呼吸道感染是全球疾病负担的主要贡献者。定量微生物风险评估(QMRA)具有作为快速部署框架的潜力,可用于了解呼吸道病原体传播并告知感染控制政策。
■本文的目标是评估,激励,并告知进一步发展QMRA作为快速工具的使用,以了解呼吸道病原体的传播并改善感染控制政策的证据基础。
■我们进行了文献综述,以确定关于呼吸道病原体的气溶胶吸入或接触传播的完整QMRA框架的同行评审研究。从每一项确定的研究中,我们提取并总结了有关应用暴露模型方法的信息,剂量-反应模型,和参数值,包括风险表征。最后,我们回顾了模型结果和政策之间的联系.
■我们确定了在16个不同国家进行的93项研究,这些研究具有针对不同呼吸道病原体的完整QMRA框架。包括SARS-CoV-2,军团菌。,金黄色葡萄球菌,流感,和炭疽芽孢杆菌.在不同和复杂的传播途径中确定了六个不同的暴露模型。在57项研究中,暴露模型框架通过对潜在干预措施的疗效进行建模的能力而被告知.在干预措施中,掩蔽,通风,社交距离,和其他环境源控制通常被评估。病原体浓度,气溶胶浓度,和分配系数是敏感性分析确定的影响暴露参数。大多数(84%,n=78)研究提出了与政策相关的内容,包括a)确定疾病负担以要求政策干预,b)确定基于风险的法规阈值,c)告知干预和控制策略,d)为QMRA在政策中的应用提出建议和建议。
■我们确定需要进一步开发针对呼吸道病原体的QMRA框架,以优先考虑适当的气溶胶暴露建模方法,考虑模型有效性和复杂性之间的权衡,并纳入增强对QMRA结果信心的研究。https://doi.org/10.1289/EHP12695.
UNASSIGNED: Respiratory tract infections are major contributors to the global disease burden. Quantitative microbial risk assessment (QMRA) holds potential as a rapidly deployable framework to understand respiratory pathogen transmission and inform policy on infection control.
UNASSIGNED: The goal of this paper was to evaluate, motivate, and inform further development of the use of QMRA as a rapid tool to understand the transmission of respiratory pathogens and improve the evidence base for infection control policies.
UNASSIGNED: We conducted a literature
review to identify peer-reviewed studies of complete QMRA frameworks on aerosol inhalation or contact transmission of respiratory pathogens. From each of the identified studies, we extracted and summarized information on the applied exposure model approaches, dose-response models, and parameter values, including risk characterization. Finally, we reviewed linkages between model outcomes and policy.
UNASSIGNED: We identified 93 studies conducted in 16 different countries with complete QMRA frameworks for diverse respiratory pathogens, including SARS-CoV-2,
Legionella spp., Staphylococcus aureus, influenza, and Bacillus anthracis. Six distinct exposure models were identified across diverse and complex transmission pathways. In 57 studies, exposure model frameworks were informed by their ability to model the efficacy of potential interventions. Among interventions, masking, ventilation, social distancing, and other environmental source controls were commonly assessed. Pathogen concentration, aerosol concentration, and partitioning coefficient were influential exposure parameters as identified by sensitivity analysis. Most (84%, n=78) studies presented policy-relevant content including a) determining disease burden to call for policy intervention, b) determining risk-based threshold values for regulations, c) informing intervention and control strategies, and d) making recommendations and suggestions for QMRA application in policy.
UNASSIGNED: We identified needs to further the development of QMRA frameworks for respiratory pathogens that prioritize appropriate aerosol exposure modeling approaches, consider trade-offs between model validity and complexity, and incorporate research that strengthens confidence in QMRA results. https://doi.org/10.1289/EHP12695.