The role of time-varying viral shedding in modelling environmental surveillance for public health: revisiting the 2013 poliovirus outbreak in Israel
The role of time-varying viral shedding in modelling environmental surveillance for public health: revisiting the 2013 poliovirus outbreak in Israel
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DOI：
10.1098/rsif.2022.0006
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发表时间：
2022-05-18
影响因子：
3.9
通讯作者：
Eisenberg, Joseph N. S.
中科院分区：
文献类型：
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作者：
Brouwer, Andrew F.;Eisenberg, Marisa C.;Eisenberg, Joseph N. S.
环境病原体监测是一种敏感的工具，可以发现早期爆发，目前正用于追踪脊髓灰质炎病毒和其他病原体。然而，纵向环境监测信号的解释是困难的，因为感染发病率和废水中的病毒载量之间的关系取决于随时间变化的脱落强度。我们开发了一个随时间变化的脊髓灰质炎病毒脱落强度的数学模型，该模型与一系列免疫状态下的专家意见一致。将这种脱落模型转化为传染病传播模型，我们分析了2013年以色列脊髓灰质炎病毒爆发期间7个地点的定量聚合酶链反应数据。与恒定散毒模型相比，我们的时变散毒模型估计了一个较慢的峰值（四周后），在感染前接种疫苗的人群较多，累积发病率较低。我们还估计人群平均排毒时间为29天（95% CI 28-31），长于专家意见建议的据称已接种三剂或三剂以上灭活脊髓灰质炎疫苗（IPV）的人群。一种解释是IPV可能不会显著影响脱落持续时间。使用随时间变化的脱落与纵向环境监测相结合的现实模型可能会提高我们对脊髓灰质炎病毒，SARS-CoV-2或其他病原体爆发动力学的理解。
Environmental pathogen surveillance is a sensitive tool that can detect early-stage outbreaks, and it is being used to track poliovirus and other pathogens. However, interpretation of longitudinal environmental surveillance signals is difficult because the relationship between infection incidence and viral load in wastewater depends on time-varying shedding intensity. We developed a mathematical model of time-varying poliovirus shedding intensity consistent with expert opinion across a range of immunization states. Incorporating this shedding model into an infectious disease transmission model, we analysed quantitative, polymerase chain reaction data from seven sites during the 2013 Israeli poliovirus outbreak. Compared to a constant shedding model, our time-varying shedding model estimated a slower peak (four weeks later), with more of the population reached by a vaccination campaign before infection and a lower cumulative incidence. We also estimated the population shed virus for an average of 29 days (95% CI 28-31), longer than expert opinion had suggested for a population that was purported to have received three or more inactivated polio vaccine (IPV) doses. One explanation is that IPV may not substantially affect shedding duration. Using realistic models of time-varying shedding coupled with longitudinal environmental surveillance may improve our understanding of outbreak dynamics of poliovirus, SARS-CoV-2, or other pathogens.