Unraveling the drivers of MERS-CoV transmission
Unraveling the drivers of MERS-CoV transmission
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DOI：
10.1073/pnas.1519235113
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发表时间：
2016-08-09
影响因子：
11.1
通讯作者：
Ferguson, Neil M.
中科院分区：
文献类型：
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作者：
Cauchemez, Simon;Nouvellet, Pierre;Ferguson, Neil M.
中东呼吸综合征冠状病毒（MERS-CoV）有1700多例实验室确诊感染，仍然是公共卫生的重大威胁。然而，由于缺乏关于动物宿主和人与人之间传播方式的详细数据，中东呼吸综合征冠状病毒流行的驱动因素仍然缺乏特征。在此，我们制定了一个统计框架，对2013年1月至2014年7月期间在沙特阿拉伯王国（KSA）发现的681例中东呼吸综合征冠状病毒病例的传播模式进行全面分析。我们评估了来自动物宿主的感染、不同程度的混合和传播的异质性如何导致中东呼吸综合征冠状病毒在沙特阿拉伯的流行。我们估计12%[95%可信区间（CI）： 9%， 15%]的病例来自水库感染，其余病例通过聚集性（60%;CI: 57%, 63%）、区域内（23%;CI: 20%, 27%）或区域间（5%;CI: 2%, 8%）的人际传播感染。集群开始时的再现数平均为0.45 (CI: 0.33, 0.58)，但SD较大（0.53,CI: 0.35, 0.78）。在12% （CI: 6%, 18%）的群集中，它是bb101，但在平均10例后，它的原始值下降了大约一半（47% CI: 34%, 63%）。鉴于卫生保健系统中持续存在大规模暴发的风险，人类持续接触来自水库的中东呼吸综合征冠状病毒是一个重大问题。我们提出的方法允许传染病传播的研究，当数据连接的情况下，彼此仍然有限和不确定。
With more than 1,700 laboratory-confirmed infections, Middle East respiratory syndrome coronavirus (MERS-CoV) remains a significant threat for public health. However, the lack of detailed data on modes of transmission from the animal reservoir and between humans means that the drivers of MERS-CoV epidemics remain poorly characterized. Here, we develop a statistical framework to provide a comprehensive analysis of the transmission patterns underlying the 681 MERS-CoV cases detected in the Kingdom of Saudi Arabia (KSA) between January 2013 and July 2014. We assess how infections from the animal reservoir, the different levels of mixing, and heterogeneities in transmission have contributed to the buildup of MERS-CoV epidemics in KSA. We estimate that 12% [95% credible interval (CI): 9%, 15%] of cases were infected from the reservoir, the rest via human-to-human transmission in clusters (60%; CI: 57%, 63%), within (23%; CI: 20%, 27%), or between (5%; CI: 2%, 8%) regions. The reproduction number at the start of a cluster was 0.45 (CI: 0.33, 0.58) on average, but with large SD (0.53; CI: 0.35, 0.78). It was >1 in 12% (CI: 6%, 18%) of clusters but fell by approximately one-half (47% CI: 34%, 63%) its original value after 10 cases on average. The ongoing exposure of humans to MERS-CoV from the reservoir is of major concern, given the continued risk of substantial outbreaks in health care systems. The approach we present allows the study of infectious disease transmission when data linking cases to each other remain limited and uncertain.