Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England.
Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England.
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SARS-COV-2血统的估计可传播和影响B.1.1.7在英国。
DOI：
10.1126/science.abg3055
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发表时间：
2021-04-09
期刊：
影响因子：
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通讯作者：
Edmunds WJ
中科院分区：
文献类型：
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作者：
Davies NG;Abbott S;Barnard RC;Jarvis CI;Kucharski AJ;Munday JD;Pearson CAB;Russell TW;Tully DC;Washburne AD;Wenseleers T;Gimma A;Waites W;Wong KLM;van Zandvoort K;Silverman JD;CMMID COVID-19 Working Group;COVID-19 Genomics UK (COG-UK) Consortium;Diaz-Ordaz K;Keogh R;Eggo RM;Funk S;Jit M;Atkins KE;Edmunds WJ
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）有能力产生具有主要基因组变化的变体。UK变体B.1.1.7（也称为VOC 202012/01）具有许多改变病毒附着和进入人类细胞的突变。Davies等人使用各种统计和动态建模方法，描述了B.1.1.7变体在英国的传播特征。作者发现，该变异的传播性比前代血统高43%至90%，但没有看到疾病严重程度变化的明确证据，尽管增强的传播将导致更高的发病率和更多的住院率。在控制措施放松后，病毒可能会大量死灰复燃，可能需要大大加快疫苗的推出以控制疫情。2020年底在英国出现的主要冠状病毒变体比其前身更具传播性，并可能引发复活。导致COVID-19的严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）的几种新型变体于2020年底出现。其中之一，关注变种（VOC）202012/01（谱系B.1.1.7）于2020年9月首次在英格兰东南部发现，并在短短几个月内蔓延成为英国的主要谱系。B.1.1.7已经传播到全球至少114个国家。VOC 202012/01的快速传播表明，它比先前存在的SARS-CoV-2变体更有效地在人与人之间传播。这可能导致全球COVID-19住院和死亡人数激增，因此迫切需要估计VOC 202012/01传播的速度有多快，它是否与疾病的严重程度有关，以及哪些控制措施可能有效减轻其影响。我们使用了社会接触和流动性数据，以及与英格兰SARS-CoV-2社区测试数据相关的人口统计学指标，以评估新变体的传播是否可能是某些地理区域或特定人口亚群中较高基线传播率的人为因素。然后，我们使用了一系列互补的统计分析和数学模型来估计VOC 202012/01在来自英国、丹麦、瑞士和美国的多个数据集上的传播率。最后，我们扩展了一个数学模型，该模型已被广泛用于预测英国的COVID-19动态，以考虑两个竞争的SARS-CoV-2谱系：VOC 202012/01和预先存在的变体。通过将该模型与英格兰七个地区的感染，住院和死亡的各种数据源进行拟合，我们评估了为什么新变体似乎传播得更快的不同假设，估计了与新变体相关的疾病严重程度，并评估了包括疫苗接种和非药物干预在内的控制措施。结合多条证据线使我们能够得出可靠的推论。VOC 202012/01的快速传播不是接触行为的地理差异的人为因素，并且在年龄、性别或社会经济阶层方面没有实质性差异。我们估计，新的变体具有比先前存在的变体高43%至90%的繁殖数（95%可信区间的范围，38%至130%）。丹麦、瑞士和美国也出现了类似的增长。对这种繁殖数量增加的最简单的解释是，感染VOC 202012/01的人比感染先前存在的变体的人更具传染性，尽管也有合理的支持，即更长的传染期和多种机制可能正在运作。我们对严重程度的估计是不确定的，并且与严重程度从中度降低到中度增加的任何情况都是一致的（例如，32%降低到20%的死亡几率考虑感染）。尽管如此，我们根据截至二零二零年十二月二十四日的数据拟合的数学模型预测，二零二一年的COVID-19病例及死亡人数将大幅增加，截至二零二一年三月底英格兰的观察负担证实了这一点。在没有严格的非药物干预措施和加速疫苗推广的情况下，预计2021年前6个月英格兰的COVID-19死亡人数将超过2020年。现在英格兰超过98%的SARS-CoV-2阳性感染是由于VOC 202012/01，这种新变种的传播导致COVID-19病例和死亡人数激增。其他国家应该为可能出现的类似结果做好准备。(A)VOC 202012/01（谱系B.1.1.7）在英格兰的传播。(B)VOC 20 2012/01的估计相对传递率（平均值和95%置信区间）在整个英国、英格兰、丹麦、瑞士和美国相似。(C)2020年12月15日至2021年6月30日英格兰的预计COVID-19死亡人数（中位数和95%置信区间）。疫苗推广和控制措施有助于减轻挥发性有机化合物的负担202012/01。2020年9月，一种严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）变异体VOC 202012/01（谱系B.1.1.7）出现在英格兰东南部，并迅速向固定化方向传播。使用各种统计和动态建模方法，我们估计，这种变体具有43%至90%（95%可信区间的范围，38%至130%）比先前存在的变体更高的繁殖数量。拟合的双应变动态传播模型显示，VOC 202012/01将导致COVID-19病例的大量重新出现。在没有严格的控制措施（包括有限关闭教育机构及大幅加快疫苗推广）的情况下，预计二零二一年首六个月英格兰各地的COVID-19住院人数及死亡人数将超过二零二零年。VOC 20 2012/01已在全球范围内传播，在丹麦、瑞士和美国也显示出类似的传播增加（59 - 74%）。
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the capacity to generate variants with major genomic changes. The UK variant B.1.1.7 (also known as VOC 202012/01) has many mutations that alter virus attachment and entry into human cells. Using a variety of statistical and dynamic modeling approaches, Davies et al. characterized the spread of the B.1.1.7 variant in the United Kingdom. The authors found that the variant is 43 to 90% more transmissible than the predecessor lineage but saw no clear evidence for a change in disease severity, although enhanced transmission will lead to higher incidence and more hospital admissions. Large resurgences of the virus are likely to occur after the easing of control measures, and it may be necessary to greatly accelerate vaccine roll-out to control the epidemic. Science, this issue p. eabg3055 The major coronavirus variant that emerged at the end of 2020 in the UK is more transmissible than its predecessors and could spark resurgences. Several novel variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, emerged in late 2020. One of these, Variant of Concern (VOC) 202012/01 (lineage B.1.1.7), was first detected in southeast England in September 2020 and spread to become the dominant lineage in the United Kingdom in just a few months. B.1.1.7 has since spread to at least 114 countries worldwide. The rapid spread of VOC 202012/01 suggests that it transmits more efficiently from person to person than preexisting variants of SARS-CoV-2. This could lead to global surges in