暴发的本迪布焦病毒病（BVD）疫情凸显出丝状病毒仍是一种难以预测的全球健康威胁，尤其是在资源有限的环境中。疫情呈散发性发生，限制了证据的生成。我们实施了一项快速研究需求评估（RRNA），以快速、系统地综合已发表的研究证据，并识别证据基础中的空白，从而为管理策略和研究策略提供支持。
方法： 我们检索了Ovid Medline、Embase和Scopus，通过组合本迪布焦和人类的关键词与叙词表主题词，查找1999年1月1日至2026年2月6日期间发表的原始研究。该检索还通过截至2026年6月25日在PubMed和MedRxiv中进行的更新检索加以补充。检索以英文进行，但无语言限制。符合条件的研究纳入人类或人类样本，并聚焦于至少一个RRNA领域（临床特征、免疫反应、传播、危险因素、医学应对措施及相关社会和行为因素）。两名评价者筛选记录以确定纳入，一名评价者提取数据，并由第二名评价者对部分数据进行核查。数据采用描述性分析。
结果： 29项原始研究符合纳入条件，涉及1593例可能或确诊BVD病例。在这29项研究中，大多数为观察性研究（n = 28，96.6%），且最常在乌干达（n = 15，51.7%）和刚果民主共和国（n = 10，34.5%）开展。仅纳入一项干预性研究，即一项非随机干预性研究，探讨EBOV疫苗接种后对EBOV、SUDV和BDBV的交叉反应性。在报告年龄的研究中，大多数（58.6%，17/29）纳入成人（18岁及以上），八项（27.6%）纳入儿童（0-18岁），仅两项（6.9%）纳入孕妇。发热、呕吐、腹泻、头痛、乏力、吞咽困难、厌食、呼吸困难和腹痛是最常报告的症状。出血表现的发生率为10.4%至54.0%，一项基于既往疫情的荟萃分析估计病死率为32.8%（CI 25.8-40.2）。关于自然感染或疫苗接种后对既往埃博拉暴露的交叉反应性证据稀少且相互矛盾。一项研究在EBOV疫苗接种参与者中发现了低水平交叉反应性，另一项在EBOV幸存者中发现，而第三项在EBOV疫苗接种后未检测到交叉反应性。还报告了长期后遗症、持续存在的BVD幸存者污名化以及社区认知有限。
解释： 尽管承认此类快速评估的局限性，我们的研究结果表明，迫切需要进行协调投资，开展纳入孕妇和儿童的应对措施试验，并辅以观察性研究、社区参与和共同创造。
资助： 美国国家卫生研究院（NIHR）和惠康信托基金会。

英文摘要

BACKGROUND: The 2026 Bundibugyo virus disease (BVD) outbreak in DRC and Uganda underscores that filoviruses remain an unpredictable global health threat, particularly in resource-limited settings. The sporadic occurrence of outbreaks has constrained evidence-generation. We implemented a Rapid Research Needs Appraisal (RRNA) to rapidly and systematically synthesise published research evidence and identify gaps in the evidence base to support management and research strategies.
METHODS: We searched Ovid Medline, Embase and Scopus for primary research studies published between Jan 1, 1999, and Feb 6, 2026 by combining keywords and thesaurus headings for Bundibugyo and humans. This search was supplemented by an updated search in PubMed and MedRxiv up to June 25, 2026. Searches were conducted in English, but without language restrictions. Eligible studies including humans or human samples focused on at least one of the RRNA domains (clinical characteristics, immune response, transmission, risk factors, medical countermeasures and associated social and behavioural factors). Two reviewers screened records for inclusion, one reviewer extracted data with a second reviewer checking a proportion of the data. Data were analysed descriptively.
FINDINGS: 29 primary studies were eligible for inclusion, accounting for 1593 probable or confirmed BVD cases. Of these 29 studies, most were observational (n = 28, 96.6%) and were most commonly conducted in Uganda (n = 15, 51.7%) and the DRC (n = 10, 34.5%). Only one interventional study was included, a non-randomized interventional study exploring EBOV, SUDV and BDBV cross-reactivity following EBOV vaccination. Among studies that reported age, most (58.6%, 17/29) included adults (18+ years), eight (27.6%) included children (0-18 years), and only two (6.9%) included pregnant women. Fever, vomiting, diarrhoea, headache, fatigue, dysphagia, anorexia, dyspnoea and abdominal pain were the most commonly reported symptoms. Haemorrhagic manifestations ranged from 10.4 to 54.0%, with a meta-analysis estimating a CFR of 32.8% (CI 25.8-40.2) based on past outbreaks. Evidence on cross-reactivity to previous Ebola exposure following natural infection of vaccination was sparse and conflicting. One study identified low levels of cross-reactivity in EBOV vaccinated participants, another among EBOV survivors, whereas a third did not detect cross-reactivity following EBOV vaccination. Long-term sequelae, persistent BVD survivor stigma and limited community awareness were also reported.
INTERPRETATION: Whilst acknowledging the limitations of such a rapid appraisal, our findings show that urgent, coordinated investment is needed in countermeasure trials inclusive of pregnant women and children, supported by observational studies community engagement and co-production.
FUNDING: The National Institute for Health Research (NIHR) and the Wellcome Trust.