Department of Environmental Sciences, Emory University, Atlanta, GA 30322, USA.; Global Health Institute, Emory University, Atlanta, GA 30322, USA.
Tropical Public Health Unit Network, Queensland Health, Cairns, Queensland 4870, Australia.; Metro South Public Health Unit, Metro South Health, Coopers Plains, Brisbane, Queensland 4113, Australia.
Sci Adv. 2017 Feb 17;3(2):e1602024. doi: 10.1126/sciadv.1602024. eCollection 2017 Feb.
The widespread transmission of dengue viruses (DENV), coupled with the alarming increase of birth defects and neurological disorders associated with Zika virus, has put the world in dire need of more efficacious tools for -borne disease mitigation. We quantitatively investigated the epidemiological value of location-based contact tracing (identifying potential out-of-home exposure locations by phone interviews) to infer transmission foci where high-quality insecticide applications can be targeted. Space-time statistical modeling of data from a large epidemic affecting Cairns, Australia, in 2008-2009 revealed a complex pattern of transmission driven primarily by human mobility (Cairns accounted for ~60% of virus transmission to and from residents of satellite towns, and 57% of all potential exposure locations were nonresidential). Targeted indoor residual spraying with insecticides in potential exposure locations reduced the probability of future DENV transmission by 86 to 96%, compared to unsprayed premises. Our findings provide strong evidence for the effectiveness of combining contact tracing with residual spraying within a developed urban center, and should be directly applicable to areas with similar characteristics (for example, southern USA, Europe, or Caribbean countries) that need to control localized -borne virus transmission or to protect pregnant women's homes in areas with active Zika transmission. Future theoretical and empirical research should focus on evaluation of the applicability and scalability of this approach to endemic areas with variable population size and force of DENV infection.
登革热病毒(DENV)的广泛传播,加上寨卡病毒导致的出生缺陷和神经紊乱病例的惊人增加,使世界迫切需要更有效的媒介传播疾病控制工具。我们定量研究了基于位置的接触者追踪(通过电话访谈确定潜在的户外活动地点)在推断传播焦点方面的流行病学价值,以便可以对这些传播焦点进行高质量的杀虫剂喷洒。对 2008-2009 年澳大利亚凯恩斯市大流行期间的大量数据进行时空统计建模,揭示了一种主要由人类流动性驱动的复杂传播模式(凯恩斯市约占卫星城镇居民输入和输出病毒的 60%,所有潜在暴露地点中有 57%是非居民场所)。与未喷洒场所相比,在潜在暴露地点进行有针对性的室内杀虫剂残留喷洒,可将未来登革热传播的概率降低 86%至 96%。我们的研究结果为在发达城市中心将接触者追踪与残留喷洒相结合的有效性提供了有力证据,并且应该直接适用于具有类似特征的地区(例如,美国南部、欧洲或加勒比国家),这些地区需要控制局部媒介传播的病毒或保护寨卡病毒传播活跃地区孕妇的居所。未来的理论和实证研究应集中评估这种方法在具有可变人口规模和登革热感染强度的流行地区的适用性和可扩展性。