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Gonorrhea cluster detection in Manitoba, Canada: Spatial, temporal, and spatio-temporal analysis 加拿大马尼托巴省的淋病集群检测:空间、时间和时空分析
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-31 DOI: 10.1016/j.idm.2024.05.009
Amin Abed , Mahmoud Torabi , Zeinab Mashreghi

In Canada, Gonorrhea infection ranks as the second most prevalent sexually transmitted infection. In 2018, Manitoba reported an incidence rate three times greater than the national average. This study aims to investigate the spatial, temporal, and spatio-temporal patterns of Gonorrhea infection in Manitoba, using individual-level laboratory-confirmed administrative data provided by Manitoba Health from 2000 to 2016. Age and sex patterns indicate that females are affected by infections at younger ages compared to males. Moreover, there is an increase in repeated infections in 2016, accounting for 16% of the total infections. Spatial analysis at the 96 Manitoba regional health authority districts highlights significant positive spatial autocorrelation, demonstrating a clustered distribution of the infection. Northern districts of Manitoba and central Winnipeg were identified as significant clusters. Temporal analysis shows seasonal patterns, with higher infections in late summer and fall. Additionally, spatio-temporal analysis reveals clusters during high-risk periods, with the most likely cluster in the northern districts of Manitoba from January 2006 to June 2014, and a secondary cluster in central Winnipeg from June 2004 to November 2012. This study identifies that Gonorrhea infection transmission in Manitoba has temporal, spatial, and spatio-temporal variations. The findings provide vital insights for public health and Manitoba Health by revealing high-risk clusters and emphasizing the need for focused and localized prevention, control measures, and resource allocation.

在加拿大,淋病感染是第二大最普遍的性传播感染。2018 年,马尼托巴省报告的发病率是全国平均水平的三倍。本研究旨在利用马尼托巴省卫生部提供的 2000 年至 2016 年个人层面实验室确认的行政数据,调查马尼托巴省淋病感染的空间、时间和时空模式。年龄和性别模式表明,与男性相比,女性感染的年龄更小。此外,2016 年重复感染人数有所增加,占总感染人数的 16%。对马尼托巴省 96 个地区卫生局辖区的空间分析显示,空间自相关性呈显著正相关,表明感染呈集群分布。马尼托巴省北部地区和温尼伯市中心被确定为重要的集群。时间分析显示出季节性模式,夏末和秋季感染率较高。此外,时空分析还揭示了高风险时期的集群,2006年1月至2014年6月期间,马尼托巴省北部地区最有可能出现集群,2004年6月至2012年11月期间,温尼伯中部地区出现次要集群。这项研究表明,马尼托巴省的淋病感染传播存在时间、空间和时空变化。研究结果为公共卫生和马尼托巴省卫生部门提供了重要的启示,揭示了高风险集群,强调了有重点的本地化预防、控制措施和资源分配的必要性。
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引用次数: 0
Analysing vaccine efficacy evaluated in phase 3 clinical trials carried out during outbreaks 分析疫情爆发期间开展的第 3 期临床试验中评估的疫苗疗效
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-23 DOI: 10.1016/j.idm.2024.05.007
Francisco Antonio Bezerra Coutinho , Marcos Amaku , Fernanda Castro Boulos , José Alfredo de Sousa Moreira , João Italo Dias Franca , Julio Antonio do Amaral , Eliana Nogueira Castro de Barros , Claudio José Struchiner , Esper Jorge Kallas , Eduardo Massad

