Different Mechanisms for Heterogeneity in Leprosy Susceptibility Can Explain Disease Clustering within Households 英文参考文献.docVIP
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Different Mechanisms for Heterogeneity in Leprosy Susceptibility Can Explain Disease Clustering within Households 英文参考文献
DifferentMechanismsforHeterogeneityinLeprosy
SusceptibilityCanExplainDiseaseClusteringwithin
Households
EgilFischer¤a,SakeDeVlas,AbrahamMeima¤b,DikHabbema,JanRichardus*
DepartmentofPublicHealth,ErasmusMC,UniversityMedicalCenterRotterdam,Rotterdam,TheNetherlands
Abstract
Theepidemiologyofleprosyischaracterizedbyheterogeneityinsusceptibilityandclusteringofdiseasewithinhouseholds.
We aim to assess the extent to which different mechanisms for heterogeneity in leprosy susceptibility can explain
householdclusteringasobservedinalargestudyamongcontactsofleprosypatients. Weusedamicrosimulationmodel,
parameterizing it with data from over 20,000 contacts of leprosy patients in Bangladesh. We simulated six mechanisms
producing heterogeneity in susceptibility: (1) susceptibility was allocated at random to persons (i.e. no additional
mechanism),(2)ahouseholdfactor,(3,4)ageneticfactor(dominantorrecessive),or(5,6)halfahouseholdfactorandhalf
genetic.Wefurtherassumedthatafractionof5%,10%,and20%ofthepopulationwassusceptible,leadingtoatotalof18
scenariostobefittedtothedata.Weobtainedanacceptablefitforeachofthesixmechanisms,therebyexcludingnoneof
the possible underlying mechanisms for heterogeneity of susceptibility to leprosy. However, the distribution of leprosy
among contacts did differ between mechanisms, and predicted trends in the declining leprosy case detection were
dependent on the assumed mechanism, with genetic-based susceptibility showing the slowest decline. Clustering of
leprosywithinhouseholdsispartiallycausedbyanincreasedtransmissionwithinhouseholdsindependentoftheleprosy
susceptibilitymechanism.Evenalargeanddetaileddatasetoncontactsofleprosypatientscouldnotunequivocallyreveal
themechanismmostlikelyresponsibleforheterogeneityinleprosysusceptibility.
Citation:FischerE,DeVlasS,MeimaA,HabbemaD,RichardusJ(2010)DifferentMechanismsforHeterogeneityinLeprosySusceptibilityCanExplainDisease
ClusteringwithinHouseholds.PLoSONE5(11):e14061.doi:10.1371/journal.pone.0014061
Edi
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