Assessment of the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in the Middle East and risk of international spread using a novel maximum likelihood analysis approach.
Assessment of the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in the Middle East and risk of international spread using a novel maximum likelihood analysis approach.
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DOI：
10.2807/1560-7917.es2014.19.23.20824
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发表时间：
2014-06-12
期刊：
影响因子：
--
通讯作者：
Colizza, V
中科院分区：
文献类型：
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作者：
Poletto, C;Pelat, C;Colizza, V
新型中东（ME）呼吸综合征冠状病毒（MERS-CoV）的出现引起了全球公共卫生对当前形势及其未来演变的担忧。在这里，我们建议对中东地区的集群数据和一组欧洲国家的进口数据进行综合最大似然分析，以评估传播情况和散发性感染的发生率。我们的方法基于整合全球移动数据的空间传输模型，并考虑到人畜共患/环境传播和查明不足的变化。考虑到截至 2013 年 8 月 31 日的疫情数据，ME 的最大似然估计表明发生亚临界流行病，其繁殖数 R 为 0.50（95% 置信区间 (CI)：0.30-0.77），与每日零星传入率 psp 为 0.28（95% CI：0.12-0.85）相关。中东地区的感染似乎主要以人畜共患/环境传播为主，可能尚未确定（估计病例与观察病例的比率 (0.116) 等于 2.41，95% CI：1.03-7.32）。情况没有随着时间的推移而演变。对中东和非洲国家航班乘客数据的分析表明，存在输入风险较高的地区。虽然消除了全球卫生安全面临的直接威胁，但该分析为未来参考和更新提供了基线情景，建议加强监测以限制查明不足，并呼吁在全球高输入风险地区保持警惕。
The emergence of the novel Middle East (ME) respiratory syndrome coronavirus (MERS-CoV) has raised global public health concerns regarding the current situation and its future evolution. Here we propose an integrative maximum likelihood analysis of both cluster data in the ME and importations in a set of European countries to assess the transmission scenario and incidence of sporadic infections. Our approach is based on a spatial-transmission model integrating mobility data worldwide and allows for variations in the zoonotic/environmental transmission and under-ascertainment. Maximum likelihood estimates for the ME, considering outbreak data up to 31 August 2013, indicate the occurrence of a subcritical epidemic with a reproductive number R of 0.50 (95% confidence interval (CI): 0.30-0.77) associated with a daily rate of sporadic introductions psp of 0.28 (95% CI: 0.12-0.85). Infections in the ME appear to be mainly dominated by zoonotic/environmental transmissions, with possible under-ascertainment (ratio of estimated to observed (0.116) sporadic cases equal to 2.41, 95% CI: 1.03-7.32). No time evolution of the situation emerges. Analyses of flight passenger data from ME countries indicate areas at high risk of importation. While dismissing an immediate threat for global health security, this analysis provides a baseline scenario for future reference and updates, suggests reinforced surveillance to limit under-ascertainment, and calls for alertness in high importation risk areas worldwide.