利用國際旅客量與境外移入病例推估疾病來源國的疫情趨勢：以東南亞登革熱疫情為例

Estimating epidemic trends of source countries through international travel and imported cases: a case study of dengue in Southeast Asia

杜承軒(Chen-Hsuan Tu)

指導教授 ： 溫在弘

國立臺灣大學/理學院/地理環境資源學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202102201

摘要

目標：完整疫情資訊對防治跨國傳染病相當重要，但衛生機關對於跨國的境外疫情即時掌握能力有其侷限性。本研究目標透過境外移入病例及國際間移動量，探索疫情傳播輸出國及輸入國之間的量化關係，推估疾病來源國的疫情趨勢，以提高對於境外疫情資訊的掌握。方法：本研究以登革熱在東南亞國家傳播至臺灣為案例，透過流行病學數理模式與機率分配之假設，建立來源疫情回推模型 (REDOS)，分析星馬兩國2014年至2017年實際疫情進行驗證。結果：研究結果說明境外移入病例數量與來源國疫情與國家之間移動量呈現正比之關係。透過驗證結果顯示，利用境外移入病例及國際旅客量能有效地捕捉來源國的疫情趨勢，以餘弦相似性及混淆矩陣等指標評估推估疫情與真實疫情，大多都能達到0.8以上的相似性及較高的準確度。並藉此能進一步評估疫情潛在移入國之未來境外移入風險，作為疫情爆發的早期預警。本研究亦開發網頁平台，提供互動式操作及雲端計算，呈現視覺化回推結果及風險評估。結論：本研究從疾病移入國家受到境外病例的角度，理解疫情資料不開放之疫情移出國家的真實疫情趨勢，研究成果強調主動蒐集，對於較困難掌握疫情情報、非WHO會員國的臺灣有重要意義，亦能提供對於境外疫情資料不完整的情況下，在當地進行疫情的早期預警與提前因應。

關鍵字

登革熱 ； 疫情分析 ； 境外移入 ； 移動率 ； 風險評估

並列摘要

Objectives. Capturing the overseas disease outbreaks is important information for epidemic early warning and disease prevention. However, the health authority lacks the effective platform for monitoring global epidemic information in time and space. The objective of the study is to propose a new method for estimating the epidemic trends in the foreign countries through international travels and imported cases.
Methods. Dengue fever in Southeast Asian countries was used as a case study. Integrating the imported cases in Taiwan and international travels from Southeast Asia, the mathematical model called “Reverse Estimation for Dengue Outbreaks in Source Countries (REDOS)” was built for estimating dengue incidence in Malaysia and Singapore from 2014 to 2017.
Results. Our results show that the model using international travels and imported cases can capture the epidemic trends of source countries. It can also further estimate the epidemic importation risk for destination countries. Cloud-based interactive dashboard is also established as the prototype of the epidemic early-warning system to visualize effectively disease outbreaks in time and space.
Conclusion. Our study demonstrates the feasibility of estimating epidemic trends of foreign countries through international travels and imported cases. In our dengue fever case study, the model framework provides insights on how dengue epidemics import to Taiwan and also how the epidemics export to other East Asian regions, and even whole world.

並列關鍵字

dengue fever ； epidemic analysis ； disease importations ； imported cases ； international mobility ； risk evaluation

參考文獻

【期刊論文】

Brady, O. J., P. W. Gething, S. Bhatt, J. P. Messina, J. S. Brownstein, A. G. Hoen, C. L. Moyes, A. W. Farlow, T. W. Scott, S. I. Hay. 2012. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis, 6(8), e1760.

Chinazzi, M., J. T. Davis, M. Ajelli, C. Gioannini, M. Litvinova, S. Merler, A. P. Piontti, K. Mu, L. Rossi, K. Sun, C. Viboud, X. Xiong, H. Yu, M. E. Halloran, I. M. Longini Jr., A. Vespignani. 2020. The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science, 368(6489), 395-400.

Choi, J., Y. Cho, E. Shim, H. Woo. 2016. Web-based infectious disease surveillance systems and public health perspectives: a systematic review. BMC Public Health, 16(1), 1238.

Dickens, B. L., H. Sun, M. Jit, A. R. Cook, L. R. Carrasco. 2018. Determining environmental and anthropogenic factors which explain the global distribution of Aedes aegypti and Ae. albopictus. BMJ Glob Health, 3(4), e000801.