家庭传播的 2009 年流感大流行的甲型 H1N1 病毒在美国。

Household transmission of 2009 pandemic influenza A (H1N1) virus in the United States.

机构信息

Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London.

出版信息

N Engl J Med. 2009 Dec 31;361(27):2619-27. doi: 10.1056/NEJMoa0905498.

DOI:10.1056/NEJMoa0905498

PMID:20042753

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3840270/

Abstract

BACKGROUND

As of June 11, 2009, a total of 17,855 probable or confirmed cases of 2009 pandemic influenza A (H1N1) had been reported in the United States. Risk factors for transmission remain largely uncharacterized. We characterize the risk factors and describe the transmission of the virus within households.

METHODS

Probable and confirmed cases of infection with the 2009 H1N1 virus in the United States were reported to the Centers for Disease Control and Prevention with the use of a standardized case form. We investigated transmission of infection in 216 households--including 216 index patients and their 600 household contacts--in which the index patient was the first case patient and complete information on symptoms and age was available for all household members.

RESULTS

An acute respiratory illness developed in 78 of 600 household contacts (13%). In 156 households (72% of the 216 households), an acute respiratory illness developed in none of the household contacts; in 46 households (21%), illness developed in one contact; and in 14 households (6%), illness developed in more than one contact. The proportion of household contacts in whom acute respiratory illness developed decreased with the size of the household, from 28% in two-member households to 9% in six-member households. Household contacts 18 years of age or younger were twice as susceptible as those 19 to 50 years of age (relative susceptibility, 1.96; Bayesian 95% credible interval, 1.05 to 3.78; P=0.005), and household contacts older than 50 years of age were less susceptible than those who were 19 to 50 years of age (relative susceptibility, 0.17; 95% credible interval, 0.02 to 0.92; P=0.03). Infectivity did not vary with age. The mean time between the onset of symptoms in a case patient and the onset of symptoms in the household contacts infected by that patient was 2.6 days (95% credible interval, 2.2 to 3.5).

CONCLUSIONS

The transmissibility of the 2009 H1N1 influenza virus in households is lower than that seen in past pandemics. Most transmissions occur soon before or after the onset of symptoms in a case patient.

摘要

背景

截至 2009 年 6 月 11 日，美国共报告了 17855 例 2009 年甲型 H1N1 大流行性流感疑似或确诊病例。传播的危险因素在很大程度上仍未得到明确。我们描述了病毒在家庭内传播的危险因素和情况。

方法

美国向疾病预防控制中心报告了 2009 年 H1N1 病毒感染的疑似和确诊病例，并使用标准化病例报告表进行了报告。我们对 216 个家庭中的感染传播情况进行了调查，这些家庭包括 216 个索引病例及其 600 个家庭接触者，其中索引病例是首例病例患者，所有家庭接触者的症状和年龄信息完整。

结果

在 600 个家庭接触者中，有 78 个（13%）出现急性呼吸道疾病。在 156 个家庭（216 个家庭中的 72%）中，没有一个家庭接触者出现急性呼吸道疾病；在 46 个家庭（21%）中，一个接触者患病；在 14 个家庭（6%）中，有多个接触者患病。随着家庭规模的增大，出现急性呼吸道疾病的家庭接触者比例逐渐降低，从两口之家的 28%降至六口之家的 9%。18 岁及以下的家庭接触者的易感性是 19 至 50 岁接触者的两倍（相对易感性，1.96；贝叶斯 95%可信区间，1.05 至 3.78；P=0.005），50 岁以上的家庭接触者的易感性低于 19 至 50 岁的接触者（相对易感性，0.17；95%可信区间，0.02 至 0.92；P=0.03）。传染性与年龄无关。从病例患者出现症状到该患者感染的家庭接触者出现症状的平均时间为 2.6 天（95%可信区间，2.2 至 3.5）。