Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
BMC Med. 2019 Sep 9;17(1):172. doi: 10.1186/s12916-019-1396-4.
Wolbachia-infected mosquitoes reduce dengue virus transmission, and city-wide releases in Yogyakarta city, Indonesia, are showing promising entomological results. Accurate estimates of the burden of dengue, its spatial distribution and the potential impact of Wolbachia are critical in guiding funder and government decisions on its future wider use.
Here, we combine multiple modelling methods for burden estimation to predict national case burden disaggregated by severity and map the distribution of burden across the country using three separate data sources. An ensemble of transmission models then predicts the estimated reduction in dengue transmission following a nationwide roll-out of wMel Wolbachia.
We estimate that 7.8 million (95% uncertainty interval [UI] 1.8-17.7 million) symptomatic dengue cases occurred in Indonesia in 2015 and were associated with 332,865 (UI 94,175-754,203) lost disability-adjusted life years (DALYs). The majority of dengue's burden was due to non-severe cases that did not seek treatment or were challenging to diagnose in outpatient settings leading to substantial underreporting. Estimated burden was highly concentrated in a small number of large cities with 90% of dengue cases occurring in 15.3% of land area. Implementing a nationwide Wolbachia population replacement programme was estimated to avert 86.2% (UI 36.2-99.9%) of cases over a long-term average.
These results suggest interventions targeted to the highest burden cities can have a disproportionate impact on dengue burden. Area-wide interventions, such as Wolbachia, that are deployed based on the area covered could protect people more efficiently than individual-based interventions, such as vaccines, in such dense environments.
感染沃尔巴克氏体的蚊子可降低登革热病毒的传播率，印度尼西亚日惹市的全市范围释放显示出有希望的昆虫学结果。准确估计登革热的负担、其空间分布以及沃尔巴克氏体的潜在影响，对于指导资金和政府在未来更广泛地使用该方法的决策至关重要。
在这里，我们结合了多种用于负担估计的建模方法，以预测按严重程度细分的全国病例负担，并使用三个单独的数据源绘制全国负担分布情况。然后，一组传输模型预测在全国范围内推出 wMel 沃尔巴克氏体后，登革热传播的估计减少量。
我们估计，2015 年印度尼西亚有 780 万（95%置信区间[UI]为 180 万至 1770 万）例有症状的登革热病例，与 332865 例（UI 为 94175 至 754203 例）丧失残疾调整生命年（DALY）有关。登革热的大部分负担归因于未寻求治疗或在门诊环境中难以诊断的非严重病例，导致大量漏报。估计的负担高度集中在少数大城市，90%的登革热病例发生在占土地面积 15.3%的地区。估计实施全国范围内的沃尔巴克氏体种群替代计划将在长期平均水平上避免 86.2%（UI 为 36.2%至 99.9%）的病例。
这些结果表明，针对负担最高的城市的干预措施可以对登革热负担产生不成比例的影响。像沃尔巴克氏体这样的区域范围干预措施，根据覆盖的区域进行部署，可以比个体为基础的干预措施（如疫苗）在这种密集的环境中更有效地保护人们。
