Association Between Human Cases and Poultry Outbreaks of Highly Pathogenic Avian Influenza in Vietnam From 2003 to 2007: A Nationwide Study
Association Between Human Cases and Poultry Outbreaks of Highly Pathogenic Avian Influenza in Vietnam From 2003 to 2007: A Nationwide Study
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DOI：
10.1111/j.1865-1682.2009.01086.x
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发表时间：
2009-10-01
影响因子：
4.3
通讯作者：
Noble, A.
中科院分区：
文献类型：
--
作者：
Minh, P. Q.;Schauer, B.;Noble, A.
本研究利用罕见事件logistic回归，量化了2003-2007年期间越南家禽（n = 3050）高致病性H5N1禽流感暴发与人类病例（n = 99）之间的时空关联。在调整了已知混杂因素的影响后，如果同一地区在1周和4周后分别报告了家禽疫情，向当局报告人间病例的几率分别增加了6.17倍[95%可信区间（CI） 3.33-11.38]和2.48倍（95%可信区间（CI） 1.20 - 5.13）。当综合考虑同一地区和邻近地区的家禽暴发时，同一周、1周后和4周后发生的家禽暴发使人间病例的几率分别增加2.75（95%可信区间1.43-5.30）、2.56（95%可信区间1.31-5.00）和2.70（95%可信区间1.56-4.66）倍。我们的研究发现了该国北部和南部人间病例与家禽疫情之间存在不同程度关联的证据。考虑到从报告人间病例的前4周到后4周的9周间隔，在南部，同一地区58%的病例和83%的病例发生在同一地区或邻近地区，而在北部，相同的结果仅为23%和42%。在研究期间，人类和家禽病例之间的关联强度有所下降。我们的结论是，如果要最大限度地减少人类接触，需要通过结合预防和其他措施的针对特定病原体的监测来加强饲主对家禽临床疾病的报告。
This study quantifies the spatio-temporal association between outbreaks of highly pathogenic avian influenza H5N1 in domestic poultry (n = 3050) and human cases (n = 99) in Vietnam during 2003-2007, using rare events logisitic, regression. After adjusting for the effect of known confounders, the odds of a human case being reported to authorities increased by a factor of 6.17 [95% confidence interval (CI) 3.33-11.38] and 2.48 (95% CI 1.20 - 5.13) if poultry outbreaks were reported in the same district I week and 4 weeks later respectively. When jointly considering poultry outbreaks in the same and neighbouring districts, occurrence of poultry outbreaks in the same week, 1-week later, and 4 weeks later increased the odds of a human case by a factor of 2.75 (95% CI 1.43-5.30), 2.56 (95% Cl 1.31-5.00) and 2.70 (95% CI 1.56-4.66) respectively. Our study found evidence of different levels of association between human cases and poultry outbreaks in the North and the South of the country. When considering the 9-week interval extending from 4 weeks before to 4 weeks after the week of reporting a human case, in the South poultry outbreaks were recorded in 58% of cases in the same district and 83% of cases in either the same or neighbouring districts, whereas in the North the equivalent results were only 23% and 42%. The strength of the association between human and poultry cases declined over the study period. We conclude that owner reporting of clinical disease in poultry needs to be enhanced by targeted agent-specific surveillance integrated with preventive and other measures, if human exposure is to be minimized.