基于EV71疫苗接种的江苏省手足口病动力学模型研究
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摘要
目的构建江苏省手足口病动力学模型,分析江苏省手足口病的流行情况,预测发病趋势,并模拟肠道病毒71型(enterovirus 71,EV71)疫苗接种对EV71所致手足口病的控制效果。方法构建具有仓室结构的手足口病动力学模型,建立微分方程组,用2013-2016年江苏省手足口病发病数据对模型进行拟合,求出江苏省手足口病的基本再生数,再将疫苗接种纳入模型,模拟不同疫苗接种覆盖率下手足口病的发病情况。结果 2013-2016年江苏省手足口病基本再生数R_0分别为1.31(IQR:0.99～1.48)、1.37(IQR:0.97～1.52)、1.34(IQR:1.00～1.61)和1.38(IQR:1.00～1.76)。随着EV71疫苗免疫接种覆盖率的增加,EV71所致手足口病的发病数逐渐减少。当EV71疫苗年接种率保持在一个相对较高的水平(75%)时,5年后EV71所致手足口病的年发病数将降至同年未接种疫苗时的10%。结论 2013-2016年江苏省手足口病流行趋势较稳定,疫苗接种对于控制EV71所致手足口病具有重要的作用。
Objective To establish a dynamic model of hand foot and mouth disease in Jiangsu Province, analyze the epidemic of hand foot and mouth disease in Jiangsu, predict the trend of this disease and simulate the effect of EV71 vaccination on the control of hand foot and mouth disease caused by EV71. Methods A compartmental model of hand foot and mouth disease was constructed.A group of differential equations was established. The incidence data of hand foot and mouth disease was used to fit the model and calculate the basic reproduction number of this disease in Jiangsu. Then, vaccination was added to the model and the incidence of hand foot and mouth disease under different vaccination coverage rates was simulated. Results The basic reproduction numbers of hand foot and mouth disease in Jiangsu between 2013 and 2016 were 1.31(IQR:0.99-1.48), 1.37(IQR:0.97-1.52), 1.34(IQR:1.00-1.61) and 1.38(IQR:1.00-1.76), respectively. With the increase of immunization coverage of EV71 vaccine, the cases of hand foot and mouth disease caused by EV71 decreased accordingly. When the annual immunization rate of EV71 vaccine was maintained at a high level(75%), the annual incidence of hand foot and mouth disease caused by EV71 after 5 years reduced to 10% of that in the same year when there was no vaccination. Conclusions The epidemic trend of hand foot and mouth disease in Jiangsu is stable from 2013 to 2016. Vaccination plays an important role in controlling hand foot and mouth disease caused by EV71.
Objective To establish a dynamic model of hand foot and mouth disease in Jiangsu Province, analyze the epidemic of hand foot and mouth disease in Jiangsu, predict the trend of this disease and simulate the effect of EV71 vaccination on the control of hand foot and mouth disease caused by EV71. Methods A compartmental model of hand foot and mouth disease was constructed.A group of differential equations was established. The incidence data of hand foot and mouth disease was used to fit the model and calculate the basic reproduction number of this disease in Jiangsu. Then, vaccination was added to the model and the incidence of hand foot and mouth disease under different vaccination coverage rates was simulated. Results The basic reproduction numbers of hand foot and mouth disease in Jiangsu between 2013 and 2016 were 1.31(IQR:0.99-1.48), 1.37(IQR:0.97-1.52), 1.34(IQR:1.00-1.61) and 1.38(IQR:1.00-1.76), respectively. With the increase of immunization coverage of EV71 vaccine, the cases of hand foot and mouth disease caused by EV71 decreased accordingly. When the annual immunization rate of EV71 vaccine was maintained at a high level(75%), the annual incidence of hand foot and mouth disease caused by EV71 after 5 years reduced to 10% of that in the same year when there was no vaccination. Conclusions The epidemic trend of hand foot and mouth disease in Jiangsu is stable from 2013 to 2016. Vaccination plays an important role in controlling hand foot and mouth disease caused by EV71.
