Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis.
Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis.
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DOI：
10.1136/bmjopen-2015-009936
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发表时间：
2016-02-23
期刊：
影响因子：
2.9
通讯作者：
Mizumoto K
中科院分区：
文献类型：
--
作者：
Nishiura H;Endo A;Saitoh M;Kinoshita R;Ueno R;Nakaoka S;Miyamatsu Y;Dong Y;Chowell G;Mizumoto K
调查中东呼吸综合征（MERS）在韩国的异质性传播模式，特别关注超级传播者的流行病学特征。回顾性流行病学分析。城市中二级和三级保健中心的多种保健设施。共有185例实验室确诊病例，发病日期和最可能的感染源部分已知。超级传播者被确定使用的传输树。根据不同类型的寄主，估计了生殖数，即由单个原发病例产生的继发病例的平均数，作为时间的函数。总共确定了五个超级传播者。由于传播树的重建，整个暴发过程中的繁殖数估计为1.0，而原发病例产生的继发病例的方差为52.1。参与此次疫情的所有超级传播者似乎都在多个医疗机构产生了大量接触（相关性：p<0.01），在访问多个医疗机构和其他机构的患者中平均产生了4.0（0.0-8.6）和28.6（0.0-63.9）例继发病例。2015年6月13日及之后，与时间相关的繁殖数大幅下降至1以下。访问多个设施的超级传播者通过产生不成比例的继发病例来推动疫情。我们的研究结果强调了限制医疗机构接触的必要性。追踪接触者的努力有助于对疑似病例进行早期实验室检测和诊断。
To investigate the heterogeneous transmission patterns of Middle East respiratory syndrome (MERS) in the Republic of Korea, with a particular focus on epidemiological characteristics of superspreaders. Retrospective epidemiological analysis. Multiple healthcare facilities of secondary and tertiary care centres in an urban setting. A total of 185 laboratory-confirmed cases with partially known dates of illness onset and most likely sources of infection. Superspreaders were identified using the transmission tree. The reproduction number, that is, the average number of secondary cases produced by a single primary case, was estimated as a function of time and according to different types of hosts. A total of five superspreaders were identified. The reproduction number throughout the course of the outbreak was estimated at 1.0 due to reconstruction of the transmission tree, while the variance of secondary cases generated by a primary case was 52.1. All of the superspreaders involved in this outbreak appeared to have generated a substantial number of contacts in multiple healthcare facilities (association: p<0.01), generating on average 4.0 (0.0–8.6) and 28.6 (0.0–63.9) secondary cases among patients who visited multiple healthcare facilities and others. The time-dependent reproduction numbers declined substantially below the value of 1 on and after 13 June 2015. Superspreaders who visited multiple facilities drove the epidemic by generating a disproportionate number of secondary cases. Our findings underscore the need to limit the contacts in healthcare settings. Contact tracing efforts could assist early laboratory testing and diagnosis of suspected cases.