MRC Centre for Outbreak Analysis Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
PLoS Comput Biol. 2010 Feb 19;6(2):e1000683. doi: 10.1371/journal.pcbi.1000683.
Outbreaks of H5N1 in poultry in Vietnam continue to threaten the livelihoods of those reliant on poultry production whilst simultaneously posing a severe public health risk given the high mortality associated with human infection. Authorities have invested significant resources in order to control these outbreaks. Of particular interest is the decision, following a second wave of outbreaks, to move from a "stamping out" approach to the implementation of a nationwide mass vaccination campaign. Outbreaks which occurred around this shift in policy provide a unique opportunity to evaluate the relative effectiveness of these approaches and to help other countries make informed judgements when developing control strategies. Here we use Bayesian Markov Chain Monte Carlo (MCMC) data augmentation techniques to derive the first quantitative estimates of the impact of the vaccination campaign on the spread of outbreaks of H5N1 in northern Vietnam. We find a substantial decrease in the transmissibility of infection between communes following vaccination. This was coupled with a significant increase in the time from infection to detection of the outbreak. Using a cladistic approach we estimated that, according to the posterior mean effect of pruning the reconstructed epidemic tree, two thirds of the outbreaks in 2007 could be attributed to this decrease in the rate of reporting. The net impact of these two effects was a less intense but longer-lasting wave and, whilst not sufficient to prevent the sustained spread of outbreaks, an overall reduction in the likelihood of the transmission of infection between communes. These findings highlight the need for more effectively targeted surveillance in order to help ensure that the effective coverage achieved by mass vaccination is converted into a reduction in the likelihood of outbreaks occurring which is sufficient to control the spread of H5N1 in Vietnam.
越南家禽中 H5N1 的爆发继续威胁到依赖家禽生产的人们的生计,同时由于人类感染相关的高死亡率,也对公众健康构成严重威胁。当局投入了大量资源来控制这些爆发。特别值得关注的是,在第二轮爆发之后,当局决定从“消灭”方法转向实施全国范围的大规模疫苗接种运动。在政策转变前后发生的疫情爆发为评估这些方法的相对有效性提供了独特的机会,并有助于其他国家在制定控制策略时做出明智的判断。在这里,我们使用贝叶斯马尔可夫链蒙特卡罗 (MCMC) 数据增强技术,首次对疫苗接种活动对越南北部 H5N1 疫情传播的影响进行定量估计。我们发现,接种疫苗后,各公社之间的感染传播可传播性大大降低。这与疫情爆发检测到的时间显著增加有关。通过系统发育方法,我们估计,根据修剪重建流行树的后验均值效应,2007 年的三分之二疫情可归因于报告率的降低。这两个因素的综合影响是疫情强度降低但持续时间更长,尽管不足以阻止疫情的持续传播,但总体上降低了公社之间感染传播的可能性。这些发现强调需要更有针对性的监测,以确保大规模疫苗接种所实现的有效覆盖转化为降低疫情发生的可能性,足以控制 H5N1 在越南的传播。