A perspective on multiple waves of influenza pandemics.
A perspective on multiple waves of influenza pandemics.
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DOI：
10.1371/journal.pone.0060343
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Wan XF
中科院分区：
文献类型：
--
作者：
Mummert A;Weiss H;Long LP;Amigó JM;Wan XF
美国过去四次流感大流行爆发的一个显著特点是多波感染。然而，造成流感或其他急性传染病多波的机制尚不确定。了解这些机制可以为卫生当局制定和实施预防和控制策略提供知识。我们展示了五种不同的机制，每种机制都可以产生两波急性传染病的感染。前两种机制捕获病毒传播性和行为变化的变化。第三种机制涉及群体异质性（例如，人口学、地理学），其中每个波通过一个子群体传播。第四种机制是病毒突变，导致个体的延迟易感性。第五种机制是免疫力下降。每种机制都被纳入单独的数学模型，然后模拟爆发。我们使用模型来检查感染个体的初始数量的影响（例如，疫情爆发初期的边境控制）以及接种疫苗的时间和数量。四个模型，单独或以任何组合，再现了美国2009年H1N1流感大流行的两波，无论是定性还是定量。一个模型仅定性地再现了这两种波。所有模型都表明，显著减少或延迟感染个体的初始数量对发病率几乎没有影响。相反，这种减少或延迟导致单个波，而不是两个波。此外，其中四个模型还表明，早于2009年10月（H1N1疫苗最初分发时）开始的疫苗接种计划可以消除第二波感染，而10月开始的更多疫苗不会消除第二波。
A striking characteristic of the past four influenza pandemic outbreaks in the United States has been the multiple waves of infections. However, the mechanisms responsible for the multiple waves of influenza or other acute infectious diseases are uncertain. Understanding these mechanisms could provide knowledge for health authorities to develop and implement prevention and control strategies. We exhibit five distinct mechanisms, each of which can generate two waves of infections for an acute infectious disease. The first two mechanisms capture changes in virus transmissibility and behavioral changes. The third mechanism involves population heterogeneity (e.g., demography, geography), where each wave spreads through one sub-population. The fourth mechanism is virus mutation which causes delayed susceptibility of individuals. The fifth mechanism is waning immunity. Each mechanism is incorporated into separate mathematical models, and outbreaks are then simulated. We use the models to examine the effects of the initial number of infected individuals (e.g., border control at the beginning of the outbreak) and the timing of and amount of available vaccinations. Four models, individually or in any combination, reproduce the two waves of the 2009 H1N1 pandemic in the United States, both qualitatively and quantitatively. One model reproduces the two waves only qualitatively. All models indicate that significantly reducing or delaying the initial numbers of infected individuals would have little impact on the attack rate. Instead, this reduction or delay results in a single wave as opposed to two waves. Furthermore, four of these models also indicate that a vaccination program started earlier than October 2009 (when the H1N1 vaccine was initially distributed) could have eliminated the second wave of infection, while more vaccine available starting in October would not have eliminated the second wave.
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