Giuseppe
Emeritus
[Source: ScienceDirect, full page: (LINK). Abstract, edited.]
Journal of Theoretical Biology, Available online 6 January 2014 / In Press, Accepted Manuscript
Probabilistic differential diagnosis of Middle East respiratory syndrome (MERS) using the time from immigration to illness onset among imported cases: Diagnosing imported cases of MERS
Keisuke Ejima<SUP>a</SUP><SUP>, </SUP><SUP>b</SUP>, Kazuyuki Aihara<SUP>b</SUP><SUP> </SUP><SUP>c</SUP>, Hiroshi Nishiura<SUP>a</SUP><SUP> </SUP><SUP>d</SUP>
<SUP></SUP>
<SUP>a</SUP> Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; <SUP>b</SUP> Department of Mathematical Informatics, Graduate School of Information Science and Technology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; <SUP>c</SUP> Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan; <SUP>d</SUP> PRESTO, Japan Science and Technology Agency, Saitama, Japan
Received 24 December 2012 - Revised 25 December 2013 - Accepted 26 December 2013 - Available online 6 January 2014
Highlights
Abstract
Middle East respiratory syndrome (MERS) has spread worldwide since 2012. As the clinical symptoms of MERS tend to be non-specific, the incubation period has been shown to complement differential diagnosis, especially to rule out influenza. However, because an infection event is seldom directly observable, the present study aims to construct a diagnostic model that predicts the probability of MERS diagnosis given the time from immigration to illness onset among imported cases who are suspected of MERS. Addressing censoring by considering the transmission dynamics in an exporting country, we demonstrate that the illness onset within 2 days from immigration is suggestive of influenza. Two exceptions to suspect MERS even for those with illness onset within 2 days since immigration are (i) when we observe substantial community transmissions of MERS and (ii) when the cases are at high risk of MERS (e.g. cases with close contact in hospital or household). It is vital to collect the information of the incubation period upon emergence of a novel infectious disease, and moreover, in our model, the fundamental transmission dynamics including the initial growth rate has to be explored to differentiate the disease diagnoses with non-specific symptoms.
Keywords: Importation; Epidemiology; Coronavirus; Mathematical model; Influenza; Incubation period
Corresponding author at: Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Tel: +81 3 5841 3688; fax: +81 3 5841 3637.
Copyright ? 2014 Published by Elsevier Ltd.
Note to users: Accepted manuscripts are Articles in Press that have been peer reviewed and accepted for publication by the Editorial Board of this journal. They have not yet been copy edited and/or formatted in the journal house style, and may not yet have the full ScienceDirect functionality, e.g., supplementary files may still need to be added, links to references may not resolve yet etc. The text could still change before final publication.
Although accepted manuscripts do not have all bibliographic details available yet, they can already be cited using the year of online publication and the DOI, as follows: author(s), article title, journal (year), DOI. Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names and use of punctuation.
When the final article is assigned to an issue of the journal, the Article in Press version will be removed and the final version will appear in the associated published issue of the journal. The date the article was first made available online will be carried over.
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Journal of Theoretical Biology, Available online 6 January 2014 / In Press, Accepted Manuscript
Probabilistic differential diagnosis of Middle East respiratory syndrome (MERS) using the time from immigration to illness onset among imported cases: Diagnosing imported cases of MERS
Keisuke Ejima<SUP>a</SUP><SUP>, </SUP><SUP>b</SUP>, Kazuyuki Aihara<SUP>b</SUP><SUP> </SUP><SUP>c</SUP>, Hiroshi Nishiura<SUP>a</SUP><SUP> </SUP><SUP>d</SUP>
<SUP></SUP>
<SUP>a</SUP> Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; <SUP>b</SUP> Department of Mathematical Informatics, Graduate School of Information Science and Technology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; <SUP>c</SUP> Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan; <SUP>d</SUP> PRESTO, Japan Science and Technology Agency, Saitama, Japan
Received 24 December 2012 - Revised 25 December 2013 - Accepted 26 December 2013 - Available online 6 January 2014
Highlights
- Clinical symptoms of MERS tend to be non-specific.
- The incubation period complements differential diagnosis, ruling out influenza.
- The time from immigration to illness in imported cases also informs diagnosis.
- Illness onset within 2 days from immigration is suggestive of influenza.
Abstract
Middle East respiratory syndrome (MERS) has spread worldwide since 2012. As the clinical symptoms of MERS tend to be non-specific, the incubation period has been shown to complement differential diagnosis, especially to rule out influenza. However, because an infection event is seldom directly observable, the present study aims to construct a diagnostic model that predicts the probability of MERS diagnosis given the time from immigration to illness onset among imported cases who are suspected of MERS. Addressing censoring by considering the transmission dynamics in an exporting country, we demonstrate that the illness onset within 2 days from immigration is suggestive of influenza. Two exceptions to suspect MERS even for those with illness onset within 2 days since immigration are (i) when we observe substantial community transmissions of MERS and (ii) when the cases are at high risk of MERS (e.g. cases with close contact in hospital or household). It is vital to collect the information of the incubation period upon emergence of a novel infectious disease, and moreover, in our model, the fundamental transmission dynamics including the initial growth rate has to be explored to differentiate the disease diagnoses with non-specific symptoms.
Keywords: Importation; Epidemiology; Coronavirus; Mathematical model; Influenza; Incubation period
Corresponding author at: Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Tel: +81 3 5841 3688; fax: +81 3 5841 3637.
Copyright ? 2014 Published by Elsevier Ltd.
Note to users: Accepted manuscripts are Articles in Press that have been peer reviewed and accepted for publication by the Editorial Board of this journal. They have not yet been copy edited and/or formatted in the journal house style, and may not yet have the full ScienceDirect functionality, e.g., supplementary files may still need to be added, links to references may not resolve yet etc. The text could still change before final publication.
Although accepted manuscripts do not have all bibliographic details available yet, they can already be cited using the year of online publication and the DOI, as follows: author(s), article title, journal (year), DOI. Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names and use of punctuation.
When the final article is assigned to an issue of the journal, the Article in Press version will be removed and the final version will appear in the associated published issue of the journal. The date the article was first made available online will be carried over.
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