Uncertainty in predictions of disease spread and public health responses to bioterrorism and emerging diseases
Uncertainty in predictions of disease spread and public health responses to bioterrorism and emerging diseases
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DOI：
10.1073/pnas.0600816103
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发表时间：
2006-10-17
影响因子：
11.1
通讯作者：
Dwyer, Greg
中科院分区：
文献类型：
--
作者：
Elderd, Bret D.;Dukic, Vanja M.;Dwyer, Greg
对生物恐怖主义和新出现的疾病的担忧导致流行病模型被广泛用于评估公共卫生战略。部分是因为流行病模型往往非常好地捕捉到以前流行病的动态，很少有人注意到参数估计的不确定性可能会如何影响模型预测。为了了解这种影响，我们使用贝叶斯统计学严格估计了流行病模型参数的不确定性，重点是天花生物恐怖主义。然后，我们使用疫苗接种模型将模型参数中的不确定性转化为不确定性，在这两种疫苗接种策略中，哪一种策略将对生物恐怖主义、大规模疫苗接种或社交接触疫苗接种提供更好的反应，即所谓的“微量疫苗接种”。我们的结果表明，模型参数的不确定性非常高，这种不确定性对疫苗接种策略具有重要的影响。例如，在一种看似合理的情况下，最有可能的结果是，大规模接种疫苗将比微量接种多拯救大约10万人的生命。然而，由于参数的高度不确定性，大规模疫苗接种也很有可能比微量疫苗接种挽救20万人或更多的生命。因此，除了对最有可能的结果提供最好的反应外，大规模接种疫苗还有一个好处，那就是防止只有轻微可能性但实质上更可怕的结果。因此，对不确定性的严格估计可以揭示公共卫生战略的隐藏优势，这表明正式的不确定性估计应该在流行病规划中发挥关键作用。
Concerns over bioterrorism and emerging diseases have led to the widespread use of epidemic models for evaluating public health strategies. Partly because epidemic models often capture the dynamics of prior epidemics remarkably well, little attention has been paid to how uncertainty in parameter estimates might affect model predictions. To understand such effects, we used Bayesian statistics to rigorously estimate the uncertainty in the parameters of an epidemic model, focusing on smallpox bioterrorism. We then used a vaccination model to translate the uncertainty in the model parameters into uncertainty in which of two vaccination strategies would provide a better response to bioterrorism, mass vaccination, or vaccination of social contacts, so-called "trace vaccination." Our results show that the uncertainty in the model parameters is remarkably high and that this uncertainty has important implications for vaccination strategies. For example, under one plausible scenario, the most likely outcome is that mass vaccination would save approximate to 100,000 more lives than trace vaccination. Because of the high uncertainty in the parameters, however, there is also a substantial probability that mass vaccination would save 200,000 or more lives than trace vaccination. In addition to providing the best response to the most likely outcome, mass vaccination thus has the advantage of preventing outcomes that are only slightly less likely but that are substantially more horrific. Rigorous estimates of uncertainty thus can reveal hidden advantages of public health strategies, suggesting that formal uncertainty estimation should play a key role in planning for epidemics.