Department for Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
Viruses. 2022 Jul 22;14(8):1605. doi: 10.3390/v14081605.
Systematic reviews of 591 primary studies of the modes of transmission for SARS-CoV-2 show significant methodological shortcomings and heterogeneity in the design, conduct, testing, and reporting of SARS-CoV-2 transmission. While this is partly understandable at the outset of a pandemic, evidence rules of proof for assessing the transmission of this virus are needed for present and future pandemics of viral respiratory pathogens. We review the history of causality assessment related to microbial etiologies with a focus on respiratory viruses and suggest a hierarchy of evidence to integrate clinical, epidemiologic, molecular, and laboratory perspectives on transmission. The hierarchy, if applied to future studies, should narrow the uncertainty over the twin concepts of causality and transmission of human respiratory viruses. We attempt to address the translational gap between the current research evidence and the assessment of causality in the transmission of respiratory viruses with a focus on SARS-CoV-2. Experimentation, consistency, and independent replication of research alongside our proposed framework provide a chain of evidence that can reduce the uncertainty over the transmission of respiratory viruses and increase the level of confidence in specific modes of transmission, informing the measures that should be undertaken to prevent transmission.
对 591 项 SARS-CoV-2 传播模式的主要研究进行系统回顾显示，在 SARS-CoV-2 的设计、实施、检测和报告方面存在显著的方法学缺陷和异质性。虽然在大流行初期这在一定程度上是可以理解的，但目前和未来的病毒性呼吸道病原体流行都需要评估该病毒传播的证据规则。我们回顾了与微生物病因学相关的因果关系评估历史，重点是呼吸道病毒，并提出了一个证据层次结构，以整合关于传播的临床、流行病学、分子和实验室观点。如果将该层次结构应用于未来的研究，应该可以缩小对人类呼吸道病毒因果关系和传播这两个概念的不确定性。我们试图解决当前研究证据与呼吸道病毒传播因果关系评估之间的转化差距，重点关注 SARS-CoV-2。实验、一致性和研究的独立复制以及我们提出的框架提供了一个证据链，可以减少呼吸道病毒传播的不确定性，并提高对特定传播模式的信心，为应采取的预防传播措施提供信息。
