在存在储存库暴露或输入性病例的情况下估计繁殖数的一些简单规则
Some simple rules for estimating reproduction numbers in the presence of reservoir exposure or imported cases
摘要：
基本繁殖数（$R_0$）是孤立种群中疾病灭绝或存活的阈值参数。然而，没有一个人类群体是与其他人类或动物群体完全隔离的。我们使用房室模型推导出简单的规则，为当地人传人和暴露于其他来源的人群的基本繁殖数：无论是水库暴露或输入病例。我们引入了病毒驱动型或输入驱动型疾病的概念：在没有宿主暴露或输入病例（自$R_0<1$以来）的情况下，这些疾病将在目标人群中灭绝，但仍然可能具有充分的传播性，以至于许多或大多数感染都是从该人群中的人类获得的。我们表明，在最简单的情况下，$R_0<1$当且仅当从外部来源获得的感染的比例超过疾病的患病率，并探讨如何人口异质性和多种菌株的相互作用影响这一规则。我们将这些规则应用于两个艰难梭菌感染和定植的病例研究：艰难梭菌在医院环境中占输入病例的比例，而C.一般人群中的艰难梭菌占暴露于动物水库。我们证明，即使是医院适应的，高传播性的NAP 1/RT 027菌株的C。艰难梭菌在住院患者的里程碑式研究中具有<1的繁殖数，因此在研究医院的定殖和感染入院中得以维持。我们认为C.如果只有13.0%的传播可归因于动物宿主，则应将艰难梭菌视为病毒驱动型。
英文摘要：
The basic reproduction number ($R_0$) is a threshold parameter for disease extinction or survival in isolated populations. However no human population is fully isolated from other human or animal populations. We use compartmental models to derive simple rules for the basic reproduction number for populations with local person-to-person transmission and exposure from some other source: either a reservoir exposure or imported cases. We introduce the idea of a reservoir-driven or importation-driven disease: diseases that would become extinct in the population of interest without reservoir exposure or imported cases (since $R_0<1$), but nevertheless may be sufficiently transmissible that many or most infections are acquired from humans in that population. We show that in the simplest case, $R_0<1$ if and only if the proportion of infections acquired from the external source exceeds the disease prevalence and explore how population heterogeneity and the interactions of multiple strains affect this rule. We apply these rules in two cases studies of Clostridium difficile infection and colonisation: C. difficile in the hospital setting accounting for imported cases, and C. difficile in the general human population accounting for exposure to animal reservoirs. We demonstrate that even the hospital-adapted, highly-transmissible NAP1/RT027 strain of C. difficile had a reproduction number <1 in a landmark study of hospitalised patients and therefore was sustained by colonised and infected admissions to the study hospital. We argue that C. difficile should be considered reservoir-driven if as little as 13.0% of transmission can be attributed to animal reservoirs.
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