阿根廷安第斯病毒的“超级传播者”和人际传播分析
阿根廷安第斯病毒的“超级传播者”和人际传播分析
作者： 小柯机器人 发布时间：2020/12/4 12:59:13
本期文章：《新英格兰医学杂志》：Vol.383 No.23
美国陆军传染病医学研究所Gustavo Palacios联合阿根廷国家传染病研究所Valeria P. Martínez团队研究了阿根廷安第斯病毒的“超级传播者”和人际传播。2020年12月2日，该研究发表在《新英格兰医学杂志》上。
2018年11月至2019年2月，阿根廷丘布特省发生安第斯病毒（ANDV）汉坦病毒肺综合征的人际传播，导致34例确诊感染和11例死亡。了解ANDV人际传播的基因组学、流行病学和临床特征对于设计有效的干预措施至关重要。
研究组通过患者报告和公共卫生中心获得了临床和流行病学信息，对汉坦病毒肺综合征爆发的原因，即ANDV感染采用血清学检测、接触追踪和下一代测序来进行鉴定，并重建了人与人之间的传播事件。
啮齿动物宿主将ANDV单向引入人群后，3名有症状的感染者参加了人群密集的社交活动，从而导致传播。在确诊了18例病例之后，公共卫生官员对确诊病例进行了隔离，并要求可能的接触者自我隔离，这些措施很可能会减少进一步的传播。在实施控制措施之前，中位繁殖数（感染期间由感染者引起的继发病例数）为2.12，而在实施控制措施后降为0.96。
研究组使用27名患者的标本对此次疫情中涉及的ANDV毒株进行了全基因组测序，结果发现该毒株（Epuyen/18-19）与引起汉坦病毒肺综合征的ANDV致病毒株（Epilink/96）相似，Epilink/96曾于1996年在阿根廷埃尔博尔森镇引发首次人传人。此次暴发中涉及ANDV汉坦病毒肺综合征患者的临床研究表明，病毒载量高且肝损伤的患者比其他患者更容易传播感染。疾病的严重程度、基因组多样性、年龄和住院时间与二次传播没有明确关联。
研究结果表明，在患有ANDV汉坦病毒肺综合征的患者中，高病毒滴度加上大规模社交聚会或人与人之间的广泛接触，可显著增加病毒传播风险。
附：英文原文
Title: “Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina
Author: Valeria P. Martínez, Ph.D.,, Nicholas Di Paola, Sc.D.,, Daniel O. Alonso, B.Sc.,, Unai Pérez-Sautu, Ph.D.,, Carla M. Bellomo, Ph.D.,, Ayelén A. Iglesias, B.Sc.,, Rocio M. Coelho, B.Sc.,, Beatriz López, B.Sc.,, Natalia Periolo, Ph.D.,, Peter A. Larson, Ph.D.,, Elyse R. Nagle, M.Sc.,, Joseph A. Chitty, B.Sc.,, Catherine B. Pratt, M.Sc.,, Jorge Díaz, Ph.D.,, Daniel Cisterna, Ph.D.,, Josefina Campos, B.Sc.,, Heema Sharma, M.Sc.,, Bonnie Dighero-Kemp, B.Sc.,, Emiliano Biondo, M.D.,, Lorena Lewis, B.Sc.,, Constanza Anselmo, B.Sc.,, Camila P. Olivera, B.Sc.,, Fernanda Pontoriero, B.Sc.,, Enzo Lavarra, M.D.,, Jens H. Kuhn, M.D.,, Teresa Strella, M.D.,, Alexis Edelstein, Ph.D.,, Miriam I. Burgos, M.D.,, Mario Kaler, M.D.,, Adolfo Rubinstein, Ph.D.,, Jeffrey R. Kugelman, Ph.D.,, Mariano Sanchez-Lockhart, Ph.D.,, Claudia Perandones, Ph.D.,, and Gustavo Palacios, Ph.D.
Issue&Volume: 2020-12-02
Abstract:
Background
From November 2018 through February 2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome occurred in Chubut Province, Argentina, and resulted in 34 confirmed infections and 11 deaths. Understanding the genomic, epidemiologic, and clinical characteristics of person-to-person transmission of ANDV is crucial to designing effective interventions.
Methods
Clinical and epidemiologic information was obtained by means of patient report and from public health centers. Serologic testing, contact-tracing, and next-generation sequencing were used to identify ANDV infection as the cause of this outbreak of hantavirus pulmonary syndrome and to reconstruct person-to-person transmission events.
Results
After a single introduction of ANDV from a rodent reservoir into the human population, transmission was driven by 3 symptomatic persons who attended crowded social events. After 18 cases were confirmed, public health officials enforced isolation of persons with confirmed cases and self-quarantine of possible contacts; these measures most likely curtailed further spread. The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented. Full genome sequencing of the ANDV strain involved in this outbreak was performed with specimens from 27 patients and showed that the strain that was present (Epuyén/18–19) was similar to the causative strain (Epilink/96) in the first known person-to-person transmission of hantavirus pulmonary syndrome caused by ANDV, which occurred in El Bolsón, Argentina, in 1996. Clinical investigations involving patients with ANDV hantavirus pulmonary syndrome in this outbreak revealed that patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission.
Conclusions
Among patients with ANDV hantavirus pulmonary syndrome, high viral titers in combination with attendance at massive social gatherings or extensive contact among persons were associated with a higher likelihood of transmission.
DOI: 10.1056/NEJMoa2009040
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2009040