Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of environmental surveillance data
Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of environmental surveillance data
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DOI：
10.1073/pnas.1808798115
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发表时间：
2018-11-06
影响因子：
11.1
通讯作者：
Eisenberg, Marisa C.
中科院分区：
文献类型：
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作者：
Brouwer, Andrew F.;Eisenberg, Joseph N. S.;Eisenberg, Marisa C.
2013-2014年，通过对污水系统的环境监测发现，以色列爆发了野生1型脊髓灰质炎病毒(WPV1)。没有报告急性迟缓性麻痹病例，在开展双价口服脊髓灰质炎疫苗接种运动(BOPV)后疫情消退。随着我们接近全球根除脊髓灰质炎，只有通过环境监测才能越来越多地发现脊髓灰质炎。我们开发了一个框架，将定量聚合酶链式反应(QPCR)周期阈值数据转换为比例的WPV1和OPV1浓度，用于在确定的、分区的传染病传播模型中进行推断。我们使用这种方法来估计流行曲线和传播动态，以及评估替代疫苗接种方案。我们的分析估计疫情在6月下旬达到高峰，比之前通过分析粪便样本得出的估计要早得多，尽管确切的流行轨迹仍不确定。我们估计基本繁殖数为1.62(95%可信区间为1.04-2.02)。模型估计表明，59%(95%可信区间9-77%)的易感人群(主要是10岁以下儿童)在6个多月多一点的时间内感染了WPV1，主要是在疫苗接种活动开始之前，疫苗接种活动避免了10%(95%可信区间1-24%)的WPV1感染。随着我们接近全球根除脊髓灰质炎，利用定量聚合酶链式反应进行环境监测可以作为一种高度敏感的方法来加强疾病监测。我们的分析方法将公共卫生与环境数据联系起来，如果系统地收集这些数据，可以指导根除工作。
Israel experienced an outbreak of wild poliovirus type 1 (WPV1) in 2013-2014, detected through environmental surveillance of the sewage system. No cases of acute flaccid paralysis were reported, and the epidemic subsided after a bivalent oral polio vaccination (bOPV) campaign. As we approach global eradication, polio will increasingly be detected only through environmental surveillance. We developed a framework to convert quantitative polymerase chain reaction (qPCR) cycle threshold data into scaled WPV1 and OPV1 concentrations for inference within a deterministic, compartmental infectious disease transmission model. We used this approach to estimate the epidemic curve and transmission dynamics, as well as assess alternate vaccination scenarios. Our analysis estimates the outbreak peaked in late June, much earlier than previous estimates derived from analysis of stool samples, although the exact epidemic trajectory remains uncertain. We estimate the basic reproduction number was 1.62 (95% CI 1.04-2.02). Model estimates indicate that 59% (95% CI 9-77%) of susceptible individuals (primarily children under 10 years old) were infected with WPV1 over a little more than six months, mostly before the vaccination campaign onset, and that the vaccination campaign averted 10% (95% CI 1-24%) of WPV1 infections. As we approach global polio eradication, environmental monitoring with qPCR can be used as a highly sensitive method to enhance disease surveillance. Our analytic approach brings public health relevance to environmental data that, if systematically collected, can guide eradication efforts.