Influenza Infection Risk and Predominant Exposure Route: Uncertainty Analysis
Influenza Infection Risk and Predominant Exposure Route: Uncertainty Analysis
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DOI：
10.1111/j.1539-6924.2011.01600.x
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发表时间：
2011-10-01
期刊：
影响因子：
3.8
通讯作者：
Adida, Elodie
中科院分区：
文献类型：
--
作者：
Jones, Rachael M.;Adida, Elodie
对流感的有效的非药物干预措施中断了对感染风险产生重大贡献的暴露途径。本文中，我们使用不确定性分析（点间隔方法）和蒙特卡洛模拟来探索感染风险和主要暴露途径的幅度。我们利用了一个先前出版的数学模型，该模型是参加一个卧床不起的传染病的人。感染风险对病毒排放和接触率的幅度敏感。液滴喷雾暴露对感染风险的贡献随咳嗽频率增加，并随着咳嗽颗粒的病毒浓度降低。我们考虑了两种感染性情况：基于人类的研究，与在可呼吸气溶胶中吸入的病毒相比，沉积在上呼吸道中的病毒的感染力更大；基于对豚鼠的研究，这两个位置的同等感染性。鉴于病毒在整个呼吸道中具有同等的感染概率，因此平均总体感染风险为9.8 x 10（-2）（95％0.78）。然而，当上呼吸道中的病毒不如吸入病毒感染力较低时，总体感染风险低几个数量级。在这种情况下，吸入是一条重要的曝光途径。在两种感染性情况下，接触传播都很重要。仅在可呼吸颗粒中的病毒的存在会使平均整体感染风险增加1-3个数量级，吸入> = = = 99％的感染风险。分析表明，在不同大小，呼气事件频率和呼吸道不同部位的呼气颗粒中，病毒浓度的不确定性降低将阐明流感的主要暴露途径。
An effective nonpharmaceutical intervention for influenza interrupts an exposure route that contributes significantly to infection risk. Herein, we use uncertainty analysis (point-interval method) and Monte Carlo simulation to explore the magnitude of infection risk and predominant route of exposure. We utilized a previously published mathematical model of a susceptible person attending a bed-ridden infectious person. Infection risk is sensitive to the magnitude of virus emission and contact rates. The contribution of droplet spray exposure to infection risk increases with cough frequency, and decreases with virus concentration in cough particles. We consider two infectivity scenarios: greater infectivity of virus deposited in the upper respiratory tract than virus inhaled in respirable aerosols, based on human studies; and equal infectivity in the two locations, based on studies in guinea pigs. Given that virus have equal probability of infection throughout the respiratory tract, the mean overall infection risk is 9.8 x 10(-2) (95th percentile 0.78). However, when virus in the upper respiratory tract is less infectious than inhaled virus, the overall infection risk is several orders of magnitude lower. In this event, inhalation is a significant exposure route. Contact transmission is important in both infectivity scenarios. The presence of virus in only respirable particles increases the mean overall infection risk by 1-3 orders of magnitude, with inhalation contributing >= 99% of the infection risk. The analysis indicates that reduction of uncertainties in the concentration of virus in expiratory particles of different sizes, expiratory event frequency, and infectivity at different sites in the respiratory tract will clarify the predominant exposure routes for influenza.