In this paper we examine several definitions of vaccine efficacy (VE) that we found in the literature, for diseases that express themselves in outbreaks, that is, when the force of infection grows in time, reaches a maximum and then vanishes. The fact that the disease occurs in outbreaks results in several problems that we analyse. We propose a mathematical model that allows the calculation of VE for several scenarios. Vaccine trials usually needs a large number of volunteers that must be enrolled. Ideally, all volunteers should be enrolled in approximately the same time, but this is generally impossible for logistic reasons and they are enrolled in a fashion that can be replaced by a continuous density function (for example, a Gaussian function). The outbreak can also be replaced by a continuous density function, and the use of these density functions simplifies the calculations. Assuming, for example Gaussian functions, one of the problems one can immediately notice is that the peak of the two curves do not occur at the same time. The model allows us to conclude: First, the calculated vaccine efficacy decreases when the force of infection increases; Second, the calculated vaccine efficacy decreases when the gap between the peak in the force of infection and the peak in the enrollment rate increases; Third, different trial protocols can be simulated with this model; different vaccine efficacy definitions can be calculated and in our simulations, all result are approximately the same. The final, and perhaps most important conclusion of our model, is that vaccine efficacy calculated during outbreaks must be carefully examined and the best way we can suggest to overcome this problem is to stratify the enrolled volunteer's in a cohort-by-cohort basis and do the survival analysis for each cohort, or apply the Cox proportional hazards model for each cohort.

在本文中,我们研究了在文献中找到的几种疫苗效力(VE)定义,它们适用于以爆发形式表现的疾病,即感染力随时间增长、达到最大值然后消失的疾病。疾病以爆发形式出现这一事实导致了几个问题,我们对此进行了分析。我们提出了一个数学模型,可以计算几种情况下的 VE。疫苗试验通常需要招募大量志愿者。理想情况下,所有志愿者都应在大致相同的时间内注册,但由于物流原因,这通常是不可能的。爆发也可以用连续密度函数代替,使用这些密度函数可以简化计算。例如,假设使用高斯函数,我们马上就会发现一个问题,即两条曲线的峰值并不是同时出现的。通过该模型我们可以得出以下结论:首先,当感染力增加时,计算出的疫苗效价会降低;其次,当感染力峰值与注册率峰值之间的差距增大时,计算出的疫苗效价会降低;第三,可以用这个模型模拟不同的试验方案;可以计算出不同的疫苗效价定义,而在我们的模拟中,所有结果都大致相同。最后,也许是我们的模型得出的最重要的结论是,必须仔细研究疫苗爆发期间计算出的疫苗效力,而我们能提出的解决这一问题的最佳方法是按队列对注册志愿者进行分层,并对每个队列进行生存分析,或对每个队列应用 Cox 比例危险模型。
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引用次数: 0
Understanding the impact of HIV on mpox transmission in the MSM population: A mathematical modeling study 了解艾滋病病毒对男男性行为者传播艾滋病的影响:数学建模研究
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-21 DOI: 10.1016/j.idm.2024.05.008
Andrew Omame , Qing Han , Sarafa A. Iyaniwura , Adeniyi Ebenezer , Nicola L. Bragazzi , Xiaoying Wang , Jude D. Kong , Woldegebriel A. Woldegerima

The recent mpox outbreak (in 2022–2023) has different clinical and epidemiological features compared with previous outbreaks of the disease. During this outbreak, sexual contact was believed to be the primary transmission route of the disease. In addition, the community of men having sex with men (MSM) was disproportionately affected by the outbreak. This population is also disproportionately affected by HIV infection. Given that both diseases can be transmitted sexually, the endemicity of HIV, and the high sexual behavior associated with the MSM community, it is essential to understand the effect of the two diseases spreading simultaneously in an MSM population. Particularly, we aim to understand the potential effects of HIV on an mpox outbreak in the MSM population. We develop a mechanistic mathematical model of HIV and mpox co-infection. Our model incorporates the dynamics of both diseases and considers HIV treatment with anti-retroviral therapy (ART). In addition, we consider a potential scenario where HIV infection increases susceptibility to mpox, and investigate the potential impact of this mechanism on mpox dynamics. Our analysis shows that HIV can facilitate the spread of mpox in an MSM population, and that HIV treatment with ART may not be sufficient to control the spread of mpox in the population. However, we showed that a moderate use of condoms or reduction in sexual contact in the population combined with ART is beneficial in controlling mpox transmission. Based on our analysis, it is evident that effective control of HIV, specifically through substantial ART use, moderate condom compliance, and reduction in sexual contact, is imperative for curtailing the transmission of mpox in an MSM population and mitigating the compounding impact of these intertwined epidemics.

