A Scenario-Based Evaluation of the Middle East Respiratory Syndrome Coronavirus and the Hajj
A Scenario-Based Evaluation of the Middle East Respiratory Syndrome Coronavirus and the Hajj
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DOI：
10.1111/risa.12253
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发表时间：
2014-08-01
期刊：
影响因子：
3.8
通讯作者：
MacIntyre, C. Raina
中科院分区：
文献类型：
--
作者：
Gardner, Lauren M.;Rey, David;MacIntyre, C. Raina
2012年4月至2014年6月，阿拉伯半岛、欧洲、北非、东南亚、中东和美国报告了820例中东呼吸综合征冠状病毒（MERS-CoV）实验室确诊病例。观察到的流行病学与SARS不同，SARS表现出典型的流行曲线，并在8个月内结束。MERS-CoV在人群中的持续时间要长得多，生殖数量较低，有一些人传人的证据，但在其他方面呈零星模式，这很难解释。利用现有的流行病学数据，我们实施了数学模型来探索MERS-CoV在朝觐等大规模集会背景下的传播动态，并发现观察到的流行病学与预期流行病学之间存在差异。2012年或2013年返回朝觐的朝圣者中没有发生流行病，这与病毒在人群中长期存在的事实相矛盾。对这一差异的解释包括持续、重复的非人/散发性来源，大部分未发现或未报告的人传人病例，或两者兼而有之。此外，中东呼吸综合征冠状病毒发生在一个主要的全球交通枢纽和举办重大群众集会的地区，因此必须了解该病毒在人群中持续存在的原因和手段。
Between April 2012 and June 2014, 820 laboratory-confirmed cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported in the Arabian Peninsula, Europe, North Africa, Southeast Asia, the Middle East, and the United States. The observed epidemiology is different to SARS, which showed a classic epidemic curve and was over in eight months. The much longer persistence of MERS-CoV in the population, with a lower reproductive number, some evidence of human-to-human transmission but an otherwise sporadic pattern, is difficult to explain. Using available epidemiological data, we implemented mathematical models to explore the transmission dynamics of MERS-CoV in the context of mass gatherings such as the Hajj pilgrimage, and found a discrepancy between the observed and expected epidemiology. The fact that no epidemic occurred in returning Hajj pilgrims in either 2012 or 2013 contradicts the long persistence of the virus in human populations. The explanations for this discrepancy include an ongoing, repeated nonhuman/sporadic source, a large proportion of undetected or unreported human-to-human cases, or a combination of the two. Furthermore, MERS-CoV is occurring in a region that is a major global transport hub and hosts significant mass gatherings, making it imperative to understand the source and means of the yet unexplained and puzzling ongoing persistence of the virus in the human population.