The role of disease transmission and conferred immunity in outbreaks:: Analysis of the 1993 Cryptosporidium outbreak in Milwaukee, Wisconsin
The role of disease transmission and conferred immunity in outbreaks:: Analysis of the 1993 Cryptosporidium outbreak in Milwaukee, Wisconsin
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DOI：
10.1093/aje/kwi005
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发表时间：
2005-01-01
影响因子：
5
通讯作者：
Colford, JM
中科院分区：
文献类型：
--
作者：
Eisenberg, JNS;Lei, XD;Colford, JM
作者研究了关于1993年事件原因的两种相互竞争的假设。威斯康星州的密尔沃基爆发隐孢子虫病。第一个是，饮用水流入物的卵囊污染，加上处理厂故障，导致了点源爆发。第二种说法是，这次疫情是传播过程的结果，传播过程放大了饮用水流出物中的卵囊浓度。对该模型的分析表明，1）人与人之间的直接传播占10%，（95%置信区间：6%，21%）的总病例; 2）关闭饮用水厂防止了19%（95%置信区间：17%，21%）与工厂未关闭的情况相比，主要由导致易感人群耗竭的赋予免疫力驱动的结果;以及3）由于传染性人将病原体排放到污水中，这些病原体通过密歇根湖环境运输到饮用水工厂，以及通过接触饮用水感染易感人群。发病率数据与这一假设一致。进一步的模拟表明，增加废水流出物和饮用水流入物之间的距离可能阻止了疫情的爆发。
The authors examined two competing hypotheses regarding the cause of the 1993. Cryptosporidium outbreak in Milwaukee, Wisconsin. The first was that oocyst contamination of the drinking-water influent, coupled with a treatment plant failure, resulted in a point-source outbreak. The second was that the outbreak was the result of transmission processes that amplified the oocyst concentration in the drinking-water effluent. Analysis of the model suggested that 1) transmission directly from person to person contributed 10% (95% confidence interval: 6%, 21 %) of the total cases; 2) closing the drinking-water plant prevented 19% (95% confidence interval: 17%, 21 %) of the additional cases of disease that occurred compared with the scenario in which the plant had not been closed, a result primarily driven by conferred immunity that resulted in depletion of the susceptible population; and 3) the outbreak was caused by a transmission cycle due to infectious persons shedding pathogens into the sewage, environmental transport of these pathogens via Lake Michigan to the drinking-water plant, and infection of susceptible persons via exposure to drinking water. The incidence data were consistent with this hypothesis. Further simulations suggested, that increasing the distance between the wastewater effluent and the drinking-water influent may have prevented the outbreak.