最近(2022-2023 年)爆发的麻风腮与以往爆发的麻风腮相比,具有不同的临床和流行病学特征。在这次疫情中,性接触被认为是该疾病的主要传播途径。此外,男男性行为者(MSM)群体受到疫情的影响尤为严重。这一人群感染艾滋病毒的比例也特别高。鉴于这两种疾病都可以通过性传播、艾滋病病毒的流行以及男男性行为者群体的高性行为,了解这两种疾病同时在男男性行为者群体中传播的影响至关重要。特别是,我们的目标是了解艾滋病病毒对男男性行为人群中流行性疱疹爆发的潜在影响。我们建立了一个 HIV 和 mpox 共同感染的机理数学模型。我们的模型包含了这两种疾病的动态变化,并考虑了 HIV 的抗逆转录病毒疗法(ART)。此外,我们还考虑了 HIV 感染会增加对 mpox 易感性的潜在情况,并研究了这种机制对 mpox 动态的潜在影响。我们的分析表明,艾滋病病毒会促进痘疹在男男性行为人群中的传播,而通过抗逆转录病毒疗法治疗艾滋病病毒可能不足以控制痘疹在人群中的传播。然而,我们的研究表明,在人群中适度使用安全套或减少性接触与抗逆转录病毒疗法相结合,有利于控制痘病毒的传播。根据我们的分析,很明显,有效控制艾滋病毒,特别是通过大量使用抗逆转录病毒疗法、适度使用安全套和减少性接触,对于遏制麻疹在男男性行为者人群中的传播和减轻这些相互交织的流行病的复合影响至关重要。
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引用次数: 0
On optimal control at the onset of a new viral outbreak 论新病毒爆发初期的优化控制
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-15 DOI: 10.1016/j.idm.2024.05.006
Alexandra Smirnova, Xiaojing Ye

We propose a versatile model with a flexible choice of control for an early-pandemic outbreak prevention when vaccine/drug is not yet available. At that stage, control is often limited to non-medical interventions like social distancing and other behavioral changes. For the SIR optimal control problem, we show that the running cost of control satisfying mild, practically justified conditions generates an optimal strategy, u(t), t ∈ [0, T], that is sustainable up until some moment τ ∈ [0, T). However, for any t ∈ [τ, T], the function u(t) will decline as t approaches T, which may cause the number of newly infected people to increase. So, the window from 0 to τ is the time for public health officials to prepare alternative mitigation measures, such as vaccines, testing, antiviral medications, and others. In addition to theoretical study, we develop a fast and stable computational method for solving the proposed optimal control problem. The efficiency of the new method is illustrated with numerical examples of optimal control trajectories for various cost functions and weights. Simulation results provide a comprehensive demonstration of the effects of control on the epidemic spread and mitigation expenses, which can serve as invaluable references for public health officials.

我们提出了一个灵活选择控制措施的多功能模型,用于在疫苗/药物尚未问世的情况下预防大流行病的早期爆发。在这一阶段,控制通常仅限于非医疗干预,如社会疏远和其他行为改变。对于 SIR 最佳控制问题,我们表明,满足温和、实际合理条件的控制运行成本会产生一个最佳策略 u(t),t ∈ [0, T],该策略可持续到某个时刻 τ∈ [0, T)。然而,对于任意 t∈ [τ, T],函数 u(t) 会随着 t 接近 T 而下降,这可能会导致新感染人数增加。因此,从 0 到 τ 的窗口期是公共卫生官员准备其他缓解措施的时间,如疫苗、检测、抗病毒药物等。除了理论研究,我们还开发了一种快速稳定的计算方法来解决所提出的最优控制问题。新方法的效率通过各种成本函数和权重的最优控制轨迹的数值示例来说明。模拟结果全面展示了控制对疫情传播和减灾支出的影响,可为公共卫生官员提供宝贵的参考。
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引用次数: 0
Learning from the COVID-19 pandemic: A systematic review of mathematical vaccine prioritization models 从 COVID-19 大流行中学习:疫苗优先次序数学模型系统回顾
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-15 DOI: 10.1016/j.idm.2024.05.005
Gilberto González-Parra , Md Shahriar Mahmud , Claus Kadelka

