A Metapopulation Model to Assess the Capacity of Spread of Meticillin-Resistant Staphylococcus aureus ST398 in Humans 英文参考文献.docVIP
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A Metapopulation Model to Assess the Capacity of Spread of Meticillin-Resistant Staphylococcus aureus ST398 in Humans 英文参考文献
AMetapopulationModeltoAssesstheCapacityof
SpreadofMeticillin-ResistantStaphylococcusaureus
ST398inHumans
ThibaudPorphyre*¤a,EfstathiosStamatiosGiotis¤b,DavidHughLloyd,KatharinaDorothea
ClementineSta¨rk
VeterinaryEpidemiologyandPublicHealthGroup,DepartmentofVeterinaryClinicalSciences,RoyalVeterinaryCollege,Hatfield,UnitedKingdom
Abstract
The emergence of the livestock-associated clone of meticillin-resistant Staphylococcus aureus (MRSA) ST398 is a serious
public health issue throughout Europe. In The Netherlands a stringent ‘search-and-destroy’ policy has been adopted,
keeping low the level of MRSA prevalence. However, reports have recently emerged of transmission events between
humansshowingnolinkstolivestock,contradictingbeliefthatMRSAST398ispoorlytransmissibleinhumans.Thequestion
regarding the transmissibility of MRSA ST398 in humans therefore remains of great interest. Here, we investigated the
capacityofMRSAST398tospreadintoanentirelysusceptiblehumanpopulationsubjecttotheeffectofasingleMRSA-
positivecommercialpigfarm.Usingastochastic,discrete-timemetapopulationmodel,weexploredtheeffectofvarying
both the probability of persistent carriage and that of acquiring MRSA due to contact with pigs on the transmission
dynamicsofMRSAST398inhumans.Inparticular,weassessedthevalueandkeydeterminantsofthebasicreproduction
ratio (R0) for MRSA ST398. Simulations showed that the presence of recurrent exposures with pigs in risky populations
allows MRSA ST398 to persist in the metapopulation and transmission events to occur beyond the farming community,
evenwhentheprobabilityofpersistentcarriageislow.Wefurthershowedthatpersistentcarriageshouldoccurinlessthan
10%ofthetimeforMRSAST398toconserveepidemiologicalcharacteristicssimilartowhathasbeenpreviouslyreported.
Theseresultsindicatethatimplementingcontrolpolicythatonlytargetshumancarriersmaynotbesufficienttocontrol
MRSAST398inthecommunityifitremainsinpigs.Wearguethatfarm-levelcontrolmeasuresshouldbeimplementedifan
eradicationprogra
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