Biosecurity Program, Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
Risk Anal. 2020 May;40(5):915-925. doi: 10.1111/risa.13472. Epub 2020 Mar 13.
The Grunow-Finke assessment tool (GFT) is an accepted scoring system for determining likelihood of an outbreak being unnatural in origin. Considering its high specificity but low sensitivity, a modified Grunow-Finke tool (mGFT) has been developed with improved sensitivity. The mGFT has been validated against some past disease outbreaks, but it has not been applied to ongoing outbreaks. This study is aimed to score the outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia using both the original GFT and mGFT. The publicly available data on human cases of MERS-CoV infections reported in Saudi Arabia (2012-2018) were sourced from the FluTrackers, World Health Organization, Saudi Ministry of Health, and published literature associated with MERS outbreaks investigations. The risk assessment of MERS-CoV in Saudi Arabia was analyzed using the original GFT and mGFT criteria, algorithms, and thresholds. The scoring points for each criterion were determined by three researchers to minimize the subjectivity. The results showed 40 points of total possible 54 points using the original GFT (likelihood: 74%), and 40 points of a total possible 60 points (likelihood: 67%) using the mGFT, both tools indicating a high likelihood that human MERS-CoV in Saudi Arabia is unnatural in origin. The findings simply flag unusual patterns in this outbreak, but do not prove unnatural etiology. Proof of bioattacks can only be obtained by law enforcement and intelligence agencies. This study demonstrated the value and flexibility of the mGFT in assessing and predicting the risk for an ongoing outbreak with simple criteria.
格鲁诺-芬克评估工具（GFT）是一种公认的评分系统，用于确定疫情是否源自人为。考虑到其特异性高但敏感性低，因此开发了一种改良的格鲁诺-芬克工具（mGFT），以提高敏感性。mGFT 已针对过去的一些疾病暴发进行了验证，但尚未应用于正在发生的暴发。本研究旨在使用原始 GFT 和 mGFT 对沙特阿拉伯中东呼吸综合征冠状病毒（MERS-CoV）暴发进行评分。从 FluTrackers、世界卫生组织、沙特卫生部和与 MERS 暴发调查相关的已发表文献中获取了沙特阿拉伯报告的人类 MERS-CoV 感染病例的公开数据（2012-2018 年）。使用原始 GFT 和 mGFT 标准、算法和阈值对沙特阿拉伯的 MERS-CoV 风险进行了分析。通过三位研究人员确定了每个标准的评分点，以尽量减少主观性。结果显示，使用原始 GFT 得分为 54 分中的 40 分（可能性：74%），使用 mGFT 得分为 60 分中的 40 分（可能性：67%），这两种工具都表明沙特阿拉伯的人类 MERS-CoV 极有可能源自人为。这些发现仅标记了该暴发中的异常模式，但不能证明人为病因。只有执法和情报机构才能通过法律手段获得生物攻击的证据。本研究表明，mGFT 在使用简单标准评估和预测正在发生的暴发的风险方面具有价值和灵活性。
