Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility.
Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility.
复制标题
DOI：
10.1016/s1473-3099(13)70304-9
复制
发表时间：
2014-01
影响因子：
56.3
通讯作者：
Ferguson, Neil M.
中科院分区：
文献类型：
--
作者：
Cauchemez, Simon;Fraser, Christophe;Van Kerkhove, Maria D.;Donnelly, Christi A.;Riley, Steven;Rambaut, Andrew;Enouf, Vincent;van der Werf, Sylvie;Ferguson, Neil M.
截至2013年8月8日，新型中东呼吸综合征冠状病毒（MERS-CoV）已在全球范围内造成111例病毒学确认或可能的人类感染病例。我们分析了流行病学和遗传数据，以评估人类感染的程度，病例检测的性能以及MERS CoV在有和没有控制措施的情况下的传播潜力。我们从公共来源收集了所有确诊和可能病例的综合数据库，并根据病例群数据估计了潜伏期和生成时间。我们利用前往中东的游客人数及其逗留时间的数据，估计了中东有症状病例的数量。我们进行了独立的分析，观察了事件集群的增长、病毒种群的增长、集群指数病例的复制数量以及集群大小，以确定流行病和传播情景的动态特性。截至2013年8月8日，有症状病例的估计数量为940例（95% CI 290-2200），表明至少62%的人类有症状病例未被检测到。我们发现，通过常规监测发现的原发病例的病死率（74%; 95%CI 49-91）由于检测偏倚而偏高;继发病例的病死率为20%（7-42）。近几个月来，轻症病例的发现（或临床管理）似乎有所改善。对人群聚集的分析表明，当实施感染控制时，传播链不能自我维持，但在没有控制的情况下，R在0.8 - 1.3之间。三个独立的数据来源提供了证据，证明R不可能远大于1，上限为1.2 - 1.5。通过显示，一个缓慢增长的流行病正在进行中，无论是在人类或动物水库，量化的不确定性估计，并提供第一次估计的规模的流行病和程度的情况下检测偏差，我们提供了有价值的信息，更明智的风险评估。医学研究理事会、比尔和梅林达·盖茨基金会、欧盟FP 7和国家普通医学科学研究所。
The novel Middle East respiratory syndrome coronavirus (MERS-CoV) had, as of Aug 8, 2013, caused 111 virologically confirmed or probable human cases of infection worldwide. We analysed epidemiological and genetic data to assess the extent of human infection, the performance of case detection, and the transmission potential of MERS-CoV with and without control measures. We assembled a comprehensive database of all confirmed and probable cases from public sources and estimated the incubation period and generation time from case cluster data. Using data of numbers of visitors to the Middle East and their duration of stay, we estimated the number of symptomatic cases in the Middle East. We did independent analyses, looking at the growth in incident clusters, the growth in viral population, the reproduction number of cluster index cases, and cluster sizes to characterise the dynamical properties of the epidemic and the transmission scenario. The estimated number of symptomatic cases up to Aug 8, 2013, is 940 (95% CI 290–2200), indicating that at least 62% of human symptomatic cases have not been detected. We find that the case-fatality ratio of primary cases detected via routine surveillance (74%; 95% CI 49–91) is biased upwards because of detection bias; the case-fatality ratio of secondary cases was 20% (7–42). Detection of milder cases (or clinical management) seemed to have improved in recent months. Analysis of human clusters indicated that chains of transmission were not self-sustaining when infection control was implemented, but that R in the absence of controls was in the range 0·8–1·3. Three independent data sources provide evidence that R cannot be much above 1, with an upper bound of 1·2–1·5. By showing that a slowly growing epidemic is underway either in human beings or in an animal reservoir, quantification of uncertainty in transmissibility estimates, and provision of the first estimates of the scale of the epidemic and extent of case detection biases, we provide valuable information for more informed risk assessment. Medical Research Council, Bill & Melinda Gates Foundation, EU FP7, and National Institute of General Medical Sciences.