EPIFIL: A dynamic model of infection and disease ln lymphatic filariasis
EPIFIL: A dynamic model of infection and disease ln lymphatic filariasis
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DOI：
10.4269/ajtmh.1998.59.606
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发表时间：
1998-10-01
影响因子：
3.3
通讯作者：
Bundy, DAP
中科院分区：
文献类型：
--
作者：
Chan, MS;Srividya, A;Bundy, DAP
缺乏描述感染与发病之间动态关系的定量框架限制了社区层面控制淋巴丝虫病的努力。在本文中，我们描述了 EPIFIL（丝虫病感染强度和慢性疾病的动态模型）的开发和验证。使用完善的迁移-死亡公式对感染动态进行建模，其中结合了随着时间的推移对感染性幼虫的免疫力的获得。疾病（淋巴水肿和鞘膜积液）的动态被建模为多种因素的催化功能，包括蠕虫负荷和免疫病理反应的影响。该模型使用从印度南部本地治里班克罗夫特丝虫病流行区收集的年龄分层数据进行参数化。拟合的参数表明，一个相对简单的模型仅包括对感染的获得性免疫力和不可逆的疾病进展，可以令人满意地解释观察到的感染和疾病模式。疾病进展被认为是蠕虫引起的损伤的结果，并且鞘膜积液的发生率较高，而淋巴水肿的发生率较低。这表明免疫病理学的参与可能不是观察到的年龄-疾病概况的必要组成部分。这些发现支持蠕虫负荷在慢性丝虫病的发生和进展中的核心作用。
The lack of a quantitative framework that describes the dynamic relationships between infection and morbidity has constrained efforts aimed at the community-level control of lymphatic filariasis. In this paper, we describe the development and validation of EPIFIL, a dynamic model of filariasis infection intensity and chronic disease. Infection dynamics are modeled using the well established immigration-death formulation, incorporating the acquisition of immunity to infective larvae over time. The dynamics of disease (lymphodema and hydrocele) are modeled as a catalytic function of a variety of factors, including worm load and the impact of immunopathological responses. The model was parameterized using age-stratified data collected from a Bancroftian filariasis endemic area in Pondicherry in southern India. The fitted parameters suggest that a relatively simple model including only acquired immunity to infection and irreversible progression to disease can satisfactorily explain the observed infection and disease patterns. Disease progression is assumed to be a consequence of worm induced damage and to occur at a high rate for hydrocele and a low rate for lymphodema. This suggests that immunopathology involvement may not be a necessary component of observed age-disease profiles. These findings support a central role for worm burden in the initiation and progression of chronic filarial disease.