Mathematical modelling of bacterial carriage in children

与大量其他儿童接触的儿童面临持续性细菌感染的风险。这种情况解释了历史上儿童耳部和胸部感染以及皮肤溃疡的高发率。不断变化的社会环境（家庭规模变小、住房条件改善、营养和卫生条件改善）以及抗生素的使用，解释了自20世纪初以来富裕社区中此类感染的下降。然而，即使在今天，在富裕国家，参加集体托儿服务的儿童患耳部感染的风险很高。由于许多细菌具有耐药性，现在抗生素的效果比最初引入时要差得多。此外，在巴布亚新几内亚和其他发展中国家的土著社区，儿童感染艾滋病毒的情况持续不断，造成听力丧失、慢性呼吸系统疾病、晚年心脏病和肾病。利用以前从土著社区和儿童保育儿童的其他研究中收集的数据，数学模型允许我们问如果？，并回答重要的公共卫生问题：哪些环境和公共卫生措施可以减少托儿和高危人群的交叉感染周期？2. 多大的肺炎球菌疫苗覆盖率才能消除托儿中心、更广泛的社区和高危人群的疫苗特异性细菌？3. 届时，未被疫苗覆盖的细菌感染是否会增加？4. 如果限制抗生素的使用，耐药细菌会消失吗？5. 抗生素在什么情况下有助于控制感染？该模型将促进对土著社区细菌感染和儿童保育的社会和健康成本的了解，并利用教育情景促进采用最具成本效益和社会可接受的干预措施。

Children exposed to larger numbers of other children are at risk of persistent bacterial infections. Such circumstances explain the high rates of ear and chest infections, and skin sores seen in children in historical times. Changing social circumstances (smaller families, better housing, nutrition and hygiene), as well as the introduction of antibiotics, explain the decline of such infections in affluent communities since the early 20th century. However, even today, in affluent countries, children attending group child care are at high risk of ear infections. As many bacteria are resistant, antibiotics are now much less effective than when they were first introduced. Furthermore, there is a continuing load of infection for children in Aboriginal communities, in PNG and other developing countries, causing hearing loss, chronic respiratory problems, and heart disease and renal disease in later life. Using data previously collected from other studies in Indigenous communities and children in child care, mathematical models allow us to ask what if?, and answer important public health questions: 1. What environmental and public health measures can reduce the cycle of cross-infection in child-care and high-risk populations? 2. What coverage rates with pneumococcal vaccine will eliminate the vaccine-specific bacteria from child care centres, from the wider community, and from high risk populations? 3. Will infections with bacteria not covered by vaccine then increase? 4. Will the resistant bacteria tend to disappear if antibiotic use is restricted? 5. Under what circumstances will antibiotics help to control infection? The modelling will promote understanding of the social and health costs of bacterial infection in Aboriginal communities and child care and use educational scenarios to promote uptake of the most cost-effective and socially acceptable interventions.