Transmission dynamics and control of cholera in Haiti: an epidemic model.
Transmission dynamics and control of cholera in Haiti: an epidemic model.
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DOI：
10.1016/s0140-6736(11)60273-0
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发表时间：
2011-04-09
期刊：
影响因子：
168.9
通讯作者：
Basu, Sanjay
中科院分区：
文献类型：
--
作者：
Andrews, Jason R.;Basu, Sanjay
海地正在经历霍乱疫情。迄今为止，官方的流行病预测没有考虑到现有的疾病趋势或传播模式，而对拟议的干预措施进行辩论时没有对其影响进行比较性估计。我们设计了霍乱传播的数学模型，并将其与海地各省的发病率数据进行了拟合。然后，我们模拟了未来的流行轨迹，以估计清洁水、疫苗接种和加强抗生素分发计划的影响。霍乱的自然动态预计将使流行率在2011年1月中旬下降。在2011年3月至12月期间，我们预计海地有779，000例（95%CI：599，000 - 914，000）霍乱病例和11，100例（95%CI：7，300 - 17，400）死亡病例，其中一半以上预计将发生在阿蒂博尼特省和西部省。如果污染水的消耗量每周减少1%，按照目前的努力，我们预计将避免105，000例（95%CI：88，000 - 116，000）和1，500例（95%CI：1，100 - 2，300）死亡。从3月1日开始为10%的人口接种疫苗的计划预计将在同一时期避免63，000例（95% CI：48，000 - 78，000）病例和900例（95% CI：600- 1，500）死亡。相比之下，将抗生素使用范围扩大到所有重度脱水患者和一半中度脱水患者的建议预计将避免9，000例（95% CI：8，000 - 10，000）病例和1，300例（95% CI：900- 2，000）死亡。2011年初霍乱流行率下降是这一流行病自然历史的一部分，不应被解释为人类干预措施取得了成功。预计到2011年11月，海地霍乱弧菌将造成至少75万例霍乱病例，大大高于目前用于资源分配的官方估计数。除了提供清洁水和接种疫苗外，扩大抗生素的获得可能会避免数千人死亡。
Haiti is experiencing a cholera epidemic. Official epidemic projections, to date, have failed to incorporate existing disease trends or patterns of transmission, while proposed interventions have been debated without comparative estimates of their impact. We designed mathematical models of cholera transmission and fit them to Haiti’s provincial incidence data. We then simulated future epidemic trajectories to estimate the impact of clean water, vaccination and enhanced antibiotic distribution programs. The natural dynamics of cholera are expected to produce a prevalence decline by mid-January 2011. Between March and December 2011, we project 779,000 (95% CI: 599,000–914,000) cases and 11,100 (95% CI: 7,300–17,400) deaths from cholera in Haiti, over half of which would be expected to occur in the Artibonite and Oueste provinces. If contaminated water consumption were reduced by 1% per week, as per current efforts, we expect 105,000 cases (95% CI: 88,000–116,000) and 1,500 (95% CI: 1,100–2,300) deaths to be averted. A plan to vaccinate 10% of the population beginning on March 1 would be predicted to avert 63,000 (95% CI: 48,000–78,000) cases and 900 (95% CI: 600–1,500) deaths over the same period. By contrast, the proposal to extend antibiotic use to all patients with severe dehydration and half of patients with moderate dehydration would be expected to avert 9,000 (95% CI: 8,000–10,000) cases and 1,300 (95% CI: 900–2,000) deaths. A decline in cholera prevalence in early 2011 is part of the natural history of the epidemic, and should not be interpreted as reflective of the success of human interventions. Vibrio cholerae in Haiti is expected to produce at least 750,000 cholera cases by November 2011, substantially higher than official estimates currently used for resource allocation. In addition to clean water provision and vaccination, expanded access to antibiotics may avert thousands of deaths.