Exit strategies: optimising feasible surveillance for detection, elimination, and ongoing prevention of COVID-19 community transmission.
Exit strategies: optimising feasible surveillance for detection, elimination, and ongoing prevention of COVID-19 community transmission.
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DOI：
10.1186/s12916-021-01934-5
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发表时间：
2021-02-17
期刊：
影响因子：
9.3
通讯作者：
Glass K
中科院分区：
文献类型：
--
作者：
Lokuge K;Banks E;Davis S;Roberts L;Street T;O'Donovan D;Caleo G;Glass K
在实施强有力的遏制措施后，多个国家和地区的COVID-19社区传播检测率较低。我们制定了一项高效、快速和可扩展的监测策略，通过彻底识别每个活跃的传播链来检测剩余的COVID-19社区病例。我们确定了措施，以便在解除遏制措施后及早发现和有效管理任何重新引入的传播，以确保不需要恢复强有力的遏制措施。我们通过以下检测来比较检测社区传播链的效率和灵敏度：医院病例;社区/初级保健的发热、咳嗽和/或ARI检测;以及无症状检测;使用监测评估方法和数学建模，使用来自澳大利亚的数据，改变检测能力、生殖数量（R）以及COVID-19和非COVID-19呼吸道症状的每周累积发病率。我们评估了系统要求，以确定所有传播链，并跟踪每百万人口中每个链中的所有病例和主要接触者。假设20%的病例无症状，30%有症状的COVID-19病例接受检测，R = 2.2，当通过医院监测确定传播链时，发生14例未识别的社区病例（8例传染性）的中位数，而通过社区监测发现7例未识别的病例（4例传染性）。据估计，7例未确认的社区上游病例将产生另外55-77例需要随访的主要接触者。如果50%的病例无症状，则未确认的社区病例将增加到10例。筛查无症状的社区成员不能彻底确定评估的任何情况下的所有病例。症状筛查检测要求的最重要决定因素是非COVID-19呼吸道疾病的水平。如果4%的社区有呼吸道症状，1%有症状的人患有COVID-19，则详尽的症状筛查需要使用1/4合并法进行约11，600次测试/百万人口，98%的病例被发现（2%漏诊），灵敏度为99.9%。即使灵敏度下降到70%，在所有检查的情况下，合并检测病例比单独检测更有效。筛查社区中的所有急性呼吸道疾病，结合详尽细致的病例和接触者识别和管理，可以适当地早期发现和消除COVID-19社区传播。一个重要组成部分是识别、检测和管理所有接触者，包括上游接触者（即已确定病例的潜在感染源及其相关传播链）。当测试容量有限时，即使测试灵敏度降低，池化也可以提高案例检测能力。对监测的各个方面的有效性至关重要的是适当的社区参与，信息传递，以优化测试的吸收和遵守其他措施。在线版本包含补充材料，可通过10.1186/s12916-021-01934-5获得。
Following implementation of strong containment measures, several countries and regions have low detectable community transmission of COVID-19. We developed an efficient, rapid, and scalable surveillance strategy to detect remaining COVID-19 community cases through exhaustive identification of every active transmission chain. We identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not require reinstatement. We compared efficiency and sensitivity to detect community transmission chains through testing of the following: hospital cases; fever, cough and/or ARI testing at community/primary care; and asymptomatic testing; using surveillance evaluation methods and mathematical modelling, varying testing capacities, reproductive number (R) and weekly cumulative incidence of COVID-19 and non-COVID-19 respiratory symptoms using data from Australia. We assessed system requirements to identify all transmission chains and follow up all cases and primary contacts within each chain, per million population. Assuming 20% of cases are asymptomatic and 30% of symptomatic COVID-19 cases present for testing, with R = 2.2, a median of 14 unrecognised community cases (8 infectious) occur when a transmission chain is identified through hospital surveillance versus 7 unrecognised cases (4 infectious) through community-based surveillance. The 7 unrecognised community upstream cases are estimated to generate a further 55–77 primary contacts requiring follow-up. The unrecognised community cases rise to 10 if 50% of cases are asymptomatic. Screening asymptomatic community members cannot exhaustively identify all cases under any of the scenarios assessed. The most important determinant of testing requirements for symptomatic screening is levels of non-COVID-19 respiratory illness. If 4% of the community have respiratory symptoms, and 1% of those with symptoms have COVID-19, exhaustive symptomatic screening requires approximately 11,600 tests/million population using 1/4 pooling, with 98% of cases detected (2% missed), given 99.9% sensitivity. Even with a drop in sensitivity to 70%, pooling was more effective at detecting cases than individual testing under all scenarios examined. Screening all acute respiratory disease in the community, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of COVID-19 community transmission. An important component is identification, testing, and management of all contacts, including upstream contacts (i.e. potential sources of infection for identified cases, and their related transmission chains). Pooling allows increased case detection when testing capacity is limited, even given reduced test sensitivity. Critical to the effectiveness of all aspects of surveillance is appropriate community engagement, messaging to optimise testing uptake and compliance with other measures. The online version contains supplementary material available at 10.1186/s12916-021-01934-5.
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影响因子：
9.8
作者：
Althouse BM;Wenger EA;Miller JC;Scarpino SV;Allard A;Hébert-Dufresne L;Hu H
通讯作者：
Hu H
影响因子：
4.5
作者：
Caleo G;Duncombe J;Jephcott F;Lokuge K;Mills C;Looijen E;Theoharaki F;Kremer R;Kleijer K;Squire J;Lamin M;Stringer B;Weiss HA;Culli D;Di Tanna GL;Greig J
通讯作者：
Greig J
影响因子：
3.7
作者：
Arevalo-Rodriguez I;Buitrago-Garcia D;Simancas-Racines D;Zambrano-Achig P;Del Campo R;Ciapponi A;Sued O;Martinez-García L;Rutjes AW;Low N;Bossuyt PM;Perez-Molina JA;Zamora J
通讯作者：
Zamora J
影响因子：
3.5
作者：
Eubank, S.;Eckstrand, I;Barrett, C. L.
通讯作者：
Barrett, C. L.
影响因子：
16.6
作者：
Chang SL;Harding N;Zachreson C;Cliff OM;Prokopenko M
通讯作者：
Prokopenko M