Avilov Konstantin Konstantinovich, Romanyukha Alexei Alexeevich, Belilovsky Evgeny Mikhailovich, Borisov Sergey Evgenevich
Institute for Numerical Mathematics, Russian Academy of Sciences, 8, Gubkina Str., Moscow, 119333, Russia.
Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health, 10, Stromynka Str., Moscow, 107076, Russia.
Infect Dis Model. 2022 Jun 30;7(3):374-386. doi: 10.1016/j.idm.2022.06.007. eCollection 2022 Sep.
Little is known about the dynamics of the early stages of untreated active pulmonary tuberculosis: unknown are both the rates of progression and the model "scheme". The "parallel" scheme assumes that infectiousness of tuberculosis cases is effectively predefined at the onset of the disease, and the "serial" scheme considers all cases to be non-infectious at the onset, with some of them later becoming infectious. Our aim was to estimate the progression of the early stages of pulmonary tuberculosis using data from a present-day population. We used the routine notification data from Moscow, Russia, 2013-2018 that contained the results and time of the last fluorographic screening preceding the detection of tuberculosis cases. This provided time limits on the duration of untreated tuberculosis. Parameters of TB progression under both models were estimated. By the goodness of fit to the data, we could prefer neither the "parallel", nor the "serial" model, although the latter had a bit worse fit. On the other hand, the observed rise in the fraction of infectious tuberculosis cases with the time since the last screening was explained by the "serial" model in a more plausible way - as gradual progression of some cases to infectiousness. The "parallel" model explained it through less realistic quick removal of non-infectious cases and accumulation of the infectious ones. The results demonstrate the potential of using such detection data enriched with reassessments of the previous screenings.
对于未经治疗的活动性肺结核早期阶段的动态变化，我们了解得很少：疾病进展速度和模型“方案”均不明确。“平行”方案假定肺结核病例的传染性在疾病发作时就已有效确定，而“连续”方案则认为所有病例在发作时均无传染性，其中一些病例后来会变为有传染性。我们的目的是利用当代人群的数据来估计肺结核早期阶段的进展情况。我们使用了来自俄罗斯莫斯科2013 - 2018年的常规通报数据，这些数据包含在肺结核病例检测之前最后一次荧光透视筛查的结果和时间。这为未经治疗的肺结核持续时间提供了时间限制。我们估计了两种模型下结核病进展的参数。通过对数据的拟合优度来看，我们既不能倾向于“平行”模型，也不能倾向于“连续”模型，尽管后者的拟合稍差一些。另一方面，“连续”模型以一种更合理的方式解释了自上次筛查以来传染性肺结核病例比例随时间的上升——即一些病例逐渐发展为具有传染性。“平行”模型则通过不太现实的快速清除非传染性病例和积累传染性病例来解释这一现象。结果表明了使用这种丰富了对先前筛查重新评估的检测数据的潜力。
