乍得曼杜勒重点地区冈比亚非洲锥虫病传播模型和预测的更新。

IF 4.8 1区 医学 Q1 INFECTIOUS DISEASES
Kat S Rock, Ching-I Huang, Ronald E Crump, Paul R Bessell, Paul E Brown, Inaki Tirados, Philippe Solano, Marina Antillon, Albert Picado, Severin Mbainda, Justin Darnas, Emily H Crowley, Steve J Torr, Mallaye Peka
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引用次数: 0

摘要

背景:近年来,病媒控制、筛查和治疗冈比亚非洲锥虫病(gHAT)感染的计划使乍得曼都勒病区的病例迅速减少。为了体现人类与采采蝇之间传播的生物学特性,我们之前开发了一个机理传播模型,该模型与 2000 年至 2013 年的数据相匹配,表明传播到 2015 年已经中断。本研究概述了对模型的改进,以便(1)评估尽管病例报告数量较少,但是否已经消除了传播;(2)量化强化干预措施在减少传播中的作用;以及(3)预测未来十年不同策略下曼杜尔的 gHAT 传播轨迹:方法:利用人类病例数据(2000-2019 年)和一系列模型改进,更新了我们以前的曼都勒 gHAT 传播模型。其中包括如何将诊断特异性纳入模型,以及对拟合方法的改进(观察到的病例报告差异增加,以及如何捕捉报告不足和被动筛查的改进)。我们对两个模型的病例数据拟合情况进行了并列比较:我们估计,自 2015 年以来,由于固定医疗机构的诊断服务有所改善,被动检测率有所提高,第一阶段检测率提高了 2.1 倍,第二阶段提高了 1.5 倍。我们发现,虽然主动筛查的诊断算法估计具有很高的特异性(95% 可信区间 (CI) 99.9-100%,特异性 = 99.9%),但高筛查率和低感染率意味着最近报告的一些未得到寄生虫学确认的病例可能是假阳性。我们还发现,通过模型拟合(95% CI 96.1-99.6%,Reduction = 99.1%)估算出的重点地区采采蝇减少量与之前通过监测陷阱采采蝇捕获量的减少量相当。与之前的结果一致,该模型表明,由于加强了干预措施,2015 年的传播中断了:我们建议在曼杜尔进行更多的确证测试,以确保能够仔细监测终局。如果有一个强大的被动监测系统,对病例进行更具体的测量将能更好地告知何时停止主动筛查和病媒控制是安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad.

Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad.

Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad.

Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad.

Background: In recent years, a programme of vector control, screening and treatment of gambiense human African trypanosomiasis (gHAT) infections led to a rapid decline in cases in the Mandoul focus of Chad. To represent the biology of transmission between humans and tsetse, we previously developed a mechanistic transmission model, fitted to data between 2000 and 2013 which suggested that transmission was interrupted by 2015. The present study outlines refinements to the model to: (1) Assess whether elimination of transmission has already been achieved despite low-level case reporting; (2) quantify the role of intensified interventions in transmission reduction; and (3) predict the trajectory of gHAT in Mandoul for the next decade under different strategies.

Method: Our previous gHAT transmission model for Mandoul was updated using human case data (2000-2019) and a series of model refinements. These include how diagnostic specificity is incorporated into the model and improvements to the fitting method (increased variance in observed case reporting and how underreporting and improvements to passive screening are captured). A side-by-side comparison of fitting to case data was performed between the models.

Results: We estimated that passive detection rates have increased due to improvements in diagnostic availability in fixed health facilities since 2015, by 2.1-fold for stage 1 detection, and 1.5-fold for stage 2. We find that whilst the diagnostic algorithm for active screening is estimated to be highly specific (95% credible interval (CI) 99.9-100%, Specificity = 99.9%), the high screening and low infection levels mean that some recently reported cases with no parasitological confirmation might be false positives. We also find that the focus-wide tsetse reduction estimated through model fitting (95% CI 96.1-99.6%, Reduction = 99.1%) is comparable to the reduction previously measured by the decline in tsetse catches from monitoring traps. In line with previous results, the model suggests that transmission was interrupted in 2015 due to intensified interventions.

Conclusions: We recommend that additional confirmatory testing is performed in Mandoul to ensure the endgame can be carefully monitored. More specific measurement of cases, would better inform when it is safe to stop active screening and vector control, provided there is a strong passive surveillance system in place.

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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty Medicine-Public Health, Environmental and Occupational Health
CiteScore
16.70
自引率
1.20%
发文量
368
审稿时长
13 weeks
期刊介绍: Infectious Diseases of Poverty is a peer-reviewed, open access journal that focuses on essential public health questions related to infectious diseases of poverty. It covers a wide range of topics and methods, including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies, and their application. The journal also explores the impact of transdisciplinary or multisectoral approaches on health systems, ecohealth, environmental management, and innovative technologies. It aims to provide a platform for the exchange of research and ideas that can contribute to the improvement of public health in resource-limited settings. In summary, Infectious Diseases of Poverty aims to address the urgent challenges posed by infectious diseases in impoverished populations. By publishing high-quality research in various areas, the journal seeks to advance our understanding of these diseases and contribute to the development of effective strategies for prevention, diagnosis, and treatment.
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