The spread and control of norovirus outbreaks among hospitals in a region: a simulation model.
The spread and control of norovirus outbreaks among hospitals in a region: a simulation model.
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DOI：
10.1093/ofid/ofu030
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发表时间：
2014-09
影响因子：
4.2
通讯作者：
Lee BY
中科院分区：
文献类型：
--
作者：
Bartsch SM;Huang SS;Wong KF;Avery TR;Lee BY
诺如病毒爆发可能通过病人分享在医院之间传播。在30天内，它传播的时间为4.1-17.5%（R 0 3.74）。 由于一个地区的医院通过病人共享连接在一起，一家医院的诺如病毒疫情可能会传播到其他医院。 我们利用我们的区域医疗生态系统分析软件生成加州橙子县（OC）所有急性护理机构的基于代理的模型，并模拟不同地点的各种诺如病毒爆发，包括有和没有接触预防措施。 在诺如病毒繁殖率（R 0）估计值的低端（1.64），暴发往往局限于始发医院（≤6.1%的传播概率）。然而，在R 0的较高端（3.74），爆发在30天内传播到几乎所有其他OC医院的时间为4.1%-17.5%，无论起源医院如何。对所有有症状的病例实施接触预防措施，减少了30天内传播到其他医院的可能性和全县病例总数，但没有减少其他医院看到诺如病毒病例的数量。 一次诺如病毒爆发可以持续几个月渗透到不同医院的系统中，并表现为一系列不相关的爆发，这凸显了一个地区内的医院需要更积极、更合作地跟踪和控制最初的爆发。
Norovirus outbreak may spread among hospitals via patient sharing. Within 30 days, it spread 4.1-17.5% of the time (R0 3.74). Highlights need to cooperatively track and control outbreaks Because hospitals in a region are connected via patient sharing, a norovirus outbreak in one hospital may spread to others. We utilized our Regional Healthcare Ecosystem Analyst software to generate an agent-based model of all the acute care facilities in Orange County (OC), California and simulated various norovirus outbreaks in different locations, both with and without contact precautions. At the lower end of norovirus reproductive rate (R0) estimates (1.64), an outbreak tended to remain confined to the originating hospital (≤6.1% probability of spread). However, at the higher end of R0 (3.74), an outbreak spread 4.1%–17.5% of the time to almost all other OC hospitals within 30 days, regardless of the originating hospital. Implementing contact precautions for all symptomatic cases reduced the probability of spread to other hospitals within 30 days and the total number of cases countywide, but not the number of other hospitals seeing norovirus cases. A single norovirus outbreak can continue to percolate throughout a system of different hospitals for several months and appear as a series of unrelated outbreaks, highlighting the need for hospitals within a region to more aggressively and cooperatively track and control an initial outbreak.