引文
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[15] Takahashi S, Liao Q, Van Boeckel TP, et al. Hand, foot, and mouth disease in China: modeling epidemic dynamics of enterovirus serotypes and implications for vaccination [J]. PLoS Med., 2016,13(2):e1001958. DOI:10.1371/journal.pmed.1001958.
[2] Safi MA, Gumel AB. Dynamics of a model with quarantine-adjusted incidence and quarantine of susceptible individuals [J]. Journal of Mathematical Analysis & Applications, 2013,399(2):565-575. DOI:10.1016/j.jmaa.2012.10.015.
[3] Kermack WO, McKendrick AG. Contributions to the mathematical theory of epidemics--I. 1927 [J]. Bull Math Biol, 1991,53(1-2):33-55. DOI:10.1007/bf02464423.
[4] Edwards DM, Shachter RD, Owens DK. A dynamic model of HIV transmission for evaluating of the costs and benefits of vaccine programs [J]. Interfaces, 1998,28(3)144-166. DOI:10.1287/inte.28.3.144.
[5] Whang S, Choi S, Jung E. A dynamic model for tuberculosis transmission and optimal treatment strategies in South Korea [J]. J Theor Biol, 2011,279(1):120-131. DOI:10.1016/j.jtbi.2011.03.009.
[6] van den Driessche P, Watmough J. Reproduction numbers and sub-threshold endemic equilibria for compartmental models of disease transmission [J]. Math Biosci, 2002,180(1-2):29-48. DOI:10.1016/S0025-5564(02)00108-6.
[7] 李燕婷. 手足口病的流行病学特征及预防控制 [J]. 上海预防医学, 2008,20(6):316-317. DOI:10.3969/j.issn.1004-9231.2008.06.029. Li YT. Epidemiology, prevention and control of hand foot and mouth disease [J]. Shanghai J Prevent Med, 2008,20(6):316-317. DOI:10.3969/j.issn.1004-9231.2008.06.029.
[8] Chang LY, Tsao KC, Hsia SH, et al. Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan [J]. JAMA, 2004,291(2):222-227. DOI:10.1001/jama.291.2.222.
[9] Zhu F, Xu W, Xia J, et al. Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China [J]. N Engl J Med, 2014,370(9):818-828. DOI:10.1056/NEJMoa1304923.
[10] Zhu FC, Meng FY, Li JX, et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial [J]. Lancet, 2013,381(9882):2024-2032. DOI:10.1016/S0140-6736(13)61049-1.
[11] Ji H, Li L, Liu YM, et al. Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu Province, China [J]. Virol J, 2012,9(1):248-255. DOI:10.1186/1743-422X-9-248.
[12] 肖革新,许艳,马家奇,等. 中国手足口病影响因素广义估计方程分析 [J]. 中国公共卫生, 2012,28(9):1225-1227. DOI:10.11847/zgggws2012-28-09-31. Xiao GX, Xu Y, Ma JQ, et al. Analysis of the influence factors of HFMD in China by generalized estimation equation [J]. Chin J Public Health, 2012,28(9):1225-1227. DOI:10.11847/zgggws2012-28-09-31.
[13] Lai CC, Jiang DS, Wu HM, et al. A dynamic model for the outbreaks of hand, foot, and mouth disease in Taiwan [J]. Epidemiol Infect, 2016,144(7):1500-1511. DOI:10.1017/S0950268815002630.
[14] Wang J, Xiao Y, Cheke RA. Modelling the effects of contaminated environments on HFMD infections in mainland China [J]. Biosystems, 2015,140(1-2):1-7. DOI:10.1016/j.biosystems.2015.12.001.
[15] Takahashi S, Liao Q, Van Boeckel TP, et al. Hand, foot, and mouth disease in China: modeling epidemic dynamics of enterovirus serotypes and implications for vaccination [J]. PLoS Med., 2016,13(2):e1001958. DOI:10.1371/journal.pmed.1001958.