阿根廷安第斯病毒的「超級傳播者」和人際傳播分析
作者：
小柯機器人發布時間：2020/12/4 12:59:13
美國陸軍傳染病醫學研究所Gustavo Palacios聯合阿根廷國家傳染病研究所Valeria P. Martínez團隊研究了阿根廷安第斯病毒的「超級傳播者」和人際傳播。2020年12月2日，該研究發表在《新英格蘭醫學雜誌》上。
2018年11月至2019年2月，阿根廷丘布特省發生安第斯病毒（ANDV）漢坦病毒肺症候群的人際傳播，導致34例確診感染和11例死亡。了解ANDV人際傳播的基因組學、流行病學和臨床特徵對於設計有效的幹預措施至關重要。
研究組通過患者報告和公共衛生中心獲得了臨床和流行病學信息，對漢坦病毒肺症候群爆發的原因，即ANDV感染採用血清學檢測、接觸追蹤和下一代測序來進行鑑定，並重建了人與人之間的傳播事件。
齧齒動物宿主將ANDV單向引入人群後，3名有症狀的感染者參加了人群密集的社交活動，從而導致傳播。在確診了18例病例之後，公共衛生官員對確診病例進行了隔離，並要求可能的接觸者自我隔離，這些措施很可能會減少進一步的傳播。在實施控制措施之前，中位繁殖數（感染期間由感染者引起的繼發病例數）為2.12，而在實施控制措施後降為0.96。
研究組使用27名患者的標本對此次疫情中涉及的ANDV毒株進行了全基因組測序，結果發現該毒株（Epuyen/18-19）與引起漢坦病毒肺症候群的ANDV致病毒株（Epilink/96）相似，Epilink/96曾於1996年在阿根廷埃爾博爾森鎮引發首次人傳人。此次暴發中涉及ANDV漢坦病毒肺症候群患者的臨床研究表明，病毒載量高且肝損傷的患者比其他患者更容易傳播感染。疾病的嚴重程度、基因組多樣性、年齡和住院時間與二次傳播沒有明確關聯。
研究結果表明，在患有ANDV漢坦病毒肺症候群的患者中，高病毒滴度加上大規模社交聚會或人與人之間的廣泛接觸，可顯著增加病毒傳播風險。
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