As the world becomes ever more connected, the chance of pandemics increases as well. The recent COVID-19 pandemic and the concurrent global mass vaccine roll-out provides an ideal setting to learn from and refine our understanding of infectious disease models for better future preparedness. In this review, we systematically analyze and categorize mathematical models that have been developed to design optimal vaccine prioritization strategies of an initially limited vaccine. As older individuals are disproportionately affected by COVID-19, the focus is on models that take age explicitly into account. The lower mobility and activity level of older individuals gives rise to non-trivial trade-offs. Secondary research questions concern the optimal time interval between vaccine doses and spatial vaccine distribution. This review showcases the effect of various modeling assumptions on model outcomes. A solid understanding of these relationships yields better infectious disease models and thus public health decisions during the next pandemic.

随着世界联系的日益紧密,大流行病发生的几率也随之增加。最近的 COVID-19 大流行以及同时在全球范围内大规模推广疫苗为我们提供了一个理想的环境,让我们从传染病模型中学习并完善对其的理解,从而更好地为未来做好准备。在这篇综述中,我们系统地分析了为设计最初有限疫苗的最佳优先接种策略而开发的数学模型,并对其进行了分类。由于老年人受 COVID-19 的影响尤为严重,因此我们将重点放在明确考虑年龄因素的模型上。老年人的流动性和活动水平较低,因此会产生非同一般的权衡。次要研究问题涉及疫苗剂量的最佳时间间隔和疫苗的空间分布。本综述展示了各种建模假设对模型结果的影响。对这些关系的扎实理解将产生更好的传染病模型,从而在下一次大流行期间做出更好的公共卫生决策。
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引用次数: 0
Parameter identifiability of a within-host SARS-CoV-2 epidemic model 宿主内部 SARS-CoV-2 流行模型的参数可识别性
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-14 DOI: 10.1016/j.idm.2024.05.004
Junyuan Yang , Sijin Wu , Xuezhi Li , Xiaoyan Wang , Xue-Song Zhang , Lu Hou

Parameter identification involves the estimation of undisclosed parameters within a system based on observed data and mathematical models. In this investigation, we employ DAISY to meticulously examine the structural identifiability of parameters of a within-host SARS-CoV-2 epidemic model, taking into account an array of observable datasets. Furthermore, Monte Carlo simulations are performed to offer a comprehensive practical analysis of model parameters. Lastly, sensitivity analysis is employed to ascertain that decreasing the replication rate of the SARS-CoV-2 virus and curbing the infectious period are the most efficacious measures in alleviating the dissemination of COVID-19 amongst hosts.

参数识别是指根据观测数据和数学模型对系统中未披露的参数进行估计。在这项研究中,我们利用 DAISY,结合一系列可观测数据集,细致检验了宿主内 SARS-CoV-2 流行模型参数的结构可识别性。此外,还进行了蒙特卡罗模拟,对模型参数进行了全面的实际分析。最后,通过敏感性分析,确定降低 SARS-CoV-2 病毒的复制率和缩短感染期是缓解 COVID-19 在宿主间传播的最有效措施。
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引用次数: 0
Analysis of a diffusive two-strain malaria model with the carrying capacity of the environment for mosquitoes 分析环境对蚊子的承载能力⋆的扩散性双株疟疾模型
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-11 DOI: 10.1016/j.idm.2024.05.001
Jinliang Wang , Wenjing Wu , Yuming Chen

We propose a malaria model involving the sensitive and resistant strains, which is described by reaction-diffusion equations. The model reflects the scenario that the vector and host populations disperse with distinct diffusion rates, susceptible individuals or vectors cannot be infected by both strains simultaneously, and the vector population satisfies the logistic growth. Our main purpose is to get a threshold type result on the model, especially the interaction effect of the two strains in the presence of spatial structure. To solve this issue, the basic reproduction number (BRN) R0i and invasion reproduction number (IRN) Rˆ0i of each strain (i = 1 and 2 are for the sensitive and resistant strains, respectively) are defined. Furthermore, we investigate the influence of the diffusion rates of populations and vectors on BRNs and IRNs.

