How social structures, space, and behaviors shape the spread of infectious diseases using chikungunya as a case study
How social structures, space, and behaviors shape the spread of infectious diseases using chikungunya as a case study
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DOI：
10.1073/pnas.1611391113
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发表时间：
2016-11-22
影响因子：
11.1
通讯作者：
Cauchemez, Simon
中科院分区：
文献类型：
--
作者：
Salje, Henrik;Lessler, Justin;Cauchemez, Simon
个体是否在传染病爆发中被感染取决于许多相互关联的风险因素，这些因素可能与个体的特征有关（例如，年龄，性别），他或她的近亲（例如，家庭成员）或更广泛的社区。由于统计建模的进步，对家庭或学校中的个人进行监测的研究有助于阐明小型社会结构中传播的决定因素;但迄今为止，这种方法在很大程度上未能考虑到个人所生活的更广泛背景。在这里，我们在孟加拉国的一个农村社区爆发基孔肯雅热作为一个案例研究，以获得更全面的表征疾病传播的风险因素。我们开发了贝叶斯数据增强方法来解释感染源的不确定性，召回不确定性和未观察到的感染日期。我们发现，基孔肯雅病在家庭成员之间传播的概率为12% [95%可信区间（CI）：8-17%]，但对于居住在50米以外的人则下降到0.3%（95% CI：0.2-0.5%）。总体而言，平均传输距离为95 m（95% CI：77-113 m）。女性受感染的可能性是男性的1.5倍（95% CI：1.2-1.8），这与该国一项独立的人员流动研究估计的在家的相对风险几乎相同。据报道，每天使用蚊香对传播没有可检测的影响。这项研究表明，一个人的特点和他或她的密切和更广泛的环境之间的复杂的相互作用有助于形成传染病流行病。
Whether an individual becomes infected in an infectious disease outbreak depends on many interconnected risk factors, which may relate to characteristics of the individual (e.g., age, sex), his or her close relatives (e.g., household members), or the wider community. Studies monitoring individuals in households or schools have helped elucidate the determinants of transmission in small social structures due to advances in statistical modeling; but such an approach has so far largely failed to consider individuals in the wider context they live in. Here, we used an outbreak of chikungunya in a rural community in Bangladesh as a case study to obtain a more comprehensive characterization of risk factors in disease spread. We developed Bayesian data augmentation approaches to account for uncertainty in the source of infection, recall uncertainty, and unobserved infection dates. We found that the probability of chikungunya transmission was 12% [95% credible interval (CI): 8-17%] between household members but dropped to 0.3% for those living 50 m away (95% CI: 0.2-0.5%). Overall, the mean transmission distance was 95 m (95% CI: 77-113 m). Females were 1.5 times more likely to become infected than males (95% CI: 1.2-1.8), which was virtually identical to the relative risk of being at home estimated from an independent human movement study in the country. Reported daily use of antimosquito coils had no detectable impact on transmission. This study shows how the complex interplay between the characteristics of an individual and his or her close and wider environment contributes to the shaping of infectious disease epidemics.