大学校园猴痘疫情规划：基于模型的决策支持工具。
Planning for Mpox on a College Campus: A Model-Based Decision-Support Tool.
机构信息
Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut (A.S., M.C., J.K., V.E.P., G.G.).
Public Health Modeling Unit and Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (A.D.P.).
出版信息
Ann Intern Med. 2023 Mar;176(3):340-347. doi: 10.7326/M22-2734. Epub 2023 Jan 31.
BACKGROUND
In spring and summer 2022, an outbreak of mpox occurred worldwide, largely confined to men who have sex with men (MSM). There was concern that mpox could break swiftly into congregate settings and populations with high levels of regular frequent physical contact, like university campus communities.
OBJECTIVE
To estimate the likelihood of an mpox outbreak and the potential effect of mitigation measures in a residential college setting.
DESIGN
A stochastic dynamic SEIR (susceptible, exposed but not infectious, infectious, or recovered) model of mpox transmission in a study population was developed, composed of: a high-risk group representative of the population of MSM with a basic reproductive number ( ) of 2.4 and a low-risk group with an of 0.8. Base input assumptions included an incubation time of 7.6 days and time to recovery of 21 days.
SETTING
U.S. residential college campus.
PARTICIPANTS
Hypothetical cohort of 6500 students.
INTERVENTION
Isolation, quarantine, and vaccination of close contacts.
MEASUREMENTS
Proportion of 1000 simulations producing sustained transmission; mean cases given sustained transmission; maximum students isolated, quarantined, and vaccinated. All projections are estimated over a planning horizon of 100 days.
RESULTS
Without mitigation measures, the model estimated an 83% likelihood of sustained transmission, leading to an average of 183 cases. With detection and isolation of 20%, 50%, and 80% of cases, the average infections would fall to 117, 37, and 8, respectively. Reactive vaccination of contacts of detected cases (assuming 50% detection and isolation) reduced mean cases from 37 to 17, assuming 20 vaccinated contacts per detected case. Preemptive vaccination of 50% of the high-risk population before outbreak reduced cases from 37 to 14, assuming 50% detection and isolation.
LIMITATION
A model is a stylized portrayal of behavior and transmission on a university campus.
CONCLUSION
Based on our current understanding of mpox epidemiology among MSM in the United States, this model-based analysis suggests that future outbreaks of mpox on college campuses may be controlled with timely detection and isolation of symptomatic cases.
PRIMARY FUNDING SOURCE
National Institutes of Health National Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases.
背景
2022 年春夏之际，猴痘在全球范围内爆发，主要局限于男男性行为者（MSM）。人们担心猴痘可能会迅速蔓延到人群密集的场所和经常进行身体接触的人群，例如大学校园社区。
目的
估计在住宿学院环境中猴痘爆发的可能性和缓解措施的潜在效果。
设计
建立了一个在研究人群中传播的猴痘的随机动态 SEIR（易感、暴露但无传染性、传染性或恢复）模型，由代表 MSM 人群的高风险组和基本繁殖数（）为 2.4 的低风险组组成。基本输入假设包括潜伏期为 7.6 天，恢复期为 21 天。
地点
美国住宿学院校园。
参与者
假设的 6500 名学生队列。
干预措施
对密切接触者进行隔离、检疫和接种疫苗。
测量
产生持续传播的 1000 次模拟的比例；持续传播的平均病例数；最大隔离、检疫和接种的学生人数。所有预测都是在 100 天的规划期内进行的。
结果
如果没有缓解措施，模型估计持续传播的可能性为 83%，导致平均 183 例病例。如果检测和隔离 20%、50%和 80%的病例，平均感染人数将分别降至 117、37 和 8。接触到已检测到的病例的人进行反应性疫苗接种（假设检测和隔离率为 50%），将平均病例数从 37 例降至 17 例，假设每个检测到的病例有 20 个接触者接种疫苗。在爆发前对高危人群进行 50%的预防性疫苗接种，将病例数从 37 例减少到 14 例，假设检测和隔离率为 50%。
局限性
模型是对大学校园性行为和传播的一种风格化描绘。
结论
根据我们目前对美国男男性行为者中猴痘流行病学的理解，这项基于模型的分析表明，未来大学校园猴痘爆发可以通过及时检测和隔离有症状的病例来控制。
主要资金来源
美国国立卫生研究院国家药物滥用研究所和国家过敏和传染病研究所。
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