模拟结核病例发现的影响:感染动态的作用
Theresa S Ryckman1, Sourya Shrestha2, Anthony T Fojo3
1Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland 21287.
概括
数学模型可能低估了结核病控制. 考虑到潜在感染的清除,而不是终身风险,表明积极的病例发现活动可以比以前认为的更大程度上减少结核病发病率.
科学领域:
- 流行病学 流行病学
- 数学建模的数学建模
- 传染病控制和控制传染病
背景情况:
- 在人口层面寻找病例是对高负担地区结核病 (TB) 控制的推策略.
- 当前的数学模型经常假设感染后的终身进展风险,可能低估了病例发现干预措施.
- 潜在感染清除的可能性可能会影响长期结核病复激活率和干预影响.
研究的目的:
- 评估假设隐性感染的清除,而不是终身风险,是否会改变结核病例发现影响的预测.
- 为了比较两个流行病学模型 (常规与清除) 与印度的实证结核病数据的合适性.
主要方法:
- 开发了两个数学模型:"传统" (终身进展风险) 和"清除" (允许感染清除).
- 使用实证数据对印度结核病负担和感染进展进行了校准.
- 预测了模拟的全社区活跃病例寻找活动 (75%的覆盖率每两年一次),有或没有结核病预防治疗 (TPT) 的影响.
主要成果:
- 与"传统"模型相比",清除"模型与结核病发病率,感染流行率和历史趋势的经验数据更适合.
- "清除"模型预测,结核病发病率从病例发现后减少得更大:在10年后,结核病发病率下降了26% (15-41%),而11% (7-24%).
- 这些发现表明,结合感染清除可以提高模型准确性和结核病控制影响估计.
结论:
- 潜在感染清除的生物可能性支持将其纳入结核病流行病学模型.
- 考虑到感染清除的模型可以提供更准确的结核病控制干预措施有效性的预测.
- 在人口层面发现结核病的活跃病例可能比先前估计的更有影响力,因为模型假设终身进展风险.
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