Levintow Sara N, Remch Molly, Jones Emily P, Lessler Justin, Edwards Jessie K, Brinkley-Rubinstein Lauren, Rice Dana K, Rosen David L, Powers Kimberly A
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Epidemics. 2025 Mar;50:100809. doi: 10.1016/j.epidem.2024.100809. Epub 2024 Dec 6.
The prevention and control of infectious disease outbreaks in carceral settings face unique challenges. Transmission modeling is a powerful tool for understanding and addressing these challenges, but reviews of modeling work in this context pre-date the proliferation of outbreaks in jails and prisons during the SARS-CoV-2 pandemic. We conducted a systematic review of studies using transmission models of respiratory infections in carceral settings before and during the pandemic.
We searched PubMed, Embase, Scopus, CINAHL, and PsycInfo to identify studies published between 1970 and 2024 that modeled transmission of respiratory infectious diseases in carceral settings. We extracted information on the diseases, populations, and settings modeled; approaches used for parameterizing models and simulating transmission; outcomes of interest and techniques for model calibration, validation, and sensitivity analyses; and types, impacts, and ethical aspects of modeled interventions.
Forty-six studies met eligibility criteria, with transmission dynamics of tuberculosis modeled in 24 (52 %), SARS-CoV-2 in 20 (43 %), influenza in one (2 %), and varicella-zoster virus in one (2 %). Carceral facilities in the United States were the most common focus (15, 33 %), followed by Brazil (8, 17 %). Most studies (36, 80 %) used compartmental models (vs. individual- or agent-based). Tuberculosis studies typically modeled transmission within a single facility, while most SARS-CoV-2 studies simulated transmission in multiple places, including between carceral and community settings. Half of studies fit models to epidemiological data; three validated model predictions. Models were used to estimate past or potential future intervention impacts in 32 (70 %) studies, forecast the status quo (without changing conditions) in six (13 %), and examine only theoretical aspects of transmission in eight (17 %). Interventions commonly involved testing and treatment, quarantine and isolation, and/or facility ventilation. Modeled interventions substantially reduced transmission, but some were not well-defined or did not consider ethical issues.
The pandemic prompted urgent attention to transmission dynamics in jails and prisons, but there has been little modeling of respiratory infections other than SARS-CoV-2 and tuberculosis. Increased attention to calibration, validation, and the practical and ethical aspects of intervention implementation could improve translation of model estimates into tangible benefits for the highly vulnerable populations in carceral settings.
在监禁场所预防和控制传染病暴发面临独特挑战。传播建模是理解和应对这些挑战的有力工具，但在此背景下对建模工作的综述早于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行期间监狱和看守所中疫情的激增。我们对大流行之前和期间使用监禁场所呼吸道感染传播模型的研究进行了系统综述。
我们检索了PubMed、Embase、Scopus、CINAHL和PsycInfo，以识别1970年至2024年期间发表的对监禁场所呼吸道传染病传播进行建模的研究。我们提取了有关所建模的疾病、人群和场所的信息；用于参数化模型和模拟传播的方法；感兴趣的结果以及模型校准、验证和敏感性分析的技术；以及所建模干预措施的类型、影响和伦理方面的信息。
46项研究符合纳入标准，其中24项（52%）对结核病的传播动态进行了建模，20项（43%）对SARS-CoV-2进行了建模。一项（2%）对流感进行了建模，一项（2%）对水痘-带状疱疹病毒进行了建模。美国的监禁设施是最常见的研究重点（15项，33%），其次是巴西（8项，17%）。大多数研究（36项，80%）使用了 compartmental模型（相对于基于个体或主体的模型）。结核病研究通常对单个设施内的传播进行建模，而大多数SARS-CoV-2研究模拟了多个场所的传播，包括监禁场所与社区环境之间的传播。一半的研究将模型与流行病学数据拟合；三项研究验证了模型预测。在32项（70%）研究中，模型被用于估计过去或未来潜在干预措施的影响，六项（13%）研究预测了现状（不改变条件），八项（17%）研究仅研究了传播的理论方面。干预措施通常包括检测与治疗、隔离与检疫和/或设施通风。所建模的干预措施显著减少了传播，但有些干预措施定义不明确或未考虑伦理问题。
大流行促使人们迫切关注监狱和看守所中的传播动态，但除了SARS-CoV-2和结核病外，对呼吸道感染的建模很少。更多地关注校准、验证以及干预措施实施的实际和伦理方面，可能会改善将模型估计转化为对监禁场所中高度脆弱人群的切实利益。
