Estimating the reproductive numbers for the 2008-2009 cholera outbreaks in Zimbabwe.
Estimating the reproductive numbers for the 2008-2009 cholera outbreaks in Zimbabwe.
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DOI：
10.1073/pnas.1019712108
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发表时间：
2011-05-24
影响因子：
11.1
通讯作者：
Morris, J Glenn Jr
中科院分区：
文献类型：
--
作者：
Mukandavire, Zindoga;Liao, Shu;Morris, J Glenn Jr
霍乱仍然是全球发病和死亡的重要原因，能够引起周期性流行病。 2008年8月开始，津巴布韦爆发霍乱疫情，报告病例98,585例，死亡4,287人。这种爆发的动态，特别是在非河口地区，尚不清楚。我们探索了数学模型在了解霍乱传播动力学和评估控制流行病所需干预措施的规模方面的效用。从津巴布韦卫生和儿童福利部（MoHCW）获得了2008年11月13日至2009年7月31日期间报告的霍乱病例的每周数据。制定了数学模型并将其拟合到累计霍乱病例中，以估计2008-2009年津巴布韦霍乱疫情的基本传染数R（0）和所有10个省份的部分传染数。估计的基本再生数高度异质，范围从略高于统一的低值到 2.72。部分再生数也具有高度异质性，这表明传播途径因省而异；人际传播占所有传播的 41-95%。我们的模型表明，霍乱传播的基本模式在各省之间存在很大差异，不同省份爆发疫情对免疫接种等控制措施的适应性也存在相应差异。这些数据强调了霍乱传播动态的异质性，可能与环境、社会经济条件和文化习俗的差异有关。传统河口水库的缺乏加上 R(0) 的估计表明，在津巴布韦和周边地区战略性部署的大规模霍乱疫苗接种可以预防未来的霍乱流行，并最终消除该地区的霍乱。
Cholera remains an important global cause of morbidity and mortality, capable of causing periodic epidemic disease. Beginning in August 2008, a major cholera epidemic occurred in Zimbabwe, with 98,585 reported cases and 4,287 deaths. The dynamics of such outbreaks, particularly in nonestuarine regions, are not well understood. We explored the utility of mathematical models in understanding transmission dynamics of cholera and in assessing the magnitude of interventions necessary to control epidemic disease. Weekly data on reported cholera cases were obtained from the Zimbabwe Ministry of Health and Child Welfare (MoHCW) for the period from November 13, 2008 to July 31, 2009. A mathematical model was formulated and fitted to cumulative cholera cases to estimate the basic reproductive numbers R(0) and the partial reproductive numbers from all 10 provinces for the 2008-2009 Zimbabwe cholera epidemic. Estimated basic reproductive numbers were highly heterogeneous, ranging from a low value of just above unity to 2.72. Partial reproductive numbers were also highly heterogeneous, suggesting that the transmission routes varied by province; human-to-human transmission accounted for 41-95% of all transmission. Our models suggest that the underlying patterns of cholera transmission varied widely from province to province, with a corresponding variation in the amenability of outbreaks in different provinces to control measures such as immunization. These data underscore the heterogeneity of cholera transmission dynamics, potentially linked to differences in environment, socio-economic conditions, and cultural practices. The lack of traditional estuarine reservoirs combined with these estimates of R(0) suggest that mass vaccination against cholera deployed strategically in Zimbabwe and surrounding regions could prevent future cholera epidemics and eventually eliminate cholera from the region.