EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100714
Zachary Stanke, John L. Spouge
{"title":"Estimating age-stratified transmission and reproduction numbers during the early exponential phase of an epidemic: A case study with COVID-19 data","authors":"Zachary Stanke, John L. Spouge","doi":"10.1016/j.epidem.2023.100714","DOIUrl":"10.1016/j.epidem.2023.100714","url":null,"abstract":"<div><p>In a pending pandemic, early knowledge of age-specific disease parameters, e.g., susceptibility, infectivity, and the clinical fraction (the fraction of infections coming to clinical attention), supports targeted public health responses like school closures or sequestration of the elderly. The earlier the knowledge, the more useful it is, so the present article examines an early phase of many epidemics, exponential growth. Using age-stratified COVID-19 case counts collected in Canada, China, Israel, Italy, the Netherlands, and the United Kingdom before April 23, 2020, we present a linear analysis of the exponential phase that attempts to estimate the age-specific disease parameters given above. Some combinations of the parameters can be estimated by requiring that they change smoothly with age. The estimation yielded: (1) the case susceptibility, defined for each age-group as the product of susceptibility to infection and the clinical fraction; (2) the mean number of transmissions of infection per contact within each age-group; and (3) the reproduction number of infection within each age-group, i.e., the diagonal of the age-stratified next-generation matrix. Our restriction to data from the exponential phase indicates the combinations of epidemic parameters that are intrinsically easiest to estimate with early age-stratified case counts. For example, conclusions concerning the age-dependence of case susceptibility appeared more robust than corresponding conclusions about infectivity. Generally, the analysis produced some results consistent with conclusions confirmed much later in the COVID-19 pandemic. Notably, our analysis showed that in some countries, the reproduction number of infection within the half-decade 70–75 was unusually large compared to other half-decades. Our analysis therefore could have anticipated that without countermeasures, COVID-19 would spread rapidly once seeded in homes for the elderly.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10528737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100708
Razvan G. Romanescu , Songdi Hu , Douglas Nanton , Mahmoud Torabi , Olivier Tremblay-Savard , Md Ashiqul Haque
{"title":"The effective reproductive number: Modeling and prediction with application to the multi-wave Covid-19 pandemic","authors":"Razvan G. Romanescu , Songdi Hu , Douglas Nanton , Mahmoud Torabi , Olivier Tremblay-Savard , Md Ashiqul Haque","doi":"10.1016/j.epidem.2023.100708","DOIUrl":"10.1016/j.epidem.2023.100708","url":null,"abstract":"<div><p>Classical compartmental models of infectious disease assume that spread occurs through a homogeneous population. This produces poor fits to real data, because individuals vary in their number of epidemiologically-relevant contacts, and hence in their ability to transmit disease. In particular, network theory suggests that super-spreading events tend to happen more often at the beginning of an epidemic, which is inconsistent with the homogeneity assumption. In this paper we argue that a flexible decay shape for the effective reproductive number (<span><math><msub><mrow><mi>R</mi></mrow><mrow><mi>t</mi></mrow></msub></math></span>) indexed by the susceptible fraction (<span><math><msub><mrow><mi>S</mi></mrow><mrow><mi>t</mi></mrow></msub></math></span>) is a theory-informed modeling choice, which better captures the progression of disease incidence over human populations. This, in turn, produces better retrospective fits, as well as more accurate prospective predictions of observed epidemic curves. We extend this framework to fit multi-wave epidemics, and to accommodate public health restrictions on mobility. We demonstrate the performance of this model by doing a prediction study over two years of the SARS-CoV2 pandemic.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100700
Laura W. Pomeroy , Senya Magsi , Shannon McGill , Caroline E. Wheeler
{"title":"Mumps epidemic dynamics in the United States before vaccination (1923–1932)","authors":"Laura W. Pomeroy , Senya Magsi , Shannon McGill , Caroline E. Wheeler","doi":"10.1016/j.epidem.2023.100700","DOIUrl":"10.1016/j.epidem.2023.100700","url":null,"abstract":"<div><p>Mumps is a vaccine-preventable, reemerging, and highly transmissible infectious disease. Widespread vaccination dramatically reduced cases; however, case counts have been increasing over the past 20 years. To provide a quantitative overview of historical mumps dynamics that can act as baseline information to help identify causes of mumps reemergence, we analyzed timeseries of cases reported from 1923 to 1932 in the United States. During that time, 239,230 mumps cases were reported in 70 cities. Larger cities reported annual epidemics and smaller cities reported intermittent, sporadic outbreaks. The critical community size