Probabilistic differential diagnosis of Middle East respiratory syndrome (MERS) using the time from immigration to illness onset among imported cases

JOURNAL OF THEORETICAL BIOLOGY

卷:346

Article

Ejima, Keisuke^1,2  Aihara, Kazuyuki^2,3  Nishiura, Hiroshi^1,4 

[1] Univ Tokyo, Grad Sch Med, Bunkyo Ku, Tokyo 1130033, Japan

[2] Univ Tokyo, Grad Sch Informat Sci & Technol, Dept Math Informat, Bunkyo Ku, Tokyo 1138656, Japan

[3] Univ Tokyo, Inst Ind Sci, Meguro Ku, Tokyo 1538505, Japan

[4] Japan Sci & Technol Agcy, PRESTO, Saitama, Japan

关键词: Importation;    Epidemiology;    Coronavirus;    Mathematical model;    Incubation period;   

DOI  :  10.1016/j.jtbi.2013.12.024

来源: Elsevier

【 摘 要 】

Middle East respiratory syndrome (MERS) has spread worldwide since 2012. As the clinical symptoms of MERS tend to be non-specific, the incubation period has been shown to complement differential diagnosis, especially to rule out influenza. However, because an infection event is seldom directly observable, the present study aims to construct a diagnostic model that predicts the probability of MERS diagnosis given the time from immigration to illness onset among imported cases which are suspected of MERS. Addressing censoring by considering the transmission dynamics in an exporting country, we demonstrate that the illness onset within 2 days from immigration is suggestive of influenza. Two exceptions to suspect MERS even for those with illness onset within 2 days since immigration are (i) when we observe substantial community transmissions of MERS and (ii) when the cases are at high risk of MERS (e.g. cases with close contact in hospital or household). It is vital to collect the information of the incubation period upon emergence of a novel infectious disease, and moreover, in our model, the fundamental transmission dynamics including the initial growth rate has to be explored to differentiate the disease diagnoses with non-specific symptoms. (C) 2014 Elsevier Ltd. All rights reserved.

【 授权许可】

Free