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      Precision epidemiology for infectious disease control

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          Abstract

          Advances in genomics and computing are transforming the capacity for the characterization of biological systems, and researchers are now poised for a precision-focused transformation in the way they prepare for, and respond to, infectious diseases. This includes the use of genome-based approaches to inform molecular diagnosis and individual-level treatment regimens. In addition, advances in the speed and granularity of pathogen genome generation have improved the capability to track and understand pathogen transmission, leading to potential improvements in the design and implementation of population-level public health interventions. In this Perspective, we outline several trends that are driving the development of precision epidemiology of infectious disease and their implications for scientists’ ability to respond to outbreaks.

          Abstract

          The emerging field of precision epidemiology allows the personalized diagnosis, tracking and treatment of infectious diseases.

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          Most cited references47

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          Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.

          A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
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            A novel coronavirus associated with severe acute respiratory syndrome.

            A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Province, China. We conducted studies to identify the etiologic agent of this outbreak. We received clinical specimens from patients in seven countries and tested them, using virus-isolation techniques, electron-microscopical and histologic studies, and molecular and serologic assays, in an attempt to identify a wide range of potential pathogens. None of the previously described respiratory pathogens were consistently identified. However, a novel coronavirus was isolated from patients who met the case definition of SARS. Cytopathological features were noted in Vero E6 cells inoculated with a throat-swab specimen. Electron-microscopical examination revealed ultrastructural features characteristic of coronaviruses. Immunohistochemical and immunofluorescence staining revealed reactivity with group I coronavirus polyclonal antibodies. Consensus coronavirus primers designed to amplify a fragment of the polymerase gene by reverse transcription-polymerase chain reaction (RT-PCR) were used to obtain a sequence that clearly identified the isolate as a unique coronavirus only distantly related to previously sequenced coronaviruses. With specific diagnostic RT-PCR primers we identified several identical nucleotide sequences in 12 patients from several locations, a finding consistent with a point-source outbreak. Indirect fluorescence antibody tests and enzyme-linked immunosorbent assays made with the new isolate have been used to demonstrate a virus-specific serologic response. This virus may never before have circulated in the U.S. population. A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. Because of the death of Dr. Carlo Urbani, we propose that our first isolate be named the Urbani strain of SARS-associated coronavirus. Copyright 2003 Massachusetts Medical Society
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              Digital disease detection--harnessing the Web for public health surveillance.

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                Author and article information

                Contributors
                andersen@scripps.edu
                Journal
                Nat Med
                Nat. Med
                Nature Medicine
                Nature Publishing Group US (New York )
                1078-8956
                1546-170X
                6 February 2019
                2019
                : 25
                : 2
                : 206-211
                Affiliations
                [1 ]ISNI 0000 0004 1936 8040, GRID grid.261120.6, Pathogen and Microbiome Institute, , Northern Arizona University, ; Flagstaff, AZ USA
                [2 ]ISNI 0000000419368710, GRID grid.47100.32, Department of Epidemiology of Microbial Diseases, , Yale School of Public Health, ; New Haven, CT USA
                [3 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Department of Zoology, , University of Oxford, ; Oxford, UK
                [4 ]ISNI 0000000122199231, GRID grid.214007.0, Department of Immunology and Microbiology, , The Scripps Research Institute, ; La Jolla, CA USA
                [5 ]Scripps Research Translational Institute, La Jolla, CA USA
                Author information
                http://orcid.org/0000-0001-6431-5982
                Article
                345
                10.1038/s41591-019-0345-2
                7095960
                30728537
                f7504e6b-35bc-4a5f-a16a-f51047d2e1c9
                © Springer Nature America, Inc. 2019

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 6 July 2018
                : 3 January 2019
                Categories
                Perspective
                Custom metadata
                © The Author(s), under exclusive licence to Springer Nature Limited 2019

                Medicine
                epidemiology,genetics research,evolution,immunology,microbiology
                Medicine
                epidemiology, genetics research, evolution, immunology, microbiology

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