菲律宾结核病缓解的数学模型与干预策略。

Mathematical model and intervention strategies for mitigating tuberculosis in the Philippines.

机构信息

Department of Mathematics, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.

Institute of Mathematics, University of the Philippines Diliman, C.P. Garcia St., U.P. Campus, Diliman, Quezon City 1101, Philippines.

出版信息

J Theor Biol. 2018 Apr 14;443:100-112. doi: 10.1016/j.jtbi.2018.01.026. Epub 2018 Feb 3.

Abstract

Tuberculosis (TB) is the sixth leading cause of morbidity and mortality in the Philippines. Although significant progress has been made in the detection and cure of TB under the Directly Observed Treatment Short Course, battling against the disease is still a burdensome task. It demands a concerted effort for specific and effective interventions. In this work, a mathematical TB model fitted to the Philippine data is developed to understand its transmission dynamics. Different control strategies such as distancing, latent case finding, case holding, active case finding controls, and combinations thereof are investigated within the framework of optimal control theory. This study proposes optimal control strategies for reducing the number of high-risk latent and infectious TB patients with minimum intervention implementation costs. Results suggest that distancing control is the most efficient control strategy when a single intervention is utilized. However, full scale employment of the distancing control measure is a daunting task. This burden can be circumvented by the combination of other control interventions. Our noble finding in this study is that enhancing active case finding control instead of case holding control together with distancing and latent case finding control is shown to have significant potential for curtailing the spread of TB in the Philippines.

摘要

在菲律宾,结核病(TB)是导致发病率和死亡率的第六大原因。尽管在直接观察短期疗程下,结核病的检测和治疗已经取得了重大进展,但抗击这种疾病仍然是一项艰巨的任务。这需要为特定和有效的干预措施做出协调努力。在这项工作中,建立了一个适合菲律宾数据的结核病数学模型,以了解其传播动态。在最优控制理论框架内,研究了不同的控制策略,如隔离、潜伏病例发现、病例保持、主动病例发现控制以及它们的组合。本研究提出了降低高风险潜伏和传染性结核病患者数量的最优控制策略,同时将干预实施成本降至最低。结果表明,当使用单一干预措施时,隔离控制是最有效的控制策略。然而,全面实施隔离控制措施是一项艰巨的任务。可以通过结合其他控制干预措施来避免这种负担。我们在这项研究中的崇高发现是,加强主动病例发现控制而不是病例保持控制,同时结合潜伏病例发现和隔离控制,显示出在菲律宾遏制结核病传播的巨大潜力。

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