above which transmission continuously occurred was likely between 365,583 and 781,188 individuals but could range as high as 3,376,438 individuals. Mumps cases increased as city size increased, suggesting density-dependent transmission. Using a density-dependent SEIR model, we calculated a mean effective reproductive number (<span><math><msub><mrow><mi>R</mi></mrow><mrow><mi>e</mi></mrow></msub></math></span>) of 1.2. <span><math><msub><mrow><mi>R</mi></mrow><mrow><mi>e</mi></mrow></msub></math></span> varied by city and over time, with periodic high values that could characterize short periods of very high transmission known as superspreading events. Case counts most often peaked in March, with higher-than-average transmission from December through April and showed a correlation with weekly births. While certain city pairs in Midwestern states had synchronous outbreaks, most outbreaks were less synchronous and not driven by distance between cities. This work demonstrates the importance of long-term infectious disease surveillance data and will inform future studies on mumps reemergence and control.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Modelling the COVID-19 pandemic: Focusing on the case of Greece","authors":"Ioannis G. Violaris , Theodoros Lampros , Konstantinos Kalafatakis , Georgios Ntritsos , Konstantinos Kostikas , Nikolaos Giannakeas , Markos Tsipouras , Evripidis Glavas , Dimitrios Tsalikakis , Alexandros Tzallas","doi":"10.1016/j.epidem.2023.100706","DOIUrl":"10.1016/j.epidem.2023.100706","url":null,"abstract":"<div><p>The SARS-CoV-2 infection (COVID-19) pandemic created an unprecedented chain of events at a global scale, with European counties initially following individual pathways on the confrontation of the global healthcare crisis, before organizing coordinated public vaccination campaigns, when proper vaccines became available. In the meantime, the viral infection outbreaks were determined by the inability of the immune system to retain a long-lasting protection as well as the appearance of SARS-CoV-2 variants with differential transmissibility and virulence. How do these different parameters regulate the domestic impact of the viral epidemic outbreak? We developed two versions of a mathematical model, an original and a revised one, able to capture multiple factors affecting the epidemic dynamics. We tested the original one on five European countries with different characteristics, and the revised one in one of them, Greece. For the development of the model, we used a modified version of the classical SEIR model, introducing various parameters related to the estimated epidemiology of the pathogen, governmental and societal responses, and the concept of quarantine. We estimated the temporal trajectories of the identified and overall active cases for Cyprus, Germany, Greece, Italy and Sweden, for the first 250 days. Finally, using the revised model, we estimated the temporal trajectories of the identified and overall active cases for Greece, for the duration of the 1230 days (until June 2023). As shown by the model, small initial numbers of exposed individuals are enough to threaten a large percentage of the population. This created an important political dilemma in most countries. Force the virus to extinction with extremely long and restrictive measures or merely delay its spread and aim for herd immunity. Most countries chose the former, which enabled the healthcare systems to absorb the societal pressure, caused by the increased numbers of patients, requiring hospitalization and intensive care.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10548188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100698
Dawei Wang , Yao-Hsuan Chen , Mario Ventresca
{"title":"Optimizing age specific strategies of vaccination for prevention of cytomegalovirus infection in the US using agent-based simulation","authors":"Dawei Wang , Yao-Hsuan Chen , Mario Ventresca","doi":"10.1016/j.epidem.2023.100698","DOIUrl":"10.1016/j.epidem.2023.100698","url":null,"abstract":"<div><h3>Background:</h3><p>There is an urgent need to develop a cytomegalovirus (CMV) vaccine as it remains the leading cause of birth defects in the United States. While several CMV vaccine candidates are currently in late-stage clinical trials, the most effective vaccination program remains an open research question.</p></div><div><h3>Methods:</h3><p>To take into account the critical uncertainties when evaluating the vaccine impact on both vertical (congenital) and horizontal CMV transmissions, we developed a CMV agent-based model representative of the US population and contact network structures.</p></div><div><h3>Results:</h3><p>We evaluated 648 vaccination scenarios under various assumptions of vaccination age, vaccine efficacy, protection duration, and vaccination coverage. The optimal age of vaccination under all scenarios is shown to be during early childhood. However, a relatively modest benefit was also seen with vaccination of females of reproduction age (around age of 25) assuming near universal coverage and long vaccine-mediated protection.</p></div><div><h3>Conclusions:</h3><p>This study highlights the important need for a pediatric vaccination program in mitigating CMV in the United States. Our model is poised to investigate further location-based vaccine effectiveness questions in future planning of both clinical trials as well as eventual program implementation.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100693
