Workshop - Predicting Zoonotic Outbreaks: Building on the Plague Threshold Model

宿主-病原体动力学的实际研究往往跟不上理论概念的发展。这种不足尤其令人遗憾的一个领域是在医学和兽医科学中应用这些概念。一个具体的例子是开发一种疾病从野生动物宿主传播到人类（或家畜）种群/所谓的人畜共患病的高风险时间和/或地点的预测模型。这将是本次研讨会的主题。一个罕见的预测人畜共患病爆发的模型使用了哈萨克斯坦腺鼠疫的长期数据。在那里，以及整个中亚的大部分地区，鼠疫仍然是一个相当大的公共卫生问题，主要的宿主是大沙鼠，大沙鼠。该研究证明了沙鼠中存在“临界丰度阈值”，必须超过该阈值，鼠疫才能在其宿主中建立（并构成威胁）。此外，由于它是基于过去沙鼠的丰度，因此该模型不仅是描述性的，而且还可以用于预测未来的爆发，即预警系统。随后，该模型的输出已被用于开发一个预测性的“专家系统”，该系统正在由哈萨克斯坦的公共卫生工作者进行试点。拟议的研讨会的目的是使用鼠疫模型作为一个跳板，问（一）什么是前景，什么数据将是必要的，利用临界丰度阈值，和其他关键概念，在开发早期预警模型的其他疾病系统的野生动物是对公共卫生的威胁？事实上，简单的“阈值”模型可能有多广泛的适用性？在什么情况下需要不同的（类型）模型？(ii)如何才能最好地将这些模型转化为对公共卫生从业人员有用的工具？公共卫生工作者想要/需要什么？发达国家和发展中国家在这方面是否有区别，如果有，区别如何？(iii)如何最好地将这些预测纳入更大的风险分析和/或成本效益分析？“生态”模型/充其量/产生一种疾病在特定时间特定地点出现的概率（附带置信度）。但是，如果疾病出现而没有采取行动，那么什么是计入不采取行动的成本的最佳方式？同样，行动的成本最终被证明是不必要的？在多大程度上有必要超越纯粹经济理由的最佳做法，以考虑到“社会”因素（例如，未经治疗的疫情爆发后公众信心的丧失）。

Real-world studies of host-pathogen dynamics have often failed to keep pace with the development of theoretical concepts. One area where this shortfall is especially regrettable is the application of those concepts in the medical and veterinary sciences. A specific example is the development of predictive models of times and/or locations of high risk of a disease being passed from a wildlife reservoir to human (or domestic animal) populations / so-called zoonotic diseases. This would be the subject of this workshop. A rare example of a model predicting zoonotic outbreaks used long-term data on bubonic plague in Kazakhstan. There, and throughout much of Central Asia, where plague remains a considerable public health concern, the main reservoir host is the great gerbil, Rhombomys opimus. That study demonstrated the existence of a 'critical abundance threshold' in the gerbils, which had to be exceeded for plague to become established in its reservoir (and be a threat), Furthermore, because it was based on past gerbil abundances, the model was not only descriptive but could also be used to predict future outbreaks, i.e. an early warning system. Subsequently, the output from that model has been used to develop a predictive 'expert system' which is being piloted by public health workers in Kazakhstan. The purpose of the proposed workshop is to use the plague model as a springboard to ask (i) What are the prospects of, and what data will be necessary for, utilising critical abundance thresholds, and other key concepts, in developing early warning models for other disease systems in wildlife that are a threat to public health? Indeed, how widely applicable are simple 'threshold' models likely to be? Under what circumstances would different (types of) models be necessary? (ii) How best can such models be turned into tools that are useful to public health practitioners? What do public health workers want/need? Does this differ between the developed and the developing world, and if so how? (iii) How best can predictions such as these be incorporated into a larger risk analysis and/or cost-benefit analysis? 'Ecological' models / at best / generate a probability (with confidence attached) that a disease will be present at a particular place at a particular time. But what is the best way to incorporate the costs of inaction if the disease appears and action has not been taken? Likewise the costs of action that turns out to be unnecessary? And to what extent is it necessary to go beyond knowing what is optimal on purely economic grounds in order to take 'social' factors into account (e.g. loss of public confidence following an untreated outbreak).