Susie Cant, G Dennis Shanks, Matt J Keeling, Bridget S Penman
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引用次数: 0
摘要
直到二十世纪初,许多太平洋岛屿上的居民从未患过麻疹。随着欧洲人到太平洋岛屿旅行越来越普遍,麻疹和其他病原体的到来造成了毁灭性的后果。1911 年,斐济的罗图马岛爆发了麻疹疫情,造成岛上 13% 的人口死亡。详细记录显示,当时出现了两个死亡高峰,据报道,第一个高峰仅死于麻疹,第二个高峰则死于麻疹和腹泻。众所周知,麻疹会破坏免疫系统功能。在此,我们研究了 1911 年罗图马岛的死亡模式是否是麻疹的免疫抑制作用造成的。我们使用分区模型模拟麻疹感染和免疫抑制。在免疫抑制的情况下,我们假定个体容易受到以下两种因素的影响:(i) 与麻疹同时到达的新引入的传染源;或 (ii) 已在人群中存在的处于原有平衡状态的微生物。我们的研究表明,这两种形式的免疫抑制模型都能合理地拟合数据,而且与不包含免疫抑制的情况相比,将免疫抑制纳入模型可得出更符合实际的麻疹流行病学参数估计值。
Extreme mortality during a historical measles outbreak on Rotuma is consistent with measles immunosuppression.
Until the early twentieth century, populations on many Pacific Islands had never experienced measles. As travel to the Pacific Islands by Europeans became more common, the arrival of measles and other pathogens had devastating consequences. In 1911, Rotuma in Fiji was hit by a measles epidemic, which killed 13% of the island population. Detailed records show two mortality peaks, with individuals reported as dying solely from measles in the first and from measles and diarrhoea in the second. Measles is known to disrupt immune system function. Here, we investigate whether the pattern of mortality on Rotuma in 1911 was a consequence of the immunosuppressive effects of measles. We use a compartmental model to simulate measles infection and immunosuppression. Whilst immunosuppressed, we assume that individuals are vulnerable to dysfunctional reactions triggered by either (i) a newly introduced infectious agent arriving at the same time as measles or (ii) microbes already present in the population in a pre-existing equilibrium state. We show that both forms of the immunosuppression model provide a plausible fit to the data and that the inclusion of immunosuppression in the model leads to more realistic estimates of measles epidemiological parameters than when immunosuppression is not included.
期刊介绍:
Epidemiology & Infection publishes original reports and reviews on all aspects of infection in humans and animals. Particular emphasis is given to the epidemiology, prevention and control of infectious diseases. The scope covers the zoonoses, outbreaks, food hygiene, vaccine studies, statistics and the clinical, social and public-health aspects of infectious disease, as well as some tropical infections. It has become the key international periodical in which to find the latest reports on recently discovered infections and new technology. For those concerned with policy and planning for the control of infections, the papers on mathematical modelling of epidemics caused by historical, current and emergent infections are of particular value.