Smallpox transmission and control: Spatial dynamics in Great Britain
Smallpox transmission and control: Spatial dynamics in Great Britain
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DOI：
10.1073/pnas.0510873103
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发表时间：
2006-08-15
影响因子：
11.1
通讯作者：
Ferguson, Neil M.
中科院分区：
文献类型：
--
作者：
Riley, Steven;Ferguson, Neil M.
近年来，为可能故意重新引入天花制定应急计划已成为许多国家公共卫生组织的优先事项。我们使用了一个以个人为基础的空间模型的天花传播在英国和人口普查派生的旅行到工作的数据，准确地描述了时空动态的天花爆发的社区。一个马尔可夫链蒙特-卡罗算法的开发，以产生社会空间的接触网络，是一致的人口和通勤数据。在从探索的范围内选择三种代表性情景之前，我们测试了模型预测对关键流行病学参数的敏感性。我们研究了这些说明性情景的时空动态，并评估了症状性病例隔离、接种疫苗的接触者追踪和反应性区域大规模疫苗接种作为控制政策选择的有效性。我们的结论是，病例隔离和接触者追踪与疫苗接种将足以阻止正在进行的传播迅速，除非政策的有效性受到资源或其他限制。通过区域大规模接种疫苗，可以略微减少预期的疫情规模和持续时间，但这些益处很小，不能证明需要大量疫苗剂量及其相关的负面副作用是合理的。
Contingency planning for the possible deliberate reintroduction of smallpox has become a priority for many national public health organizations in recent years. We used an individual-based spatial model of smallpox transmission in Great Britain and census-derived journey-to-work data to accurately describe the spatiotemporal dynamics of an outbreak of smallpox in the community. A Markov chain Monte-Carlo algorithm was developed to generate sociospatial contact networks that were consistent with demographic and commuting data. We tested the sensitivity of model predictions to key epidemiological parameters before choosing three representative scenarios from within the range explored. We examined the spatiotemporal dynamics for these illustrative scenarios and assessed the efficacy of symptomatic case isolation, contact tracing with vaccination, and reactive regional mass vaccination as policy options for control. We conclude that case isolation and contact tracing with vaccination would be sufficient to halt ongoing transmission rapidly, unless policy effectiveness was compromised by resource or other constraints. A slight reduction in the expected size and duration of an outbreak could be achieved with regional mass vaccination, but these benefits are small and do not justify the high numbers of vaccine doses required and their associated negative side effects.