Transmission potential of influenza A/H7N9, February to May 2013, China.
Transmission potential of influenza A/H7N9, February to May 2013, China.
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DOI：
10.1186/1741-7015-11-214
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发表时间：
2013-10-02
期刊：
影响因子：
9.3
通讯作者：
Viboud C
中科院分区：
文献类型：
--
作者：
Chowell G;Simonsen L;Towers S;Miller MA;Viboud C
2013年3月31日，中国东部报告了首例人感染新型甲型H7N9流感病毒的病例。疫情在地理范围和规模上迅速扩大，截至2013年6月3日，中国10个省和台湾共报告了132例实验室确诊病例。最近几周，A/H7N9病例的发病率已经停滞，可能是受影响最严重地区的活禽市场关闭的结果。在这里，我们比较了甲型H7N9流感与其他新出现的病原体的传播潜力，并评估了干预措施的影响，以指导大流行的准备工作。我们使用贝叶斯方法结合SEIR（易感-暴露-有害-清除）传播模型拟合每日病例数据，以评估各省A/H7N9的繁殖数量（R），并评估2013年4月和5月关闭活禽市场的影响。模拟研究有助于量化我们的方法在新兴病原体的背景下的性能，其中人际传播是有限的，大多数病例都是由溢出事件引起的。我们还使用了其他方法来估计R的基础上个人水平的信息，以前的接触，并比较了A/H7N9流感的传播潜力与其他最近的人畜共患病。A/H7N9疫情的R估计值低于持续人际传播所需的流行阈值，并在整个研究期间保持在0.1附近，贝叶斯方法的95%可信区间（0.01至0.49）。然而，由于病例数据中包含的信息相对较少，贝叶斯估计方法由先验分布主导。我们观察到2013年4月6日之后的增长率在统计上显著减速，这与先发制人关闭活禽市场导致的A/H7N9传播减少相一致。尽管置信区间较宽，但A/H7N9的估计传播潜力似乎低于最近的人畜共患威胁，包括禽流感A/H5 N1、猪流感H3 N2 sw和尼帕病毒。尽管由于流行病学信息有限，H7N9的R估计值仍然很不确定，但所有现有证据都表明传播潜力很低。未来几个月继续监测A/H7N9的传播潜力至关重要，因为干预措施可能会放松，季节性因素可能会在寒冷的月份促进疾病传播。
On 31 March 2013, the first human infections with the novel influenza A/H7N9 virus were reported in Eastern China. The outbreak expanded rapidly in geographic scope and size, with a total of 132 laboratory-confirmed cases reported by 3 June 2013, in 10 Chinese provinces and Taiwan. The incidence of A/H7N9 cases has stalled in recent weeks, presumably as a consequence of live bird market closures in the most heavily affected areas. Here we compare the transmission potential of influenza A/H7N9 with that of other emerging pathogens and evaluate the impact of intervention measures in an effort to guide pandemic preparedness. We used a Bayesian approach combined with a SEIR (Susceptible-Exposed-Infectious-Removed) transmission model fitted to daily case data to assess the reproduction number (R) of A/H7N9 by province and to evaluate the impact of live bird market closures in April and May 2013. Simulation studies helped quantify the performance of our approach in the context of an emerging pathogen, where human-to-human transmission is limited and most cases arise from spillover events. We also used alternative approaches to estimate R based on individual-level information on prior exposure and compared the transmission potential of influenza A/H7N9 with that of other recent zoonoses. Estimates of R for the A/H7N9 outbreak were below the epidemic threshold required for sustained human-to-human transmission and remained near 0.1 throughout the study period, with broad 95% credible intervals by the Bayesian method (0.01 to 0.49). The Bayesian estimation approach was dominated by the prior distribution, however, due to relatively little information contained in the case data. We observe a statistically significant deceleration in growth rate after 6 April 2013, which is consistent with a reduction in A/H7N9 transmission associated with the preemptive closure of live bird markets. Although confidence intervals are broad, the estimated transmission potential of A/H7N9 appears lower than that of recent zoonotic threats, including avian influenza A/H5N1, swine influenza H3N2sw and Nipah virus. Although uncertainty remains high in R estimates for H7N9 due to limited epidemiological information, all available evidence points to a low transmission potential. Continued monitoring of the transmission potential of A/H7N9 is critical in the coming months as intervention measures may be relaxed and seasonal factors could promote disease transmission in colder months.
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