Cholera Transmission in Ouest Department of Haiti: Dynamic Modeling and the Future of the Epidemic.
Cholera Transmission in Ouest Department of Haiti: Dynamic Modeling and the Future of the Epidemic.
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DOI：
10.1371/journal.pntd.0004153
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发表时间：
2015
影响因子：
3.8
通讯作者：
Longini IM
中科院分区：
文献类型：
--
作者：
Kirpich A;Weppelmann TA;Yang Y;Ali A;Morris JG Jr;Longini IM
在目前的研究中，提出了一个全面的，数据驱动的，海地霍乱传播的数学模型。沿着包括短周期的人传人和长周期的人与环境和环境与人的传播，这个新的动态模型结合了2010年至2014年期间海地西部省报告的霍乱发病率和遥感数据。该模型对感染性个体有单独的分区，包括不同的传染性水平，以反映人群中有症状和无症状病例的分布。环境隔间，这是一个来源的暴露于致炎性霍乱弧菌，也分别建模的基础上，致病细菌的生物学，霍乱弧菌O1的人类到环境中的脱落，以及降水和水温的影响，霍乱弧菌的浓度和生存的水生水库。虽然报告的霍乱病例数与2010年最初爆发时相比有所下降，但易感人群人数的增加以及模型估计的环境中存在的致炎性霍乱弧菌表明，如果不进一步改善饮用水和卫生基础设施，海地可能会继续间歇性爆发霍乱。根据模型拟合的趋势和观察到的发病率，有证据表明，在最初的密集传播期之后，海地的霍乱疫情在爆发的第三年稳定下来，成为地方性流行病。模型估计数表明，易受感染的人口比例正在增加，环境中存在的致突变霍乱弧菌仍然是新感染的潜在来源。由于饮用水和卫生基础设施没有得到充分改善，这些条件可能助长海地持续的季节性霍乱流行。
In the current study, a comprehensive, data driven, mathematical model for cholera transmission in Haiti is presented. Along with the inclusion of short cycle human-to-human transmission and long cycle human-to-environment and environment-to-human transmission, this novel dynamic model incorporates both the reported cholera incidence and remote sensing data from the Ouest Department of Haiti between 2010 to 2014. The model has separate compartments for infectious individuals that include different levels of infectivity to reflect the distribution of symptomatic and asymptomatic cases in the population. The environmental compartment, which serves as a source of exposure to toxigenic V. cholerae, is also modeled separately based on the biology of causative bacterium, the shedding of V. cholerae O1 by humans into the environment, as well as the effects of precipitation and water temperature on the concentration and survival of V. cholerae in aquatic reservoirs. Although the number of reported cholera cases has declined compared to the initial outbreak in 2010, the increase in the number of susceptible population members and the presence of toxigenic V. cholerae in the environment estimated by the model indicate that without further improvements to drinking water and sanitation infrastructures, intermittent cholera outbreaks are likely to continue in Haiti. Based on the model-fitted trend and the observed incidence, there is evidence that after an initial period of intense transmission, the cholera epidemic in Haiti stabilized during the third year of the outbreak and became endemic. The model estimates indicate that the proportion of the population susceptible to infection is increasing and that the presence of toxigenic V. cholerae in the environment remains a potential source of new infections. Given the lack of adequate improvements to drinking water and sanitation infrastructure, these conditions could facilitate ongoing, seasonal cholera epidemics in Haiti.