Hepatitis-B virus endemicity: heterogeneity, catastrophic dynamics and control
Hepatitis-B virus endemicity: heterogeneity, catastrophic dynamics and control
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DOI：
10.1038/87953
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发表时间：
2001-05-01
期刊：
影响因子：
82.9
通讯作者：
Nokes, DJ
中科院分区：
文献类型：
--
作者：
Medley, GF;Lindop, NA;Nokes, DJ
乙型肝炎病毒感染在全球普遍存在，但其分布非常不均匀，不同国家的血清学标志物流行率从不到1%到超过90%不等。我们提出了一个解释这种多样性使用乙肝病毒传播动力学的数学模型，显示，第一次，“灾难性”的行为，使用现实的流行病学过程和参数。我们的主要结论是，感染的流行率在很大程度上取决于一种反馈机制，这种机制将传播率、感染时的平均年龄和与年龄有关的感染后发生疾病的概率联系起来。使用该模型，我们确定了可能的，高度非线性的化疗和免疫干预的后果，其中携带者的起始患病率是最有影响力的预测量。总而言之，我们的结果需要重新评估针对乙型肝炎的公共卫生政策。
Hepatitis-B virus infection is globally ubiquitous, but its distribution is very heterogeneous, with prevalence of serological markers in various nations ranging from less than 1% to more than 90%. We propose an explanation for this diversity using a mathematical model of hepatitis-B virus transmission dynamics that shows, for the first time,'catastrophic' behavior using realistic epidemiological processes and parameters. Our major conclusion is that the prevalence of infection is largely determined by a feedback mechanism that relates the rate of transmission, average age at infection and age-related probability of developing carriage following infection. Using the model we identify possible, highly non-linear, consequences of chemotherapy and immunization interventions, for which the starting prevalence of carriers is the most influential, predictive quantity. Taken together, our results demand a re-evaluation of public health policy towards hepatitis-B.