- 學位論文
新冠肺炎無症狀、症狀前及症狀期病程自然進展模式
Infected Disease Progression Model with Asymptomatic, Pre-symptomatic, and Symptomatic Phase for COVID-19
摘要
背景 由嚴重急性呼吸系統症候群冠狀病毒2型（Severe Acute Respiratory Syndrome COronaVirus 2 ; SARS-CoV-2）所引發的新興傳染病COVID-19（Coronavirus disease 2019），自2020年3月11日世界衛生組織宣布為全球性流行性疾病（pandemic）至2021年3月31日已造成全球累積確診病例達127,877,462例，其中包含死亡2,796,561例。境外移入的感染SARS-CoV-2個案是導致台灣COVID-19疫情流行的主要危險因素。 目的 為阻絕境外移入疫情風險，利用台灣疫情公開資料，探討國際疫情流行時期及地區的風險變化與境外移入個案無症狀、症狀前及症狀期的估計值，並據以評估不同國家入境來台旅客疾病風險，進而作為未來我國針對不同國家入境來台旅客之檢測頻率及居家檢疫日數評估依據。 方法 本研究以2020年台灣入境旅客及確診率資料建構新冠肺炎無症狀、症狀前及症狀期病程自然進展模式，將疾病動態進展中的潛伏期感染狀態區分為無症狀期（Asymptomatic phase）與症狀前期（Pre-symptomatic phase）兩階段，探討台灣的境外入境個案的各階段病程發生率，並進一步利用貝氏分析納入真實監測數據，以隨機模擬試驗設計，評估三個不同的國際疫情流行區間之各地區疫情風險，並據以提出根據旅客離境國家別的精準化檢疫策略。 結果 RT-PCR可偵測到的COVID-19的症狀前期個案在疫情第一波流行期間（2020年3月至6月）的每日發生率為106人（每十萬人口），在第二階段（2020年7月至9月）降至37人（每十萬人口），在第三階段（2020年9月至12月）回升至141人（每十萬人口）。在第一疫情流行階段，在經過5天檢疫期的一半時間，有82%的個案從症狀前期轉至有症狀出現，與第三波疫情流行階段差距不大。接種疫苗的旅客，經2次篩檢與檢疫隔離5天後症狀前期的個案幾乎達到零個案。 結論 在全球範圍的疫苗施打覆蓋率未能達到群體免疫的目標前，精確的篩檢頻率、檢疫和隔離天數策略可以依國家或地區的疫情流行風險分級，為邊境控制和管控境外移入風險與重新開放旅行與經貿交流之間的權衡取捨提供更加彈性的解決方案。
並列摘要
Background The COVID-19 (Coronavirus disease 2019) outbreak, an emerging infectious disease caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), has been declared as a pandemic by the World Health Organization on March 11, 2020. Until the end of March, there are 127,877,462 confirmed cases worldwide, and 2,796,561 deaths. Importation of SARS-CoV-2 infection from abroad is the main risk factor leading to the community-acquire COVID-19 outbreak for areas where the COVID-19 has been well-controlled. Aims To curb the transmission from the imported COVID-19 cases, the precise testing and quarantine strategy is needed. In order to assess the impact of varying strategies, one needs to understand the disease progression of COVID-19. In this study, we used the open data on imported COVID-19 cases released by Taiwan central epidemic command center (CECC) to estimate the incidence rates of asymptomatic and pre-symptomatic, and the progression rate from pre-symptomatic to symptomatic phase in three different pandemic periods. The parameters for from different areas where travelling departing from was modelled with Markovian regression model. A series of computer simulation bases on the estimated area-specific parameters throw light on precision strategies for determining the length of home quarantine and the frequency of RT-PCR test. Methods We first constructed the natural history model including the asymptomatic, pre-symptomatic and symptomatic phase of COVID-19. Data on imported confirmed cases in Taiwan, 2020, was retrieved from open resources. To estimate the incidence rate of each stage of the disease progression, the incubation period of the disease in the dynamic progression of natural history model was divided into two stages: the asymptomatic phase and the pre-symptomatic phase. A random simulation experimental design with Bayesian analysis incorporating COVID-19 surveillance data was made to assess the epidemic risk of each country in three different pandemic periods. Result The daily incidence rate (per 100,000 population) of pre-symptomatic disease of COVID-19 which can be detected by RT-PCR was 106 during the first period of pandemic, and dropped to 37 in the second period, then rose to 141 in the third period. In the first pandemic period, 82% of transition from pre-symptomatic to symptomatic was noted in the median dwell time, and decreased slightly in the third period. After five-days quarantine with two tests for passengers who have been fully vaccinated, no asymptomatic cases can be observed. Therefore, the length of quarantine could reduce from 14 to 5 days. Conclusion Considering the country-specific disease risk and vaccination rates, precise strategies with risk-strata could provide solutions for the trade-off between border control and reopening through flexible frequency of test and length of quarantine.
參考文獻
延伸閱讀
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