Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, Michigan.
Am J Trop Med Hyg. 2023 Sep 5;109(4):874-880. doi: 10.4269/ajtmh.22-0716. Print 2023 Oct 4.
Highly transmissible infections with short serial intervals, such as SARS-Cov-2 and influenza, can quickly overwhelm healthcare resources in institutional settings such as jails. We assessed the impact of intake screening measures on the risk of SARS-CoV-2 outbreaks in this setting. We identified which elements of the intake process created the largest reductions in caseload. We implemented an individual-based simulation representative of SARS-Cov-2 transmission in a large urban jail utilizing testing at entry, quarantine, and post-quarantine testing to protect its general population from mass infection. We tracked the caseload under each scenario and quantified the impact of screening steps by varying quarantine duration, removing testing, and using a range of test sensitivities. We repeated the simulations under a range of transmissibility and community prevalence levels to evaluate the sensitivity of our results. We found that brief quarantine of newly incarcerated individuals separate from the existing population of the jail to permit pre-quarantine and end-of-quarantine tests reduced SARS-CoV-2 caseload 30-70% depending on test sensitivity. These results were robust to variation in the transmissibility. Further quarantine (up to 14 days) on average created only a 5% further reduction in caseload. A multilayered intake process is necessary to limit the spread of highly transmissible pathogens with short serial intervals. The pre-symptomatic phase means that no single strategy can be effective. We also show that shorter durations of quarantine combined with testing can be nearly as effective at preventing spread as longer-duration quarantine up to 14 days.
高传染性且潜伏期短的感染，如 SARS-CoV-2 和流感，可迅速使监狱等机构环境中的医疗资源不堪重负。我们评估了在这种环境下，摄入筛查措施对 SARS-CoV-2 爆发风险的影响。我们确定了摄入过程中的哪些要素可最大程度降低病例数。我们实施了一种基于个体的模拟，利用检测手段在进入、隔离和隔离后对大型城市监狱中的 SARS-CoV-2 传播进行代表性模拟，以保护其普通人群免受大规模感染。我们跟踪了每种情况下的病例数，并通过改变隔离期、去除检测以及使用一系列检测敏感性来量化筛查步骤的影响。我们在一系列传染性和社区流行水平下重复模拟，以评估结果的敏感性。我们发现，对新入狱人员进行短暂隔离，使其与监狱中的现有人员隔离开来，以便进行隔离前和隔离结束时的检测，可根据检测敏感性降低 SARS-CoV-2 病例数 30-70%。这些结果在传染性变化时仍然稳健。进一步的隔离（最长 14 天）平均仅将病例数减少 5%。需要采用多层摄入过程来限制具有短潜伏期的高传染性病原体的传播。无症状阶段意味着没有单一策略可以有效。我们还表明，将较短的隔离期与检测相结合，可与长达 14 天的较长隔离期一样有效地防止传播。
