Virtual autopsy and community engagement for outbreak response in Africa: traditional, religious and sociocultural perspectives

摘要

In response to outbreaks, the manner in which the medical field engages with the process of death is significantly important, not only in the pathological but also in the sociocultural aspect. Certain response-methodology used could be a critical catalyst for community resistance to post-mortem examinations (e.g. hiding corpses, violence), considering how the deceased are handled in different cultures. We reviewed the traditional, religious and sociocultural aspects of post-mortem response-methodology in Africa. With no means to take blood samples, innovative sampling techniques were developed and frequently adopted in post-mortem cases. However, this approach can be met with resistance. To avoid resistance, virtual autopsy (virtopsy) involving a non-invasive or minimally invasive imaging-guided biopsy (e.g. portable ultrasound guidance) is recommended as a proper entry point to negotiations around examination of the deceased. We outline how adapting virtopsy and community engagement strategies can have many benefits to communicable disease prevention or control, public health and communities in Africa and elsewhere. This paper provides a completely new perspective by applying imaging autopsy to field studies. These are usually hospital-based procedures. Many countries can train their response and military personnel on how to perform a safe straightforward virtopsy procedure in an outbreak situation. Just as relevant, Islam is now the fastest growing religion in the world—virtopsy might appease fears and increase the autopsy rate among large Muslim populations (in Africa and elsewhere). Virtopsy use and its application might have proved very useful in the recent outbreak of Ebola in 2014 and microcephaly associated with Zika virus. Use of virtopsy may have reduced the number of Ebola cases worldwide and enabled an earlier diagnosis linking Zika virus to microcephaly during the recent outbreak in Northeast Brazil. If the diagnosis was made earlier, additional cases of Ebola or Zika may have been prevented. The issue of invasive autopsy was in all likelihood one of the greatest factors that drove Ebola underground; it prevented communities from cooperating with non-native response teams and contributed to the excessive duration and length of the outbreak. Healers may unknowingly infect others (via scarification) and themselves (via contact with others). Adapting sociocultural engagement methods and conducting a virtopsy may be more acceptable, thereby ameliorating the spread of a deadly virus more efficiently.