A fundamental limit to the effectiveness of traveller screening with molecular tests.

IF 2.2 4区 医学 Q3 INFECTIOUS DISEASES
Kate Bubar, Casey Middleton, Daniel Larremore, Katelyn Gostic
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Abstract

Despite the appeal of screening travellers to prevent case importation during infectious disease outbreaks, evidence shows that symptom screening is largely ineffective in delaying the geographical spread of infection. Molecular tests offer high sensitivity and specificity and can detect infections earlier than symptom screening, suggesting potential for improved outcomes. However, they were used to screen travellers for COVID-19 with mixed success. To investigate molecular screening's role in controlling COVID-19, and to quantify the effectiveness of screening for future pathogens of concern, we developed a probabilistic model that incorporates within-host viral kinetics. We then evaluated the potential effectiveness of screening travellers for influenza A, SARS-CoV-1, SARS-CoV-2, and Ebola virus. Even under highly optimistic assumptions, we found that the inability to detect recent infections always limits the effectiveness of traveller screening. We quantify this fundamental limit by proposing an estimator for the fraction of transmission that is preventable by screening. We also demonstrate that estimates of ascertainment overestimate reductions in transmission. These results highlight the essential role that quarantine and repeated testing play in infectious disease containment. Furthermore, our findings indicate that improving screening effectiveness requires the ability to detect infection much earlier than current state-of-the-art molecular tests.

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分子检测对旅行者筛查有效性的根本限制。
尽管呼吁在传染病暴发期间对旅行者进行筛查以防止病例输入,但有证据表明,症状筛查在延迟感染的地理传播方面基本上是无效的。分子检测具有高灵敏度和特异性,可以比症状筛查更早地发现感染,这表明有可能改善结果。然而,它们被用于筛查旅行者是否感染COVID-19,取得了不同程度的成功。为了研究分子筛选在控制COVID-19中的作用,并量化筛选未来关注的病原体的有效性,我们开发了一个包含宿主内病毒动力学的概率模型。然后,我们评估了对旅行者进行甲型流感、SARS-CoV-1、SARS-CoV-2和埃博拉病毒筛查的潜在有效性。即使在非常乐观的假设下,我们发现无法发现最近的感染总是限制了旅行者筛查的有效性。我们通过提出可通过筛查预防的传播比例的估计值来量化这一基本限制。我们还证明,确定的估计值高估了传播的减少。这些结果突出了检疫和重复检测在传染病控制中发挥的重要作用。此外,我们的研究结果表明,提高筛查效果需要比目前最先进的分子测试更早地检测感染的能力。
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来源期刊
Epidemiology and Infection
Epidemiology and Infection 医学-传染病学
CiteScore
4.10
自引率
2.40%
发文量
366
审稿时长
3-6 weeks
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.
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