Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study
Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study
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DOI：
10.1016/s0140-6736(20)30260-9
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发表时间：
2020-02-29
期刊：
影响因子：
168.9
通讯作者：
Leung, Gabriel M.
中科院分区：
文献类型：
--
作者：
Wu, Joseph T.;Leung, Kathy;Leung, Gabriel M.
自2019年12月31日以来，中国武汉市报告了2019年新型冠状病毒（2019- ncov）引起的非典型肺炎。病例已出口到中国其他城市以及国际上，有可能引发全球疫情。在这里，我们根据武汉向中国大陆以外城市输出的病例数估计了武汉的疫情规模，并预测了国内和全球公共卫生风险的程度，考虑到社会和非药物预防干预措施。方法利用2019年12月31日至2020年1月28日武汉国际输出病例数（2019年12月25日至2020年1月19日已知症状出现天数）数据，推断2019年12月1日至2020年1月25日武汉感染人数。然后对国内出口病例进行估计。我们预测了2019-nCoV在全国和全球的传播，考虑到武汉及周边城市从2020年1月23日至24日开始的全市范围内的隔离措施的影响。我们使用了来自官方航空指南的月度航班预订数据和来自腾讯数据库的中国大陆300多个地级市的人员流动数据。确诊病例数据来源于中国疾病预防控制中心发布的报告。序列间隔估计基于先前对严重急性呼吸综合征冠状病毒（SARS-CoV）的研究。采用易感暴露-感染恢复的超人群模型模拟了中国所有主要城市的疫情。使用马尔科夫链蒙特卡罗方法估计基本繁殖数，并使用得到的后验均值和95%可信区间（CrI）表示。在我们的基线情景中，我们估计截至2020年1月25日，武汉2019-nCoV的基本繁殖数为2.68 (95% CrI 2.47-2.86)， 75 815人（95% CrI 37 304-130 330）被感染。疫情倍增时间为6.4 d （95% CrI为5.8 ~ 7.1）。我们估计，在基线情景下，重庆、北京、上海、广州和深圳分别从武汉输入了461例（95% CrI 227-805）、113例（57-193）、98例（49-168）、111例（56-191）和80例（40-139）感染病例。如果2019-nCoV的传播性在国内各地和随着时间的推移是相似的，我们推断，疫情已经在中国多个主要城市呈指数级增长，比武汉的疫情滞后约1-2周。鉴于2019-nCoV已不再被控制在武汉，中国其他主要城市可能会出现局部疫情。除非立即在人口和个人层面实施实质性的公共卫生干预措施，否则与中国交通联系密切的海外大城市也可能成为疫情爆发的中心。由于大量输出症状前病例和缺乏大规模公共卫生干预措施，在全球主要城市爆发独立、自我维持的疫情可能不可避免。应准备好防备计划和缓解干预措施，以便在全球迅速部署。爱思唯尔版权所有版权所有。
Background Since Dec 31, 2019, the Chinese city of Wuhan has reported an outbreak of atypical pneumonia caused by the 2019 novel coronavirus (2019-nCoV). Cases have been exported to other Chinese cities, as well as internationally, threatening to trigger a global outbreak. Here, we provide an estimate of the size of the epidemic in Wuhan on the basis of the number of cases exported from Wuhan to cities outside mainland China and forecast the extent of the domestic and global public health risks of epidemics, accounting for social and non-pharmaceutical prevention interventions.Methods We used data from Dec 31, 2019, to Jan 28, 2020, on the number of cases exported from Wuhan internationally (known days of symptom onset from Dec 25, 2019, to Jan 19, 2020) to infer the number of infections in Wuhan from Dec 1, 2019, to Jan 25, 2020. Cases exported domestically were then estimated. We forecasted the national and global spread of 2019-nCoV, accounting for the effect of the metropolitan-wide quarantine of Wuhan and surrounding cities, which began Jan 23-24, 2020. We used data on monthly flight bookings from the Official Aviation Guide and data on human mobility across more than 300 prefecture-level cities in mainland China from the Tencent database. Data on confirmed cases were obtained from the reports published by the Chinese Center for Disease Control and Prevention. Serial interval estimates were based on previous studies of severe acute respiratory syndrome coronavirus (SARS-CoV). A susceptible-exposed-infectious-recovered metapopulation model was used to simulate the epidemics across all major cities in China. The basic reproductive number was estimated using Markov Chain Monte Carlo methods and presented using the resulting posterior mean and 95% credibile interval (CrI).Findings In our baseline scenario, we estimated that the basic reproductive number for 2019-nCoV was 2.68 (95% CrI 2.47-2.86) and that 75 815 individuals (95% CrI 37 304-130 330) have been infected in Wuhan as of Jan 25, 2020. The epidemic doubling time was 6.4 days (95% CrI 5.8-7.1). We estimated that in the baseline scenario, Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen had imported 461 (95% CrI 227-805), 113 (57-193), 98 (49-168), 111 (56-191), and 80 (40-139) infections from Wuhan, respectively. If the transmissibility of 2019-nCoV were similar everywhere domestically and over time, we inferred that epidemics are already growing exponentially in multiple major cities of China with a lag time behind the Wuhan outbreak of about 1-2 weeks.Interpretation Given that 2019-nCoV is no longer contained within Wuhan, other major Chinese cities are probably sustaining localised outbreaks. Large cities overseas with close transport links to China could also become outbreak epicentres, unless substantial public health interventions at both the population and personal levels are implemented immediately. Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally. Copyright (C) 2020 Elsevier Ltd. All rights reserved.