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Determinants of Influenza Transmission in South East Asia: Insights from a Household Cohort Study in Vietnam

机译：东南亚流感传播的决定因素：越南家庭队列研究的启示

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摘要

To guide control policies, it is important that the determinants of influenza transmission are fully characterized. Such assessment is complex because the risk of influenza infection is multifaceted and depends both on immunity acquired naturally or via vaccination and on the individual level of exposure to influenza in the community or in the household. Here, we analyse a large household cohort study conducted in 2007–2010 in Vietnam using innovative statistical methods to ascertain in an integrative framework the relative contribution of variables that influence the transmission of seasonal (H1N1, H3N2, B) and pandemic H1N1pdm09 influenza. Influenza infection was diagnosed by haemagglutination-inhibition (HI) antibody assay of paired serum samples. We used a Bayesian data augmentation Markov chain Monte Carlo strategy based on digraphs to reconstruct unobserved chains of transmission in households and estimate transmission parameters. The probability of transmission from an infected individual to another household member was 8% (95% CI, 6%, 10%) on average, and varied with pre-season titers, age and household size. Within households of size 3, the probability of transmission from an infected member to a child with low pre-season HI antibody titers was 27% (95% CI 21%–35%). High pre-season HI titers were protective against infection, with a reduction in the hazard of infection of 59% (95% CI, 44%–71%) and 87% (95% CI, 70%–96%) for intermediate (1∶20–1∶40) and high (≥1∶80) HI titers, respectively. Even after correcting for pre-season HI titers, adults had half the infection risk of children. Twenty six percent (95% CI: 21%, 30%) of infections may be attributed to household transmission. Our results highlight the importance of integrated analysis by influenza sub-type, age and pre-season HI titers in order to infer influenza transmission risks in and outside of the household.
机译：为了指导控制政策，重要的是要充分确定流感传播的决定因素。这种评估很复杂，因为流感感染的风险是多方面的，既取决于自然获得的免疫力或通过疫苗接种获得的免疫力，又取决于社区或家庭中个体暴露于流感的水平。在这里，我们使用创新的统计方法分析了2007-2010年在越南进行的一项大型家庭队列研究，以综合框架确定影响季节性（H1N1，H3N2，B）和大流行H1N1pdm09流感传播的变量的相对贡献。通过配对血清样品的血凝抑制（HI）抗体分析诊断了流感感染。我们使用基于二元图的贝叶斯数据增强马尔可夫链蒙特卡洛策略来重构家庭中未观察到的传播链并估计传播参数。从感染者传播到另一家庭成员的可能性平均为8％（95％CI，6％，10％），并且随季节前滴度，年龄和家庭规模的变化而变化。在3号规模的家庭中，从感染成员传播到季前HI抗体滴度低的孩子的可能性为27％（95％CI 21％–35％）。季前高HI滴度可预防感染，对于中等程度（中等），感染的危险性降低了59％（95％CI，44％–71％）和87％（95％CI，70％–96％）。 1∶20–1∶40）和高（≥1∶80）HI滴度。即使校正了季前HI滴度，成年人感染儿童的风险只有一半。 26％（95％CI：21％，30％）的感染可能归因于家庭传播。我们的结果强调了按流感亚型，年龄和季前HI滴度进行综合分析的重要性，以推断家庭内部和外部的流感传播风险。

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