Societal Learning in Epidemics Intervention Effectiveness during the 2003 SARS Outbreak in Singapore 英文参考文献.docVIP

SocietalLearninginEpidemics:Intervention Effectivenessduringthe2003SARSOutbreakin Singapore JohnM.Drake1¤*,SuokKaiChew2,StefanMa2 1NationalCenterforEcologicalAnalysisandSynthesis,SantaBarbara,California,UnitedStatesofAmerica,2MinistryofHealth,Singapore,Singapore Background. Rapid response to outbreaks of emerging infectious diseases is impeded by uncertain diagnoses and delayedcommunication.Understandingtheeffectofinefficientresponseisapotentiallyimportantcontributionofepidemic theory. To develop this understanding we studied societal learning during emerging outbreaks wherein patient removal acceleratesasinformationisgatheredanddisseminated.MethodsandFindings.Wedevelopedanextensionofastandard outbreak model, the simple stochastic epidemic, which accounts for societal learning. We obtained expressions for the expectedoutbreaksizeandthedistributionofepidemicduration.Wefoundthatrapidlearningnoticeablyaffectsthefinal outbreak size even when learning exhibits diminishing returns (relaxation). As an example, we estimated the learning rate forthe2003outbreakofsevereacuterespiratorysyndrome(SARS)inSingapore.Evidenceforrelaxationduringthefirsteight weeks of the outbreak was inconclusive. We estimated that if societal learning had occurred at half the actual rate, the expected final size of the outbreak would have reached nearly 800 cases, more than three times the observed number of infections.Bycontrast,theexpectedoutbreaksizeforsocietallearningtwiceaseffectivewas116cases.Conclusion.These resultsshowthattherateofsocietallearningcangreatlyaffectthefinalsizeofdiseaseoutbreaks,justifyinginvestmentin earlywarningsystemsandattentivenesstodiseaseoutbreakbybothgovernmentauthoritiesandthepublic.Wesubmitthat the burden of emerging infections, including the risk of a global pandemic, could be efficiently reduced by improving proceduresforrapiddetectionofoutbreaks,alertingpublichealthofficials,andaggressivelyeducatingthepublicatthestart ofanoutbreak. Citation: Drake JM, Chew SK, Ma