Matthew I. Betti , Lauren Farrell , Jane Heffernan
{"title":"A pair formation model with recovery: Application to mpox","authors":"Matthew I. Betti , Lauren Farrell , Jane Heffernan","doi":"10.1016/j.epidem.2023.100693","DOIUrl":"10.1016/j.epidem.2023.100693","url":null,"abstract":"<div><p>The current global outbreaks of mpox is a unique infectious disease in the way it seems to be transmitting: it has been observed to be highly concentrated in communities of men who have sex with men (MSM) through pair formation, and also provides long lasting immunity. This framework of mostly close, prolonged contact spreading a disease that admits immunity after infection is unlike similar infections which either offer little to no immunity post-infection or are lifelong infections. This creates the need for a new model framework that incorporates pair formation structure with recovery. While seemingly a straight forward model, we show how new dynamics arise from the combination of pair formation and recovery that are not present in a standard model with recovery and also not present in a pair formation model without recovery. We see that the combination of these two properties allows for waves of infection that are not seen in a standard SIR model. These dynamics suggest that outbreaks of mpox around the world may require special attention from public health. We also derive a reproduction number for this model and estimate the reproduction number of human mpox to be <span><math><mrow><mo>≈</mo><mn>2</mn><mo>.</mo><mn>3</mn></mrow></math></span> using global and Canadian data. The expression derived for <span><math><msub><mrow><mi>R</mi></mrow><mrow><mn>0</mn></mrow></msub></math></span> can help estimate key parameters for diseases transmission and public health interventions and compare to equivalent models without pair formation.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10530220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100703
Younjung Kim, Pierre Nouvellet, Lisa Rogoll, Christoph Staubach, Katja Schulz, Carola Sauter-Louis, Dirk Udo Pfeiffer, Guillaume Fournié
{"title":"Contrasting seasonality of African swine fever outbreaks and its drivers","authors":"Younjung Kim, Pierre Nouvellet, Lisa Rogoll, Christoph Staubach, Katja Schulz, Carola Sauter-Louis, Dirk Udo Pfeiffer, Guillaume Fournié","doi":"10.1016/j.epidem.2023.100703","DOIUrl":"10.1016/j.epidem.2023.100703","url":null,"abstract":"<div><p>The seasonality of African swine fever (ASF) outbreaks in domestic pigs differs between temperate and subtropical/tropical regions. We hypothesise that variations in the importance of wild boar-to-farm and farm-to-farm transmission routes shape these contrasting patterns, and we emphasise the implications for effective ASF control.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Epidemiological characteristics and transmissibility of HPV infection: A long-term retrospective study in Hokkien Golden Triangle, China, 2013–2021","authors":"Jingwen Xu , Guzainuer Abudurusuli , Jia Rui , Zhuoyang Li , Zeyu Zhao , Yilan Xia , Xiaohao Guo , Buasiyamu Abudunaibi , Benhua Zhao , Qiwei Guo , Jing-An Cui , Yulin Zhou , Tianmu Chen","doi":"10.1016/j.epidem.2023.100707","DOIUrl":"10.1016/j.epidem.2023.100707","url":null,"abstract":"<div><h3>Objective</h3><p>Multiple human papillomavirus (HPV)-associated diseases have put a significant disease burden on the world. Therefore, we conducted a study to explore the epidemiological characteristics of HPV and the transmissibility of its genotypes.</p></div><div><h3>Methods</h3><p>HPV testing data was collected from Hospital. A transmission dynamics model of HPV was constructed to simulate and compare the transmissibility of different HPV genotypes, which was quantitatively described by the basic reproduction number (<em>R</em><sub>0</sub>).</p></div><div><h3>Results</h3><p>The collected HPV subjects were mainly from Xiamen City, Zhangzhou City and Quanzhou City, together, they are known as the Hokkien golden triangle. There were variations in the distribution of HPV infections by age groups. Among all HPV genotypes, 13 of them had <em>R</em><sub>0</sub> > 1, with 10 of them being high-risk types. The top five were HPV56, 18, 58, 52 and 53, among which, HPV56, 18, 58 and 42 were of high risk, whereas HPV53 was not, and the <em>R</em><sub>0</sub> values for the five were 3.35 (CI: 0.00–9.99), 3.20 (CI: 0.00–6.46), 3.19 (CI: 1.27–6.94), 3.19 (CI: 1.01–8.42) and 2.99 (CI: 0.00–9.39), respectively. In addition, HPV52 had <em>R</em><sub>0</sub> > 1 for about 51 months, which had the longest duration.</p></div><div><h3>Conclusion</h3><p>Most high-risk HPV types in the Hokkien golden triangle could transmit among the population. Therefore, there is a need of further optimization for developing HPV vaccines and better detection methods in the region.