Beyond R(0): heterogeneity in secondary infections and probabilistic epidemic forecasting.

Beyond R(0): heterogeneity in secondary infections and probabilistic epidemic forecasting.
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DOI:
10.1098/rsif.2020.0393
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发表时间:
2020-11
期刊:
Journal of the Royal Society, Interface
影响因子:
--
通讯作者:
Allard A
Allard A
中科院分区:
其他
文献类型:
--
作者:
Hébert-Dufresne L;Althouse BM;Scarpino SV;Allard A

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基本生殖数R 0是公共卫生中最常见和最常误用的数字之一。通常用于比较疫情和预测流行病风险,这个单一的数字掩盖了不同流行病可能表现出的复杂性,即使它们具有相同的R 0。在这里,我们重新制定和扩展了一个经典的结果,从随机网络理论预测的流行病的规模使用估计的分布继发感染,利用其平均R 0和潜在的异质性。重要的是,R 0较低的流行病如果传播更均匀(因此对随机波动更稳健),则可能更大。我们说明了这种方法的潜力,使用不同的真实的流行病与已知的估计R 0,异质性和流行病的规模在没有显着的干预。此外,我们还讨论了在新兴病原体的数据稀缺的现实中,该框架可以实现的不同方式。最后,我们证明,如果没有关于新出现的传染病(如COVID-19)继发感染异质性的数据,疫情规模的不确定性范围将非常大。总的来说,我们的工作突出了在新出现的传染病暴发期间对接触者追踪的迫切需要,以及超越R 0的必要性。
The basic reproductive number, R0, is one of the most common and most commonly misapplied numbers in public health. Often used to compare outbreaks and forecast pandemic risk, this single number belies the complexity that different epidemics can exhibit, even when they have the same R0. Here, we reformulate and extend a classic result from random network theory to forecast the size of an epidemic using estimates of the distribution of secondary infections, leveraging both its average R0 and the underlying heterogeneity. Importantly, epidemics with lower R0 can be larger if they spread more homogeneously (and are therefore more robust to stochastic fluctuations). We illustrate the potential of this approach using different real epidemics with known estimates for R0, heterogeneity and epidemic size in the absence of significant intervention. Further, we discuss the different ways in which this framework can be implemented in the data-scarce reality of emerging pathogens. Lastly, we demonstrate that without data on the heterogeneity in secondary infections for emerging infectious diseases like COVID-19 the uncertainty in outbreak size ranges dramatically. Taken together, our work highlights the critical need for contact tracing during emerging infectious disease outbreaks and the need to look beyond R0.
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