长沙市甲型H1N1流感流行干预措施效果的数学模拟  

Simulating the Effects of Intervention Strategies on the Epidemic of Influenza A( H1N1) Using Dynamic Model in Changsha City

作　　者：陈田木[1] 刘如春[1] 张锡兴[1] 黄渊秀[2] 杨洋[3] 胡国清[2] 

机构地区：[1]长沙市疾病预防控制中心,410001 [2]中南大学公共卫生学院流行病与卫生统计学系 [3]佛罗里达大学公共卫生学院生物统计学系

出　　处：《中国卫生统计》2015年第2期205-210,共6页Chinese Journal of Health Statistics

基　　金：湖南省卫生厅科研项目(B2012-138);长沙市科技局科研项目(K1205028-31)资助

摘　　要：目的采用基于流行病学调查数据的动力学模型,模拟常用干预措施对控制长沙市甲型H1N1流感流行的效果。方法根据甲型H1N1流感疾病特征,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。在SEIAR模型基础上,依次构建包括隔离、治疗患者、疫苗接种等措施单独使用和联合使用的数学模型。采用长沙市实际疫情数据、暴发疫情数据、血清学调查数据、以及相关文献估算相关参数。采用软件Matlab7.1和Berkeley Madonna8.3.18实施模拟,采用累计罹患率(total attack rate,TAR)和累计感染率(total infection rate,TIR)指标评估干预效果。结果甲型H1N1流感的平均潜伏期为2.1天,平均病程为5.3天,隐性感染比例为41.54%,重症病例比例为3.11%,病死率为0.33%。长沙市甲型H1N1流感流行的基本再生数为1.81,无干预情况下流行导致的全人口TIR为73.98%、TAR为43.25%。每日隔离0.66%的患者和每日疫苗接种0.1%易感者能将TAR分别降低至29.70%和23.82%。隔离力度和疫苗接种力度越大,TAR越小。针对所有患者的治疗措施能将TAR降低至29.77%。综合干预措施效果的优劣顺序依次为:"隔离+治疗患者+疫苗接种"、"疫苗接种+治疗患者"、"隔离+疫苗接种"、"隔离+治疗患者"。结论 SEIAR模型可以较好地模拟流感流行的特点,流感流行时"隔离+治疗患者+疫苗接种"的综合干预措施效果最佳。Objectives To simulate the effects of interventions of isolation, antivirus, vaccination etc. on the epidemic of influenza A（H1N1） in Changsha city using data- dynamical model. Methods Based on the history of influenza A （H1N1）, we built a susceptible-exposed-infectious/asymptomatic-removed （SEIAR） model. Then, intervention-specific models were developed, including isolation, antivirus drug, vaccination and combined interventions accordingly. Key parameters of models were estimated based on epidemiological data, outbreak data, and serological survey data and related literature. We did the simulation using Matlab 7.1 and Berkeley Madonna 8.3.18. Total attack rate （TAR） and total infection rate （TIR） were used to assess the effects of interventions. Results The average incubation period and the average infectious period of influenza A （H1N1） was 2.1 days and 5.3 days, respectively. 41.54% of infected persons were asymptomatic. 3.11% of symptomatic patients had severe symptoms and the case fatality rate was 0.33%. The basic reproduction number （λ0） of influenza A （H1N1） pandemic was 1.81 in Changsha city. Without interventions, the TIR and TAR would be 73.98% and 43.25%, respectively. The TAR would decrease to 41.11% and 30.92% if 0.66% of the infected were isolated and 0.1% of the susceptible were vaccinated each day separately. Strong quarantine and vaccination would lead to small TAR. The TAR would fall to 29.77% if all patients received antivirus drug treatment. The effects of combined interventions decreased as follow： ‘isolation ＋ antivirus drug ＋ vaccination’, ‘antivirus drug ＋ vaccination’, ‘isolation ＋ antivirus drug’ and ‘isolation ＋ vaccination’. Conclusions SEIAR model can well simulate the transmission of influenza A（H1N1） epidemic. The combination of isolation, antivirus drug and vaccination can maximally control the transmission of influenza A（H1N1）.

关 键 词：动力学模型 甲型H1N1流感 流行 隔离 抗病毒药物 疫苗接种 

分 类 号：R511.7[医药卫生—内科学]