Reducing travel-related SARS-CoV-2 transmission with layered mitigation measures: symptom monitoring, quarantine, and testing.
Reducing travel-related SARS-CoV-2 transmission with layered mitigation measures: symptom monitoring, quarantine, and testing.
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DOI：
10.1186/s12916-021-01975-w
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发表时间：
2021-04-14
期刊：
影响因子：
9.3
通讯作者：
Alvarado-Ramy F
中科院分区：
文献类型：
--
作者：
Johansson MA;Wolford H;Paul P;Diaz PS;Chen TH;Brown CM;Cetron MS;Alvarado-Ramy F
在控制SARS-CoV-2传播与恢复旅行之间取得平衡是全球优先事项。目前的建议包括旅行前、旅行中和旅行后的缓解措施。旅行前和旅行后的策略，包括症状监测，抗原或核酸扩增检测和检疫，可以以多种方式组合，考虑可行性，依从性，有效性，成本和不良后果的不同权衡。我们使用一个数学模型来分析在不同的传染期、相对于感染时间的检测阳性率和检测灵敏度估计值下，症状监测、检测和检疫的预期有效性，以降低旅行期间和旅行后受感染旅行者的传播风险。如果感染发生在旅行前0-7天，在旅行前或旅行期间出现症状后立即隔离，可将旅行期间的传播风险降低30- 35%。出发前测试可以进一步降低风险，即使测试灵敏度低于早期测试，接近旅行时间的测试也是最佳的。例如，在出发当天进行检测可以将旅行时的风险降低44- 72%。对于旅行后的传播风险，在到达目的地前感染时间长达7天，基于症状监测的隔离将目的地的传入风险降低了42- 56%。在抵达后进行14天的隔离，不进行症状监测或检测，可以将旅行后的风险降低96-100%。然而，7天的较短隔离期结合症状监测和抵达后第5-6天的测试也有效（97- 100%）降低了传入风险，负担较轻，这可能会提高依从性。隔离是降低SARS-CoV-2从旅行者传播风险的有效措施，可以通过增加症状监测和检测来加强。最佳检测时间取决于隔离的有效性：在低依从性或没有隔离的情况下，最佳检测时间接近抵达时间;在有效隔离的情况下，几天后检测可以优化灵敏度，以便在旅行前或旅行中立即检测到感染者。这些措施可以补充社交距离、使用口罩和手部卫生等建议，以进一步降低旅行期间和旅行后的风险。
Balancing the control of SARS-CoV-2 transmission with the resumption of travel is a global priority. Current recommendations include mitigation measures before, during, and after travel. Pre- and post-travel strategies including symptom monitoring, antigen or nucleic acid amplification testing, and quarantine can be combined in multiple ways considering different trade-offs in feasibility, adherence, effectiveness, cost, and adverse consequences. We used a mathematical model to analyze the expected effectiveness of symptom monitoring, testing, and quarantine under different estimates of the infectious period, test-positivity relative to time of infection, and test sensitivity to reduce the risk of transmission from infected travelers during and after travel. If infection occurs 0–7 days prior to travel, immediate isolation following symptom onset prior to or during travel reduces risk of transmission while traveling by 30–35%. Pre-departure testing can further reduce risk, with testing closer to the time of travel being optimal even if test sensitivity is lower than an earlier test. For example, testing on the day of departure can reduce risk while traveling by 44–72%. For transmission risk after travel with infection time up to 7 days prior to arrival at the destination, isolation based on symptom monitoring reduced introduction risk at the destination by 42–56%. A 14-day quarantine after arrival, without symptom monitoring or testing, can reduce post-travel risk by 96–100% on its own. However, a shorter quarantine of 7 days combined with symptom monitoring and a test on day 5–6 after arrival is also effective (97--100%) at reducing introduction risk and is less burdensome, which may improve adherence. Quarantine is an effective measure to reduce SARS-CoV-2 transmission risk from travelers and can be enhanced by the addition of symptom monitoring and testing. Optimal test timing depends on the effectiveness of quarantine: with low adherence or no quarantine, optimal test timing is close to the time of arrival; with effective quarantine, testing a few days later optimizes sensitivity to detect those infected immediately before or while traveling. These measures can complement recommendations such as social distancing, using masks, and hand hygiene, to further reduce risk during and after travel.
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