Warwick Mathematics Institute and Department of Biological Sciences, University of Warwick, Coventry, UK.
BMC Infect Dis. 2010 Feb 14;10:25. doi: 10.1186/1471-2334-10-25.
In the event of a release of a pathogen such as smallpox, which is human-to-human transmissible and has high associated mortality, a key question is how best to deploy containment and control strategies. Given the general uncertainty surrounding this issue, mathematical modelling has played an important role in informing the likely optimal response, in particular defining the conditions under which mass-vaccination would be appropriate. In this paper, we consider two key questions currently unanswered in the literature: firstly, what is the optimal spatial scale for intervention; and secondly, how sensitive are results to the modelling assumptions made about the pattern of human contacts?
Here we develop a novel mathematical model for smallpox that incorporates both information on individual contact structure (which is important if the effects of contact tracing are to be captured accurately) and large-scale patterns of movement across a range of spatial scales in Great Britain.
Analysis of this model confirms previous work suggesting that a locally targeted 'ring' vaccination strategy is optimal, and that this conclusion is actually quite robust for different socio-demographic and epidemiological assumptions.
Our method allows for intuitive understanding of the reasons why national mass vaccination is typically predicted to be suboptimal. As such, we present a general framework for fast calculation of expected outcomes during the attempted control of diverse emerging infections; this is particularly important given that parameters would need to be interactively estimated and modelled in any release scenario.
如果发生天花等病原体的释放，这种病原体可以在人与人之间传播，死亡率很高，那么一个关键问题是如何最好地部署控制和遏制策略。鉴于围绕这个问题的普遍不确定性，数学建模在为可能的最佳应对方案提供信息方面发挥了重要作用，特别是确定了大规模接种疫苗是否合适的条件。在本文中，我们考虑了文献中尚未回答的两个关键问题：首先，干预的最佳空间尺度是多少；其次，模型对人类接触模式的假设做出的结果对模型的结果有多敏感？
在这里，我们为天花开发了一种新的数学模型，该模型既包含了个体接触结构的信息（如果要准确捕捉接触追踪的效果，则该信息很重要），又包含了在英国范围内各种空间尺度上的大规模移动模式的信息。
对该模型的分析证实了先前的工作，即局部靶向“环”疫苗接种策略是最优的，并且对于不同的社会人口和流行病学假设，这一结论实际上非常稳健。
我们的方法可以直观地理解为什么通常预测全国性大规模接种疫苗不是最佳选择的原因。因此，我们提出了一种用于快速计算不同新发传染病控制期间预期结果的通用框架；鉴于在任何释放场景中都需要交互估计和建模参数，这一点尤其重要。
