Comparing nonpharmaceutical interventions for containing emerging epidemics
Comparing nonpharmaceutical interventions for containing emerging epidemics
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DOI：
10.1073/pnas.1616438114
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发表时间：
2017-04-11
影响因子：
11.1
通讯作者：
Buckee, Caroline O.
中科院分区：
文献类型：
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作者：
Peak, Corey M.;Childs, Lauren M.;Buckee, Caroline O.
当针对病原体的药物或疫苗尚不存在或无法获得时，遏制新出现的传染病暴发的战略必须是非药物性的。这些非药物策略的成功不仅取决于隔离措施的有效性，还取决于感染的流行病学特征。然而，目前还没有系统的框架来评估不同的遏制战略与病原体的自然历史和流行病学动态之间的关系。在这里，我们比较了隔离和症状监测的有效性，通过接触者追踪，在控制流行病使用基于代理的分支模型。我们研究了流行病遏制和疾病动态的症状和传染性的7个案例研究疾病与不同的自然历史，包括埃博拉病毒，甲型流感和严重急性呼吸道综合征（SARS）之间的关系。我们表明，症状监测和隔离的相对有效性主要取决于传染病的自然史，其固有的传播性，以及在特定的医疗环境中的干预可行性。检疫症状监测的好处一般是最大化的快速过程中的疾病，但我们显示的条件下，症状监测可以单独控制某些疫情。这一定量框架可以指导政策制定者如何最好地使用非药物干预措施，并在新出现的病原体爆发期间优先考虑研究。
Strategies for containing an emerging infectious disease outbreak must be nonpharmaceutical when drugs or vaccines for the pathogen do not yet exist or are unavailable. The success of these nonpharmaceutical strategies will depend on not only the effectiveness of isolation measures but also the epidemiological characteristics of the infection. However, there is currently no systematic framework to assess the relationship between different containment strategies and the natural history and epidemiological dynamics of the pathogen. Here, we compare the effectiveness of quarantine and symptom monitoring, implemented via contact tracing, in controlling epidemics using an agent-based branching model. We examine the relationship between epidemic containment and the disease dynamics of symptoms and infectiousness for seven case-study diseases with diverse natural histories, including Ebola, influenza A, and severe acute respiratory syndrome (SARS). We show that the comparative effectiveness of symptom monitoring and quarantine depends critically on the natural history of the infectious disease, its inherent transmissibility, and the intervention feasibility in the particular healthcare setting. The benefit of quarantine over symptom monitoring is generally maximized for fast-course diseases, but we show the conditions under which symptom monitoring alone can control certain outbreaks. This quantitative framework can guide policymakers on how best to use nonpharmaceutical interventions and prioritize research during an outbreak of an emerging pathogen.