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Temporal Variability and Social Heterogeneity in Disease Transmission: The Case of SARS in Hong Kong

Identifieur interne : 000C67 ( Pmc/Checkpoint ); précédent : 000C66; suivant : 000C68

Temporal Variability and Social Heterogeneity in Disease Transmission: The Case of SARS in Hong Kong

Auteurs : Anne Cori [France] ; Pierre-Yves Boëlle [France] ; Guy Thomas [France] ; Gabriel M. Leung [République populaire de Chine] ; Alain-Jacques Valleron [France]

Source :

RBID : PMC:2717369

Abstract

The extent to which self-adopted or intervention-related changes in behaviors affect the course of epidemics remains a key issue for outbreak control. This study attempted to quantify the effect of such changes on the risk of infection in different settings, i.e., the community and hospitals. The 2002–2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong, where 27% of cases were healthcare workers, was used as an example. A stochastic compartmental SEIR (susceptible-exposed-infectious-removed) model was used: the population was split into healthcare workers, hospitalized people and general population. Super spreading events (SSEs) were taken into account in the model. The temporal evolutions of the daily effective contact rates in the community and hospitals were modeled with smooth functions. Data augmentation techniques and Markov chain Monte Carlo (MCMC) methods were applied to estimate SARS epidemiological parameters. In particular, estimates of daily reproduction numbers were provided for each subpopulation. The average duration of the SARS infectious period was estimated to be 9.3 days (±0.3 days). The model was able to disentangle the impact of the two SSEs from background transmission rates. The effective contact rates, which were estimated on a daily basis, decreased with time, reaching zero inside hospitals. This observation suggests that public health measures and possible changes in individual behaviors effectively reduced transmission, especially in hospitals. The temporal patterns of reproduction numbers were similar for healthcare workers and the general population, indicating that on average, an infectious healthcare worker did not infect more people than any other infectious person. We provide a general method to estimate time dependence of parameters in structured epidemic models, which enables investigation of the impact of control measures and behavioral changes in different settings.


Url:
DOI: 10.1371/journal.pcbi.1000471
PubMed: 19696879
PubMed Central: 2717369


Affiliations:


