222.3 🩺 內科專科考前版

222.3.0.1 1⃣ 2014-2016 W Africa Ebola Lessons

  • 28,000+ cases, 11,000+ deaths
  • Liberia, Sierra Leone, Guinea
  • HCW deaths 511 (7% of cases)
  • Mass response — international collaboration
  • Lessons: ring vaccination effective; mAbs developed; community engagement critical; safe burial practices essential

222.3.0.2 2⃣ Ervebo Ring Vaccination

  • Strategy: vaccinate contacts + contacts of contacts (4° network)
  • Single dose effective rapidly
  • 100% efficacy in 2015 trial
  • Deployed in 2018-2020 DRC + subsequent outbreaks
  • WHO stockpile

222.3.0.3 3⃣ PALM Trial 2019

  • Tested 4 therapeutics: ZMapp, remdesivir, REGN-EB3, mAb114
  • REGN-EB3 + mAb114 superior (35.1% + 33.5% mortality)
  • ZMapp + remdesivir less effective (49.7% + 53.1%)
  • mAbs became standard of care

222.3.0.4 4⃣ Returning Traveler Workup

  • Fever within 21 days of return from outbreak area
  • Immediate isolation
  • Notify Public Health
  • Specialized assessment + transport
  • Travel hx essential
  • Differential: malaria first (treatable), then filovirus

222.3.0.5 5⃣ 2024 Rwanda Marburg Outbreak

  • August 2024 onset
  • 50+ cases, mortality ~ 30% (lower than historical Marburg)
  • HCWs primarily affected
  • Vaccine emergency rollout: cAd3-Marburg + rVSV-MARV Phase 2 trials
  • Treatment: supportive + investigational mAbs (MBP091)
  • WHO + CDC coordination

222.3.0.6 6⃣ Sexual Transmission Survivor Counseling

  • Male survivors: viable virus in semen weeks-months
  • WHO recommends abstinence or condom use up to 12 months post-recovery
  • Monthly testing to confirm clearance
  • Female survivors: lower but possible risk
  • Reproductive counseling

222.3.0.7 7⃣ Post-Ebola Syndrome Management

  • Multi-disciplinary follow-up
  • Ophthalmology (uveitis common; recurrent)
  • Audiology
  • Rheumatology (arthralgia)
  • Mental health (PTSD, anxiety, depression common)
  • Reintegration into community
  • Survivor stigma

222.3.0.8 8⃣ 健保 / Taiwan

  • 通報 mandatory
  • Isolation + specialist consult
  • 衛生局 emergency response
  • Taiwan: no local cases historically; awareness for returning travelers

222.3.0.9 9⃣ Future Vaccines + Therapeutics

  • Pan-filovirus vaccines
  • Sudan-specific vaccines (2022 Uganda outbreak gap)
  • mRNA Ebola vaccine candidates
  • Improved mAb cocktails
  • Antiviral combinations

222.3.0.10 10. Bioterror Considerations

  • Filoviruses Category A bioterror potential
  • BSL-4 lab considerations
  • Stockpile + readiness
  • Surveillance + early detection