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10233942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"SARS-CoV-2 transmission patterns in educational settings during the Alpha wave in Reggio-Emilia, Italy","authors":"Carla Molina Grané , Pamela Mancuso , Massimo Vicentini , Francesco Venturelli , Olivera Djuric , Mattia Manica , Giorgio Guzzetta , Valentina Marziano , Agnese Zardini , Valeria d’Andrea , Filippo Trentini , Eufemia Bisaccia , Elisabetta Larosa , Silvia Cilloni , Maria Teresa Cassinadri , Patrizio Pezzotti , Marco Ajelli , Paolo Giorgi Rossi , Stefano Merler , Piero Poletti","doi":"10.1016/j.epidem.2023.100712","DOIUrl":"10.1016/j.epidem.2023.100712","url":null,"abstract":"<div><p>Different monitoring and control policies have been implemented in schools to minimize the spread of SARS-CoV-2. Transmission in schools has been hard to quantify due to the large proportion of asymptomatic carriers in young individuals. We applied a Bayesian approach to reconstruct the transmission chains between 284 SARS-CoV-2 infections ascertained during 87 school outbreak investigations conducted between March and April 2021 in Italy. Under the policy of reactive quarantines, we found that 42.5% (95%CrI: 29.5–54.3%) of infections among school attendees were caused by school contacts. The mean number of secondary cases infected at school by a positive individual during in-person education was estimated to be 0.33 (95%CrI: 0.23–0.43), with marked heterogeneity across individuals. Specifically, we estimated that only 26.0% (95%CrI: 17.6–34.1%) of students and school personnel who tested positive during in-person education caused at least one secondary infection at school. Positive individuals who attended school for at least 6 days before being isolated or quarantined infected on average 0.49 (95%CrI: 0.14–0.83) secondary cases. Our findings provide quantitative insights on the contribution of school transmission to the spread of SARS-CoV-2 in young individuals. Identifying positive cases within 5 days after exposure to their infector could reduce onward transmission at school by at least 30%.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10234494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EpidemicsPub Date : 2023-09-01DOI: 10.1016/j.epidem.2023.100702
D. Delport , R. Sacks-Davis , R.G. Abeysuriya , M. Hellard , N. Scott
{"title":"Lives saved by public health restrictions over the Victorian COVID-19 Delta variant epidemic wave, Aug-Nov 2021","authors":"D. Delport , R. Sacks-Davis , R.G. Abeysuriya , M. Hellard , N. Scott","doi":"10.1016/j.epidem.2023.100702","DOIUrl":"10.1016/j.epidem.2023.100702","url":null,"abstract":"<div><h3>Background</h3><p>Prior to mid-2021, Australia’s approach to COVID-19 was to eliminate community transmission. However, between August-November 2021, the state of Victoria, Australia, experienced an outbreak of the Delta variant that continued to grow despite extensive lockdowns and public health measures in place. While these public health restrictions were ultimately unable to stop community transmission, they likely had a major impact reducing transmission and adverse health outcomes relative to voluntary risk-mitigation only (e.g., in response to rising cases and deaths, some people may avoid crowded settings, hospitality, retail, social occasions, or indoor settings). This study aims to estimate the impact of the August-November 2021 enforced public health restrictions in Victoria, compared to voluntary risk-mitigation only.</p></div><div><h3>Methods</h3><p>An agent-based model was calibrated to Victorian epidemiological, health and behavioural data from 1 August to 30 November 2021, as well as policies that were implemented over that period. Two counter-factual scenarios were run for the same period with (a) no restrictions in place; or (b) voluntary risk-mitigation only, based on behaviour measured over the December-January Omicron BA.1 epidemic wave when restrictions were not in place.</p></div><div><h3>Results</h3><p>Over August-November 2021, the baseline model scenario resulted in 97,000 (91,000−102,000) diagnoses, 9100 (8500−9700) hospital admissions, and 480 (430−530) deaths. Without any restrictions in place, there were 3,228,000 (3,200,000−3,253,000) diagnoses, 375,100 (370,200−380,900) hospital admissions, and 16,700 (16,000−17,500) deaths. With voluntary risk-mitigation equal to those observed during the Omicron BA.1 epidemic wave, there were 1,507,000 (1,469,000−1,549,000) diagnoses, 130,300 (124,500−136,000) hospital admissions, and 5500 (5000−6100) deaths.</p></div><div><h3>Conclusion</h3><p>Public health restrictions implemented in Victoria over August-November 2021 are likely to have averted more than 120,000 hospitalizations and 5000 deaths relative to voluntary risk-mitigation only. During a COVID-19 epidemic wave voluntary behaviour change can reduce transmission substantially, but not to the same extent as enforced restrictions.</p></div>","PeriodicalId":49206,"journal":{"name":"Epidemics","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10265399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10547706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}