WHO report on Russian lab worker death highlights “key uncertainty”

Over the weekend, the World Health Organization released a disease outbreak report on the events surrounding the death of a Russian infectious disease researcher earlier this month, highlighting that Russia has yet to report a confirmed cause of death. With that “key uncertainty,” the United Nations health agency said it remains impossible to assess the risk of the event or whether the public health measures Russia took were adequate to prevent spread of the unknown disease.

上周末，世界卫生组织发布了一份关于本月初一名俄罗斯传染病研究人员死亡事件的疾病暴发报告，强调俄罗斯尚未报告确诊的死因。联合国卫生机构表示，由于存在这一“关键的不确定性”，目前无法评估该事件的风险，也无法判断俄罗斯采取的公共卫生措施是否足以防止这种未知疾病的传播。

The WHO reported that, so far, it has seen no evidence of ongoing transmission of the mystery disease. “However, confidence in the assessment remains limited by the absence of a confirmed etiological diagnosis, and the remaining uncertainty regarding the source and mode of exposure,” the agency wrote in its report. The agency laid out the order of events as information trickled out from Russian authorities, noting that it only became aware of the death via media reports on October 2. The WHO subsequently made contact with Russian authorities and requested information on October 3, 6, 7, and 8.

世卫组织报告称，到目前为止，尚未发现这种神秘疾病持续传播的证据。该机构在报告中写道：“然而，由于缺乏确诊的病因学诊断，且在暴露源和暴露方式上仍存在不确定性，评估的置信度仍然有限。”该机构梳理了随着俄罗斯当局信息披露而发生的一系列事件，并指出其仅在10月2日通过媒体报道才获悉这起死亡事件。随后，世卫组织与俄罗斯当局取得联系，并于10月3日、6日、7日和8日索取了相关信息。

Limited information released: Early media reports indicated that the lab worker had become ill on September 29, possibly following an incident at the lab, the Irkutsk Antiplague Research Institute (APRI) of Siberia and the Far East. Some early reports suggested that the researcher—who was identified by media as 28-year-old Darya Shipilova—died of the plague after breaking a test tube. On October 2, the Irkutsk branch of Russian health agency Rospotrebnadzor (RPN) said in a statement that a “special sanitary-epidemiological expert commission” had already met over a suspected case of a high-threat pathogen. Sanitary and epidemic control measures were put in place, including identifying, monitoring, and testing all contacts. At the time, RPN said that all contacts had tested negative for high-threat pathogens.

有限的信息披露：早期媒体报道显示，该实验室工作人员于9月29日患病，可能与西伯利亚及远东地区伊尔库茨克抗鼠疫研究所（APRI）发生的一起实验室事故有关。一些早期报道称，这名被媒体确认为28岁的达里娅·希皮洛娃（Darya Shipilova）的研究人员在打破试管后死于鼠疫。10月2日，俄罗斯卫生机构联邦消费者权益保护和公益监督局（RPN）伊尔库茨克分局发表声明称，一个“特别卫生流行病学专家委员会”已就一起疑似高威胁病原体病例召开了会议。相关卫生和防疫控制措施已经落实，包括识别、监测和检测所有接触者。当时，RPN表示所有接触者的高威胁病原体检测结果均为阴性。

On October 6, Russia’s National Focal Point for the International Health Regulations (NFP) first responded to the WHO’s information requests, saying that no case of plague had been recorded in Irkutsk Oblast. The NFP confirmed that an APRI lab worker had died from a severe case of pneumonia after developing symptoms compatible with an acute respiratory viral infection. The worker was tested for a number of high-threat pathogens, but all the tests had come back negative. Doctors categorized the cause of death as being from pneumonia of undetermined etiology. The NFP also reiterated information from RPN about the public health measures taken and that people in contact with the lab worker all tested negative for high-threat pathogens. The NFP added that the widest range of possible contacts were identified and tested in accordance with Russia’s public health laws.

10月6日，俄罗斯《国际卫生条例》国家归口单位（NFP）首次回应了世卫组织的信息请求，称伊尔库茨克州未记录到鼠疫病例。NFP证实，一名APRI实验室工作人员在出现符合急性呼吸道病毒感染的症状后，死于严重的肺炎。该工作人员接受了多种高威胁病原体的检测，但所有结果均为阴性。医生将死因归类为病因不明的肺炎。NFP还重申了RPN关于所采取公共卫生措施的信息，并表示与该实验室工作人员有接触的人员高威胁病原体检测结果均为阴性。NFP补充说，已根据俄罗斯公共卫生法律，对最广泛的可能接触者进行了识别和检测。

Uncertain risk: In follow-up responses, the NFP gave more details about testing and some results that weren’t concerning. It said authorities conducted 5,500 laboratory tests on contacts. They tested for a range of pathogens, including influenza, SARS-CoV-2, other respiratory infections, and bacterial infections, including plague and Streptococcus. Among the contacts, they identified two cases of COVID-19, three cases of rhinovirus, and one case of Haemophilus spp., a common bacteria group that includes those that can cause respiratory infections and pneumonia. They also found a few opportunistic infections. As of October 9, Russian authorities told WHO that they had not detected any high-threat pathogens in the laboratory’s research portfolio in any of the contacts, and they were no longer being monitored. The monitoring period was set for seven days for all the contacts.

不确定的风险：在后续回复中，NFP提供了关于检测的更多细节以及一些不令人担忧的结果。该机构表示，当局对接触者进行了5500次实验室检测。他们检测了一系列病原体，包括流感、SARS-CoV-2、其他呼吸道感染以及包括鼠疫和链球菌在内的细菌感染。在接触者中，他们发现了两例新冠肺炎病例、三例鼻病毒病例和一例嗜血杆菌属病例（这是一类常见的细菌，包括可引起呼吸道感染和肺炎的细菌）。他们还发现了一些机会性感染。截至10月9日，俄罗斯当局告知世卫组织，在所有接触者中均未检测到该实验室研究组合中的任何高威胁病原体，且他们已不再接受监测。所有接触者的监测期均设定为七天。

Authorities also added that the worker who died was not infected with plague bacteria, Yersinia pestis, and the worker had been vaccinated against the infection due to the occupational hazard. They added that no lab biosafety or biosecurity incident had occurred at APRI, and the deceased worker had not traveled outside the region within the two weeks before becoming ill. Reviewing all the information coming out of Russia, the WHO was largely at a loss as to what happened and what risk the event posed, concluding: “A key uncertainty for this event is the absence of a confirmed diagnosis in the deceased laboratory worker.” Without the cause of death, the agency can’t “independently assess whether the duration of the reported monitoring period for contacts was sufficient to exclude all plausible causes of the fatal illness.” They also aren’t ruling out the possibility of a laboratory-associated exposure.

当局还补充说，死者并未感染鼠疫耶尔森菌，且由于职业危害，该工作人员此前已接种过针对该感染的疫苗。他们补充称，APRI未发生任何实验室生物安全或安保事故，且死者在患病前两周内未离开过该地区。在审阅了来自俄罗斯的所有信息后，世卫组织对于究竟发生了什么以及该事件构成的风险感到茫然，并总结道：“该事件的一个关键不确定性在于死者尚未获得确诊诊断。”由于缺乏死因，该机构无法“独立评估所报告的接触者监测期是否足以排除所有导致致命疾病的合理原因”。他们也不排除实验室相关暴露的可能性。