Rubella metapopulation dynamics and importance of spatial coupling to the risk of congenital rubella syndrome in Peru
Rubella metapopulation dynamics and importance of spatial coupling to the risk of congenital rubella syndrome in Peru
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DOI：
10.1098/rsif.2010.0320
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发表时间：
2011-03-06
影响因子：
3.9
通讯作者：
Bjornstad, O. N.
中科院分区：
文献类型：
--
作者：
Metcalf, C. J. E.;Munayco, C. V.;Bjornstad, O. N.
风疹通常是一种轻微的儿童疾病，但妊娠早期感染可能导致自然流产或先天性风疹综合征（CRS），这可能导致各种出生缺陷。因此，了解这种感染的年龄结构动态具有相当大的公共卫生价值。如果疫苗接种未达到当地消除传播的阈值，则感染的平均年龄将增加。因此，对这种感染的典型关注是接种疫苗可能增加育龄个体的发病率。风疹动力学的一个被忽视的方面是年龄发病模式可能是由流行集合种群固有的空间动态塑造的。在这里，我们使用一个独特的详细的数据集从秘鲁探索的影响，这对CRS的负担。我们的研究结果表明，CRS的风险可能是特别严重的小偏远地区，预测与预期的流行情况，并与疫苗接种的结果。这一结果直接来自集合种群背景：具体而言，预防-再定植动态至关重要，因为它们允许易感个体在流行病期间显著泄漏到老年人群中，有可能使CRS风险增加多达五倍。
Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Consequently, understanding the age-structured dynamics of this infection has considerable public health value. Vaccination short of the threshold for local elimination of transmission will increase the average age of infection. Accordingly, the classic concern for this infection is the potential for vaccination to increase incidence in individuals of childbearing age. A neglected aspect of rubella dynamics is how age incidence patterns may be moulded by the spatial dynamics inherent to epidemic metapopulations. Here, we use a uniquely detailed dataset from Peru to explore the implications of this for the burden of CRS. Our results show that the risk of CRS may be particularly severe in small remote regions, a prediction at odds with expectations in the endemic situation, and with implications for the outcome of vaccination. This outcome results directly from the metapopulation context: specifically, extinction-re-colonization dynamics are crucial because they allow for significant leakage of susceptible individuals into the older age classes during inter-epidemic periods with the potential to increase CRS risk by as much as fivefold.