Fraser Christophe, Riley Steven, Anderson Roy M, Ferguson Neil M
Department of Infectious Disease Epidemiology, Imperial College, St. Mary's, London W2 1PG, United Kingdom.
Proc Natl Acad Sci U S A. 2004 Apr 20;101(16):6146-51. doi: 10.1073/pnas.0307506101. Epub 2004 Apr 7.
The aim of this study is to identify general properties of emerging infectious agents that determine the likely success of two simple public health measures in controlling outbreaks, namely (i) isolating symptomatic individuals and (ii) tracing and quarantining their contacts. Because these measures depend on the recognition of specific disease symptoms, we investigate the relative timing of infectiousness and the appearance of symptoms by using a mathematical model. We show that the success of these control measures is determined as much by the proportion of transmission occurring prior to the onset of overt clinical symptoms (or via asymptomatic infection) as the inherent transmissibility of the etiological agent (measured by the reproductive number R(0)). From published studies, we estimate these quantities for two moderately transmissible viruses, severe acute respiratory syndrome coronavirus and HIV, and for two highly transmissible viruses, smallpox and pandemic influenza. We conclude that severe acute respiratory syndrome and smallpox are easier to control using these simple public health measures. Direct estimation of the proportion of asymptomatic and presymptomatic infections is achievable by contact tracing and should be a priority during an outbreak of a novel infectious agent.
本研究的目的是确定新出现的传染病病原体的一般特性,这些特性决定了两种简单的公共卫生措施在控制疫情爆发方面可能取得的成效,即(i)隔离有症状的个体,以及(ii)追踪并隔离其接触者。由于这些措施依赖于对特定疾病症状的识别,我们通过使用数学模型来研究传染性出现的相对时间以及症状的出现情况。我们表明,这些控制措施的成功程度,既取决于在明显临床症状出现之前(或通过无症状感染)发生的传播比例,也取决于病原体的固有传播能力(以基本再生数R(0)衡量)。根据已发表的研究,我们估计了两种中等传播性病毒(严重急性呼吸综合征冠状病毒和艾滋病毒)以及两种高传播性病毒(天花和大流行性流感)的这些数值。我们得出结论,使用这些简单的公共卫生措施,严重急性呼吸综合征和天花更容易控制。通过接触者追踪可以直接估计无症状和症状前感染的比例,这在新型传染病爆发期间应作为优先事项。