隔离患者对控制学校甲型H1N1流感暴发疫情效果的数学模拟  

Mathematical Simulation of the Effect of Isolation on Influenza A(H1N1)Outbreak at School

作　　者：陈田木[1,2] 刘如春[2] 谭爱春[1] 何琼[1] 田丹平[1] 黄渊秀[1] 高林[1] 董晶[1] 李黎[1] 邓欣[1] 胡国清[1] 

机构地区：[1]中南大学公共卫生学院流行病与卫生统计学系,410078 [2]长沙市疾病预防控制中心,410001

出　　处：《中国卫生统计》2014年第3期390-394,共5页Chinese Journal of Health Statistics

基　　金：湖南省卫生厅科研项目(B2012-138);2009教育部新世纪人才计划项目(NCET-10-0782);长沙市科技局科研项目(K1205028-31)资助

摘　　要：目的采用动力学模型模拟隔离措施在学校甲型H1N1流感暴发疫情处理中的效果。方法根据甲型H1N1流感疾病特征和学校人口学特点,建立易感者-潜伏期-显性/隐性感染者-移出者(susceptible-exposed-infectious/asymptomatic-removed,SEIAR)模型,对长沙市某校甲型H1N1流感暴发疫情进行模拟,采用卡方检验评价模拟结果与实际疫情的拟合优度,并确定模型的关键参数。在SEIAR模型基础上引入隔离措施,构建易感者-潜伏期-显性/隐性感染者-移出者-隔离者(susceptible-exposed-infectious/asymptomatic-removed-quarantine,SEIARQ)模型。为方便基层公共卫生工作者,将对患者(显性感染者)的隔离等分为10个等级(10%、20%、…、90%、100%),以评估不同隔离比例的效果。结果无干预情况下,疫情基本再生数(λ0)为5.64,疫情持续31天,人群感染率高达99.51%。在对显性感染者采取隔离措施后,随着隔离比例的增加,人群感染率(含显性和隐性感染)和人群罹患率(仅含显性感染)逐渐下降。当隔离全部显性感染患者后,可减少63%的罹患率。在只隔离显性感染措施时,仅当隔离比例超过30%,疫情控制效果才相对显著。结论单纯隔离患者最多能降低63%的人群甲型H1N1流感罹患率。各地公共卫生机构应根据当地人力和物力情况,采取部分隔离(隔离比例≥30%)与其他措施相结合的方式阻断甲型H1N1疫情的发展。Objective To assess the effect of isolation on influenza A （H1N1） outbreak at school using a dynamical model. Methods Based on the history of influenza A（ H1N1 ） and the demographic characteristics Of school, we set up a sus- ceptible-exposed-infectious/asymptomatic-removed（SEIAR） model to simulate an influenza A（ H1N1 ） outbreak at school in Changsha city. Chi-square test was used to evaluate the goodness between simulated and actual outbreaks. In the SEIAR simulation, key parameters were determined based on literature. On the basis of SEIAR, we introduced ＇ isolation＇ and constructed the susceptible-exposed-infectious/asymptomatic-removed-quarantine（SEIARQ） model. To facilitate local public health practitioners,we equally divided isolation into 10 categories from 10% to 100%. Results When there was no intervention,basic repro- duction number（ k0 ） of the influenza A（H1 N1 ） outbreak at school in Changsha city reached 5.64; the outbreak would last 31 days and 99. 51% of students would be infected. When isolations were implemented to infected persons, the population infection rate（ including both symptomatic and asymptomatic infection） and the population attack rate（ only including symptomatic infec- tion） decreased gradually as the proportion of persons being isolated increased. The population attack rate would decrease by 63 % when all symptomatic persons were isolated. On the condition that there was merely isolation being made, the preventative effect of isolation would be minor unless over 30% of infected persons were isolated. Conclusion Isolation of patients can reduce up to 63% of the population attack rate of influenza A（ H1N1 ） when there are no other interventions. Local public health agencies should be based on local human and material resources to isolate part of infected persons（ isolation ratio 〉i 30% ） along with taking other measures to prevent the development of the outbreak of influenza A（H1N1 ）.

关 键 词：甲型H1N1流感 暴发 隔离 动力学模型 基本再生数 

分 类 号：R511.7[医药卫生—内科学]