我们提出了一个涉及敏感菌株和抗药性菌株的疟疾模型,该模型由反应-扩散方程描述。该模型反映了这样一种情况:病媒和宿主种群以不同的扩散率扩散,易感个体或病媒不能同时感染两种菌株,病媒种群满足逻辑增长。我们的主要目的是得到该模型的阈值型结果,尤其是存在空间结构时两种菌株的交互效应。为了解决这个问题,我们定义了每个菌株的基本繁殖数(BRN)R0i 和入侵繁殖数(IRN)Rˆ0i(i = 1 和 2 分别代表敏感菌株和抗性菌株)。此外,我们还研究了种群和载体的扩散率对 BRN 和 IRN 的影响。
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引用次数: 0
Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases 伊朗肺结核时变繁殖数的贝叶斯估计:利用涂片阳性新病例进行的 2018 至 2022 年登记研究
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-10 DOI: 10.1016/j.idm.2024.05.003
Maryam Rastegar , Eisa Nazar , Mahshid Nasehi , Saeed Sharafi , Vahid Fakoor , Mohammad Taghi Shakeri

Introduction

Tuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran.

Material and methods

The present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software.

Results

The mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35–63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96–1.15).

Conclusions

In this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

导言结核病(TB)是世界上最流行的传染病之一,在发展中国家造成了严重的公共卫生问题。据估计,2021 年伊朗的肺结核发病率为每 10 万人 13 例。本研究旨在估算伊朗肺结核的繁殖数量和序列间隔。材料和方法本国家历史队列研究于 2018 年 3 月至 2022 年 3 月进行,以伊朗卫生和医学教育部(MOHME)国家结核病和麻风病登记中心的数据为基础。研究包括伊朗的 30,762 例肺结核病例和 16,165 例涂片阳性肺结核新患者。我们在贝叶斯框架中估算了肺结核的再现数量,该框架可将不确定性纳入估算中。结果患者确诊时的平均年龄为(52.3 ± 21.2)岁,大多数患者处于 35-63 岁年龄段(37.1%)。数据中,9121 例(56.4%)为男性,7044 例(43.6%)为女性。在患者中,7459 人(46.1%)的诊断延迟了 1 至 3 个月。此外,3039 例(18.8%)为非伊朗人,2978 例(98%)为阿富汗人。经计算,肺结核病的时变繁殖数平均为 1.06 ± 0.05(95% Crl 0.96-1.15)。时变繁殖数的平均值表明,每个感染者在一段时间内至少会造成一个新的感染,而传播链并未中断。
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引用次数: 0
Chronic disease patients have fewer social contacts: A pilot survey with implications for transmission dynamics 慢性病患者的社会接触较少:一项试点调查对传播动态的影响
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-07 DOI: 10.1016/j.idm.2024.05.002
J. Vanderlocht , S. Møgelmose , K. Van Kerckhove , P. Beutels , N. Hens

Non-communicable diseases (NCD) are the most important cause of death in the world. The socio-economic costs associated with NCDs makes it imperative to prevent and control them in the 21st century. The severe toll that the COVID-19 pandemic has taken worldwide is an unfortunate illustration of our limited insight into the infectious risk for the global population. Co-incidence between NCD and infection offers an underexplored opportunity to design preventive policies. In a pilot survey, we observed that the NCD population displays a substantial reduction in their social contacting behavior as compared to the general population. This indicates that existing mathematical models based on contact surveys in the general population are not applicable to the NCD population and that the risk of acquiring an infection following a contact is probably underestimated. Our demonstration of reduced social mixing in several chronic conditions, raises the question to what extent the social mixing is influenced by the burden of disease. We advocate the design of disease-specific contact surveys to address how the burden of disease associates with social contact behavior and the risk of infection. The SARS-CoV-2 pandemic offers an unprecedented opportunity to gain insight into the importance of infection in the NCD population and to find ways to improve healthcare procedures.

