Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, United Kingdom.
Proc Natl Acad Sci U S A. 2011 Feb 15;108(7):2825-30. doi: 10.1073/pnas.1008895108. Epub 2011 Jan 31.
Evaluating the impact of different social networks on the spread of respiratory diseases has been limited by a lack of detailed data on transmission outside the household setting as well as appropriate statistical methods. Here, from data collected during a H1N1 pandemic (pdm) influenza outbreak that started in an elementary school and spread in a semirural community in Pennsylvania, we quantify how transmission of influenza is affected by social networks. We set up a transmission model for which parameters are estimated from the data via Markov chain Monte Carlo sampling. Sitting next to a case or being the playmate of a case did not significantly increase the risk of infection; but the structuring of the school into classes and grades strongly affected spread. There was evidence that boys were more likely to transmit influenza to other boys than to girls (and vice versa), which mimicked the observed assortative mixing among playmates. We also investigated the presence of abnormally high transmission occurring on specific days of the outbreak. Late closure of the school (i.e., when 27% of students already had symptoms) had no significant impact on spread. School-aged individuals (6-18 y) facilitated the introduction and spread of influenza in households, but only about one in five cases aged >18 y was infected by a school-aged household member. This analysis shows the extent to which clearly defined social networks affect influenza transmission, revealing strong between-place interactions with back-and-forth waves of transmission between the school, the community, and the household.
一是缺乏家庭以外传播的详细数据,二是缺乏适当的统计方法。在这里,我们利用在宾夕法尼亚州一所农村小学发生的 H1N1 大流行流感暴发的数据,定量分析了流感传播受到社交网络的影响。我们建立了一个传染病传播模型,利用马尔可夫链蒙特卡罗抽样方法从数据中估计模型参数。坐在病例旁边或与病例一起玩耍并不会显著增加感染风险;但是,学校按班级和年级组织的方式强烈影响了传播。有证据表明,男孩比女孩更容易将流感传染给其他男孩(反之亦然),这与观察到的玩伴之间的分类混合相吻合。我们还研究了暴发过程中特定日期是否存在异常高的传播。学校延迟关闭(即 27%的学生已经出现症状时)对传播没有显著影响。学龄个体(6-18 岁)促进了流感在家庭中的引入和传播,但只有大约五分之一的 18 岁以上个体是被学龄家庭成员感染的。这项分析表明,明确界定的社交网络在多大程度上影响了流感的传播,揭示了学校、社区和家庭之间强烈的跨地点相互作用,以及传播的往返波。