The SARS-CoV-2 pandemic: remaining uncertainties in our understanding of the epidemiology and transmission dynamics of the virus, and challenges to be overcome.
The SARS-CoV-2 pandemic: remaining uncertainties in our understanding of the epidemiology and transmission dynamics of the virus, and challenges to be overcome.
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DOI：
10.1098/rsfs.2021.0008
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发表时间：
2021-12-06
期刊：
影响因子：
4.4
通讯作者：
Baggaley RF
中科院分区：
文献类型：
--
作者：
Anderson RM;Vegvari C;Hollingsworth TD;Pi L;Maddren R;Ng CW;Baggaley RF
在过去的18个月里，对SARS-CoV-2的生物学、流行病学和发病机制的科学认识取得了很大进展。在疫苗开发和可能疗法的临床试验方面取得了非凡的进展。然而，不确定性依然存在，本审查从病毒传播、流行病学、社会距离措施的控制和大规模疫苗接种以及对所有这些因素对新出现的变种的影响的背景下对这些因素进行了评估。我们简要回顾了全球大流行的当前状态，重点是关于控制病毒传播的参数和构成基本生殖数字R0的组成部分，哪些是很好理解的，哪些是不清楚的。主要的不确定性领域包括易患无症状感染的因素、无症状的人口比例、与有症状的人相比无症状的人的传染性、这些人的病毒传播的贡献以及什么变量影响这一点。感染后和接种后免疫的持续时间目前也是未知的，也是未知的，因为现代世界人口之间的高度联系，持续的病毒进化和许多病毒变种的出现不仅在一个地方，而且在全球范围内出现了许多病毒变异的表型后果。对新变种的传播模式也进行了研究。我们回顾了从接触者追踪、家庭研究和全基因组测序中可以学到什么，关于人们在哪里感染，以及家庭是如何被感染的，因为它们构成了病毒传播的主要地点。最后，我们讨论了实现群体免疫的挑战，因为疫苗介导的免疫持续时间存在不确定性，三角洲变异的出现和快速传播表明了病毒继续进化的威胁，以及疫苗制造和交付的后勤工作，以实现全球覆盖。在未来一年，低收入和中等收入国家需要来自高收入国家的更多支持，以确保通过大规模接种疫苗建立社区范围的保护是一个全球目标，而不仅仅是高收入国家的目标。未接种疫苗的人口为病毒进化创造了机会，因为净进化速度与单位时间发生的病例数量成正比。评估在实现群体免疫方面取得成功的单位不是任何一个国家，而是世界。
Great progress has been made over the past 18 months in scientific understanding of the biology, epidemiology and pathogenesis of SARS-CoV-2. Extraordinary advances have been made in vaccine development and the execution of clinical trials of possible therapies. However, uncertainties remain, and this review assesses these in the context of virus transmission, epidemiology, control by social distancing measures and mass vaccination and the effect on all of these on emerging variants. We briefly review the current state of the global pandemic, focussing on what is, and what is not, well understood about the parameters that control viral transmission and make up the constituent parts of the basic reproductive number R0. Major areas of uncertainty include factors predisposing to asymptomatic infection, the population fraction that is asymptomatic, the infectiousness of asymptomatic compared to symptomatic individuals, the contribution of viral transmission of such individuals and what variables influence this. The duration of immunity post infection and post vaccination is also currently unknown, as is the phenotypic consequences of continual viral evolution and the emergence of many viral variants not just in one location, but globally, given the high connectivity between populations in the modern world. The pattern of spread of new variants is also examined. We review what can be learnt from contact tracing, household studies and whole-genome sequencing, regarding where people acquire infection, and how households are seeded with infection since they constitute a major location for viral transmission. We conclude by discussing the challenges to attaining herd immunity, given the uncertainty in the duration of vaccine-mediated immunity, the threat of continued evolution of the virus as demonstrated by the emergence and rapid spread of the Delta variant, and the logistics of vaccine manufacturing and delivery to achieve universal coverage worldwide. Significantly more support from higher income countries (HIC) is required in low- and middle-income countries over the coming year to ensure the creation of community-wide protection by mass vaccination is a global target, not one just for HIC. Unvaccinated populations create opportunities for viral evolution since the net rate of evolution is directly proportional to the number of cases occurring per unit of time. The unit for assessing success in achieving herd immunity is not any individual country, but the world.
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影响因子：
2.4
作者：
ANDERSON, RM;MAY, RM
通讯作者：
MAY, RM
DOI：
10.3138/jammi-2020-0030
发表时间：
2020-12-01
期刊：
Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada
影响因子：
--
作者：
Byambasuren, Oyungerel;Cardona, Magnolia;Glasziou, Paul
通讯作者：
Glasziou, Paul
DOI：
10.1098/rstb.1986.0072
发表时间：
1986-12-15
影响因子：
6.3
作者：
ANDERSON, RM;MAY, RM
通讯作者：
MAY, RM
DOI：
10.1056/nejmoa2035389
发表时间：
2021-02-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Baden LR;El Sahly HM;Essink B;Kotloff K;Frey S;Novak R;Diemert D;Spector SA;Rouphael N;Creech CB;McGettigan J;Khetan S;Segall N;Solis J;Brosz A;Fierro C;Schwartz H;Neuzil K;Corey L;Gilbert P;Janes H;Follmann D;Marovich M;Mascola J;Polakowski L;Ledgerwood J;Graham BS;Bennett H;Pajon R;Knightly C;Leav B;Deng W;Zhou H;Han S;Ivarsson M;Miller J;Zaks T;COVE Study Group
通讯作者：
COVE Study Group
影响因子：
--
作者：
ANDERSON, RM;MAY, RM
通讯作者：
MAY, RM