The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom.
PLoS Comput Biol. 2023 Dec 15;19(12):e1011187. doi: 10.1371/journal.pcbi.1011187. eCollection 2023 Dec.
Quarantine has been long used as a public health response to emerging infectious diseases, particularly at the onset of an epidemic when the infected proportion of a population remains identifiable and logistically tractable. In theory, the same logic should apply to low-incidence infections; however, the application and impact of quarantine in low prevalence settings appears less common and lacks a formal analysis. Here, we present a quantitative framework using a series of progressively more biologically realistic models of canine rabies in domestic dogs and from dogs to humans, a suitable example system to characterize dynamical changes under varying levels of dog quarantine. We explicitly incorporate health-seeking behaviour data to inform the modelling of contact-tracing and exclusion of rabies suspect and probable dogs that can be identified through bite-histories of patients presenting at anti-rabies clinics. We find that a temporary quarantine of rabies suspect and probable dogs provides a powerful tool to curtail rabies transmission, especially in settings where optimal vaccination coverage is yet to be achieved, providing a critical stopgap to reduce the number of human and animal deaths due to rabid bites. We conclude that whilst comprehensive measures including sensitive surveillance and large-scale vaccination of dogs will be required to achieve disease elimination and sustained freedom given the persistent risk of rabies re-introductions, quarantine offers a low-cost community driven solution to intersectoral health burden.
隔离长期以来一直被用作应对新发传染病的公共卫生措施，特别是在疫情爆发初期，当人群中感染的比例仍可识别且在后勤上可处理时。从理论上讲，同样的逻辑也应该适用于低发病率的感染；然而，在低流行地区，隔离的应用和影响似乎不太常见，也缺乏正式的分析。在这里，我们使用一系列越来越符合生物学现实的犬狂犬病在犬类和从犬类传播到人类的模型，提出了一个定量框架，这是一个合适的示例系统，可以描述在不同水平的犬类隔离下动态变化。我们明确纳入了寻求健康行为数据，以便对接触者追踪建模，并对狂犬病疑似和可能的犬类进行隔离，这些犬类可以通过在狂犬病诊所就诊的患者的咬伤史来识别。我们发现，对狂犬病疑似和可能的犬类进行临时隔离是遏制狂犬病传播的有力工具，特别是在尚未达到最佳疫苗接种覆盖率的情况下，这是减少因狂犬病咬伤导致的人和动物死亡数量的关键临时措施。我们的结论是，尽管需要包括敏感监测和大规模犬类疫苗接种在内的综合措施来实现消除疾病和持续的自由，因为狂犬病仍有重新引入的风险，但隔离为社区提供了一种低成本的解决方案，可以减轻跨部门的健康负担。