COVID-19 hospitalizations and deaths, so there is an urgent need to estimate how much more quickly VOC 202012/01 spreads, whether it is associated with greater or lesser severity of disease, and what control measures might be effective in mitigating its impact. We used social contact and mobility data, as well as demographic indicators linked to SARS-CoV-2 community testing data in England, to assess whether the spread of the new variant may be an artifact of higher baseline transmission rates in certain geographical areas or among specific demographic subpopulations. We then used a series of complementary statistical analyses and mathematical models to estimate the transmissibility of VOC 202012/01 across multiple datasets from the UK, Denmark, Switzerland, and the United States. Finally, we extended a mathematical model that has been extensively used to forecast COVID-19 dynamics in the UK to consider two competing SARS-CoV-2 lineages: VOC 202012/01 and preexisting variants. By fitting this model to a variety of data sources on infections, hospitalizations, and deaths across seven regions of England, we assessed different hypotheses for why the new variant appears to be spreading more quickly, estimated the severity of disease associated with the new variant, and evaluated control measures including vaccination and nonpharmaceutical interventions. Combining multiple lines of evidence allowed us to draw robust inferences. The rapid spread of VOC 202012/01 is not an artifact of geographical differences in contact behavior and does not substantially differ by age, sex, or socioeconomic stratum. We estimate that the new variant has a 43 to 90% higher reproduction number (range of 95% credible intervals, 38 to 130%) than preexisting variants. Similar increases are observed in Denmark, Switzerland, and the United States. The most parsimonious explanation for this increase in the reproduction number is that people infected with VOC 202012/01 are more infectious than people infected with a preexisting variant, although there is also reasonable support for a longer infectious period and multiple mechanisms may be operating. Our estimates of severity are uncertain and are consistent with anything from a moderate decrease to a moderate increase in severity (e.g., 32% lower to 20% higher odds of death given infection). Nonetheless, our mathematical model, fitted to data up to 24 December 2020, predicted a large surge in COVID-19 cases and deaths in 2021, which has been borne out so far by the observed burden in England up to the end of March 2021. In the absence of stringent nonpharmaceutical interventions and an accelerated vaccine rollout, COVID-19 deaths in the first 6 months of 2021 were projected to exceed those in 2020 in England. More than 98% of positive SARS-CoV-2 infections in England are now due to VOC 202012/01, and the spread of this new variant has led to a surge in COVID-19 cases and deaths. Other countries should prepare for potentially similar outcomes. (A) Spread of VOC 202012/01 (lineage B.1.1.7) in England. (B) The estimated relative transmissibility of VOC 202012/01 (mean and 95% confidence interval) is similar across the United Kingdom as a whole, England, Denmark, Switzerland, and the United States. (C) Projected COVID-19 deaths (median and 95% confidence interval) in England, 15 December 2020 to 30 June 2021. Vaccine rollout and control measures help to mitigate the burden of VOC 202012/01. A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, VOC 202012/01 (lineage B.1.1.7), emerged in southeast England in September 2020 and is rapidly spreading toward fixation. Using a variety of statistical and dynamic modeling approaches, we estimate that this variant has a 43 to 90% (range of 95% credible intervals, 38 to 130%) higher reproduction number than preexisting variants. A fitted two-strain dynamic transmission model shows that VOC 202012/01 will lead to large resurgences of COVID-19 cases. Without stringent control measures, including limited closure of educational institutions and a greatly accelerated vaccine rollout, COVID-19 hospitalizations and deaths across England in the first 6 months of 2021 were projected to exceed those in 2020. VOC 202012/01 has spread globally and exhibits a similar transmission increase (59 to 74%) in Denmark, Switzerland, and the United States.