Wearing Helen J, Rohani Pejman
Institute of Ecology and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA 30602-2202, USA.
Proc Natl Acad Sci U S A. 2006 Aug 1;103(31):11802-7. doi: 10.1073/pnas.0602960103. Epub 2006 Jul 25.
The management of infectious diseases is an increasingly important public health issue, the effective implementation of which is often complicated by difficulties in teasing apart the relative roles of extrinsic and intrinsic factors influencing transmission. Dengue, a vector-borne strain polymorphic disease, is one such infection where transmission dynamics are affected by environmental variables as well as immune-mediated serotype interactions. To understand how alternative hypotheses concerning dengue infection and transmission may explain observed multiannual cycles in disease incidence, we adopt a theoretical approach that combines both ecological and immunological mechanisms. We demonstrate that, contrary to perceived wisdom, patterns generated solely by antibody-dependent enhancement or heterogeneity in virus virulence are not consistent with serotype-specific notification data in important ways. Furthermore, to generate epidemics with the characteristic signatures observed in data, we find that a combination of seasonal variation in vector demography and, crucially, a short-lived period of cross-immunity is sufficient. We then show how understanding the persistence and eradication of dengue serotypes critically depends on the alternative assumed mechanisms.
传染病管理是一个日益重要的公共卫生问题，其有效实施常常因难以区分影响传播的外在因素和内在因素的相对作用而变得复杂。登革热是一种由媒介传播的菌株多态性疾病，就是这样一种感染，其传播动态受到环境变量以及免疫介导的血清型相互作用的影响。为了理解关于登革热感染和传播的不同假设如何解释观察到的疾病发病率的多年周期，我们采用了一种结合生态和免疫机制的理论方法。我们证明，与普遍看法相反，仅由抗体依赖性增强或病毒毒力异质性产生的模式在重要方面与血清型特异性报告数据不一致。此外，为了产生具有数据中观察到的特征性特征的流行病，我们发现媒介种群统计学的季节性变化以及至关重要的短期交叉免疫期的结合就足够了。然后我们展示了理解登革热血清型的持续存在和根除如何关键地取决于所假设的替代机制。