非传染性疾病(NCD)是世界上最重要的死亡原因。与非传染性疾病相关的社会经济成本使得预防和控制非传染性疾病成为 21 世纪的当务之急。COVID-19 大流行在全球造成的严重损失不幸说明了我们对全球人口感染风险的洞察力有限。非传染性疾病和感染之间的并发症为设计预防政策提供了一个尚未充分开发的机会。在一项试点调查中,我们观察到,与普通人群相比,非传染性疾病人群的社会接触行为大幅减少。这表明,基于普通人群接触调查的现有数学模型并不适用于非传染性疾病人群,而且接触后感染的风险很可能被低估了。我们对几种慢性疾病的社会混合程度降低的证明,提出了社会混合程度在多大程度上受疾病负担影响的问题。我们主张设计针对特定疾病的接触调查,以解决疾病负担如何与社会接触行为和感染风险相关联的问题。SARS-CoV-2 大流行提供了一个前所未有的机会,让我们可以深入了解感染在非传染性疾病人群中的重要性,并找到改善医疗保健程序的方法。
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引用次数: 0
Modeling measles transmission in adults and children: Implications to vaccination for eradication 麻疹在成人和儿童中的传播模型:疫苗接种对根除麻疹的意义
IF 8.8 3区 医学 Q1 Medicine Pub Date : 2024-05-04 DOI: 10.1016/j.idm.2024.04.012
Anjana Pokharel , Khagendra Adhikari , Ramesh Gautam , Kedar Nath Uprety , Naveen K. Vaidya

Despite the availability of successful vaccines, measles outbreaks have occurred frequently in recent years, presumably due to the lack of proper vaccination implementation. Moreover, measles cases in adult groups, albeit small in number, indicate that the previously neglected adult group may need to be brought into vaccine coverage to achieve WHO's goal of measles eradication from the globe. In this study, we develop a novel transmission dynamics model to describe measles cases in adults and children to evaluate the role of adult infection in persistent measles cases and vaccination programs for eradication. Analysis of our model, validated by measles cases from outbreaks in Nepal, provides the vaccination reproduction number (conditions for measles eradication or persistence) and the role of contact network size. Our results highlight that while children are primary targets for measles outbreaks, a small number of infections in adults may act as a reservoir for measles, causing obstacles to eradication. Furthermore, our model analysis shows that while impactful controls can be achieved by children-focused vaccines, a combined adult-child vaccination program may help assert eradication of the disease.

尽管已经有了成功的疫苗,但近年来麻疹疫情仍频繁爆发,这可能是由于缺乏适当的疫苗接种。此外,成人群体中的麻疹病例(尽管数量不多)表明,可能需要将以前被忽视的成人群体纳入疫苗覆盖范围,以实现世界卫生组织在全球根除麻疹的目标。在本研究中,我们建立了一个新的传播动力学模型来描述成人和儿童中的麻疹病例,以评估成人感染在持续性麻疹病例和根除麻疹疫苗接种计划中的作用。通过对尼泊尔爆发的麻疹病例进行验证,我们的模型分析提供了疫苗接种繁殖数(麻疹根除或持续存在的条件)以及接触网络规模的作用。我们的结果突出表明,虽然儿童是麻疹疫情的主要目标,但成人中的少量感染者可能成为麻疹的 "蓄水池",给根除麻疹造成障碍。此外,我们的模型分析表明,虽然以儿童为重点的疫苗可以实现有影响力的控制,但成人-儿童联合疫苗接种计划可能有助于根除麻疹。
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Infectious Disease Modelling
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