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PMC:2717369

Le document en format XML

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<p>The extent to which self-adopted or intervention-related changes in behaviors affect the course of epidemics remains a key issue for outbreak control. This study attempted to quantify the effect of such changes on the risk of infection in different settings, i.e., the community and hospitals. The 2002–2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong, where 27% of cases were healthcare workers, was used as an example. A stochastic compartmental SEIR (susceptible-exposed-infectious-removed) model was used: the population was split into healthcare workers, hospitalized people and general population. Super spreading events (SSEs) were taken into account in the model. The temporal evolutions of the daily effective contact rates in the community and hospitals were modeled with smooth functions. Data augmentation techniques and Markov chain Monte Carlo (MCMC) methods were applied to estimate SARS epidemiological parameters. In particular, estimates of daily reproduction numbers were provided for each subpopulation. The average duration of the SARS infectious period was estimated to be 9.3 days (±0.3 days). The model was able to disentangle the impact of the two SSEs from background transmission rates. The effective contact rates, which were estimated on a daily basis, decreased with time, reaching zero inside hospitals. This observation suggests that public health measures and possible changes in individual behaviors effectively reduced transmission, especially in hospitals. The temporal patterns of reproduction numbers were similar for healthcare workers and the general population, indicating that on average, an infectious healthcare worker did not infect more people than any other infectious person. We provide a general method to estimate time dependence of parameters in structured epidemic models, which enables investigation of the impact of control measures and behavioral changes in different settings.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">PLoS Comput Biol</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS Comput. Biol</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">ploscomp</journal-id>
<journal-title-group>
<journal-title>PLoS Computational Biology</journal-title>
</journal-title-group>
<issn pub-type="ppub">1553-734X</issn>
<issn pub-type="epub">1553-7358</issn>
<publisher>
<publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">19696879</article-id>
<article-id pub-id-type="pmc">2717369</article-id>
<article-id pub-id-type="publisher-id">08-PLCB-RA-0904R3</article-id>
<article-id pub-id-type="doi">10.1371/journal.pcbi.1000471</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline">
<subject>Infectious Diseases/Epidemiology and Control of Infectious Diseases</subject>
<subject>Infectious Diseases/Nosocomial and Healthcare-Associated Infections</subject>
<subject>Infectious Diseases/Viral Infections</subject>
<subject>Mathematics/Statistics</subject>
<subject>Public Health and Epidemiology/Epidemiology</subject>
<subject>Public Health and Epidemiology/Infectious Diseases</subject>
<subject>Public Health and Epidemiology/Nosocomial and Healthcare-Associated Infections</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Temporal Variability and Social Heterogeneity in Disease Transmission: The Case of SARS in Hong Kong</article-title>
<alt-title alt-title-type="running-head">Temporal & Social Disease Transmission Differences</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Cori</surname>
<given-names>Anne</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor1">
<sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Boëlle</surname>
<given-names>Pierre-Yves</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Thomas</surname>
<given-names>Guy</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Leung</surname>
<given-names>Gabriel M.</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Valleron</surname>
<given-names>Alain-Jacques</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff1">
<label>1</label>
<addr-line>INSERM, Paris, France</addr-line>
</aff>
<aff id="aff2">
<label>2</label>
<addr-line>Université Pierre et Marie Curie-Paris6, Paris, France</addr-line>
</aff>
<aff id="aff3">
<label>3</label>
<addr-line>School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China</addr-line>
</aff>
<contrib-group>
<contrib contrib-type="editor">
<name>
<surname>Ferguson</surname>
<given-names>Neil M.</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1">Imperial College London, United Kingdom</aff>
<author-notes>
<corresp id="cor1">* E-mail:
<email>cori@u707.jussieu.fr</email>
</corresp>
<fn fn-type="con">
<p>Conceived and designed the experiments: AC P-YB GT A-JV. Performed the experiments: AC P-YB. Analyzed the data: AC P-YB GT. Contributed reagents/materials/analysis tools: P-YB GML. Wrote the paper: AC. Contributed to drafting the manuscript: P-YB GT GML A-JF.</p>
</fn>
</author-notes>
<pub-date pub-type="collection">
<month>8</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="epub">
<day>21</day>
<month>8</month>
<year>2009</year>
</pub-date>
<volume>5</volume>
<issue>8</issue>
<elocation-id>e1000471</elocation-id>
<history>
<date date-type="received">
<day>13</day>
<month>10</month>
<year>2008</year>
</date>
<date date-type="accepted">
<day>15</day>
<month>7</month>
<year>2009</year>
</date>
</history>
<permissions>
<copyright-statement>Cori et al.</copyright-statement>
<copyright-year>2009</copyright-year>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p>
</license>
</permissions>
<abstract>
<p>The extent to which self-adopted or intervention-related changes in behaviors affect the course of epidemics remains a key issue for outbreak control. This study attempted to quantify the effect of such changes on the risk of infection in different settings, i.e., the community and hospitals. The 2002–2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong, where 27% of cases were healthcare workers, was used as an example. A stochastic compartmental SEIR (susceptible-exposed-infectious-removed) model was used: the population was split into healthcare workers, hospitalized people and general population. Super spreading events (SSEs) were taken into account in the model. The temporal evolutions of the daily effective contact rates in the community and hospitals were modeled with smooth functions. Data augmentation techniques and Markov chain Monte Carlo (MCMC) methods were applied to estimate SARS epidemiological parameters. In particular, estimates of daily reproduction numbers were provided for each subpopulation. The average duration of the SARS infectious period was estimated to be 9.3 days (±0.3 days). The model was able to disentangle the impact of the two SSEs from background transmission rates. The effective contact rates, which were estimated on a daily basis, decreased with time, reaching zero inside hospitals. This observation suggests that public health measures and possible changes in individual behaviors effectively reduced transmission, especially in hospitals. The temporal patterns of reproduction numbers were similar for healthcare workers and the general population, indicating that on average, an infectious healthcare worker did not infect more people than any other infectious person. We provide a general method to estimate time dependence of parameters in structured epidemic models, which enables investigation of the impact of control measures and behavioral changes in different settings.</p>
</abstract>
<abstract abstract-type="summary">
<title>Author Summary</title>
<p>Recent epidemics have shown that healthcare workers may be overrepresented among cases and how critical it is to protect them. For example, during the 2002–2003 severe acute respiratory syndrome (SARS) epidemics in Hong Kong, 27%of cases were healthcare workers when they were <1% of the population. Better means of protection require understanding how healthcare workers were infected and assessing their role in disease transmission. Here, we describe a method for estimating the temporal profile of the risk of infection and probability of transmission in the community and hospitals. The 2002–2003 SARS outbreak in Hong Kong is used as an example. For the SARS epidemic, we show that the risk of infection in the community and hospitals decreased with time down to zero in hospitals but remained larger in the community. This observation suggests that public health measures and behavioural changes most effectively reduced transmission in hospitals. Besides, we find that the large number of cases observed among healthcare workers is more likely a result of large and sustained exposure to hospitalized cases than to transmission among healthcare workers. These results are of interest to design control measures in the event of an influenza pandemic.</p>
</abstract>
<counts>
<page-count count="8"></page-count>
</counts>
</article-meta>
</front>
</pmc>
<affiliations>
<list>
<country>
<li>France</li>
<li>République populaire de Chine</li>
</country>
<region>
<li>Île-de-France</li>
</region>
<settlement>
<li>Paris</li>
</settlement>
</list>
<tree>
<country name="France">
<region name="Île-de-France">
<name sortKey="Cori, Anne" sort="Cori, Anne" uniqKey="Cori A" first="Anne" last="Cori">Anne Cori</name>
</region>
<name sortKey="Boelle, Pierre Yves" sort="Boelle, Pierre Yves" uniqKey="Boelle P" first="Pierre-Yves" last="Boëlle">Pierre-Yves Boëlle</name>
<name sortKey="Boelle, Pierre Yves" sort="Boelle, Pierre Yves" uniqKey="Boelle P" first="Pierre-Yves" last="Boëlle">Pierre-Yves Boëlle</name>
<name sortKey="Cori, Anne" sort="Cori, Anne" uniqKey="Cori A" first="Anne" last="Cori">Anne Cori</name>
<name sortKey="Thomas, Guy" sort="Thomas, Guy" uniqKey="Thomas G" first="Guy" last="Thomas">Guy Thomas</name>
<name sortKey="Thomas, Guy" sort="Thomas, Guy" uniqKey="Thomas G" first="Guy" last="Thomas">Guy Thomas</name>
<name sortKey="Valleron, Alain Jacques" sort="Valleron, Alain Jacques" uniqKey="Valleron A" first="Alain-Jacques" last="Valleron">Alain-Jacques Valleron</name>
<name sortKey="Valleron, Alain Jacques" sort="Valleron, Alain Jacques" uniqKey="Valleron A" first="Alain-Jacques" last="Valleron">Alain-Jacques Valleron</name>
</country>
<country name="République populaire de Chine">
<noRegion>
<name sortKey="Leung, Gabriel M" sort="Leung, Gabriel M" uniqKey="Leung G" first="Gabriel M." last="Leung">Gabriel M. Leung</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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