BACKGROUND Respiratory tract infections are major contributors to the global disease burden. Quantitative microbial risk assessment (QMRA) holds potential as a rapidly deployable framework to understand respiratory pathogen transmission and inform policy on infection control. OBJECTIVES The goal of this paper was to evaluate, motivate, and inform further development of the use of QMRA as a rapid tool to understand the transmission of respiratory pathogens and improve the evidence base for infection control policies. METHODS We conducted a literature review to identify peer-reviewed studies of complete QMRA frameworks on aerosol inhalation or contact transmission of respiratory pathogens. From each of the identified studies, we extracted and summarized information on the applied exposure model approaches, dose-response models, and parameter values, including risk characterization. Finally, we reviewed linkages between model outcomes and policy. RESULTS We identified 93 studies conducted in 16 different countries with complete QMRA frameworks for diverse respiratory pathogens, including SARS-CoV-2, Legionella spp., Staphylococcus aureus, influenza, and Bacillus anthracis. Six distinct exposure models were identified across diverse and complex transmission pathways. In 57 studies, exposure model frameworks were informed by their ability to model the efficacy of potential interventions. Among interventions, masking, ventilation, social distancing, and other environmental source controls were commonly assessed. Pathogen concentration, aerosol concentration, and partitioning coefficient were influential exposure parameters as identified by sensitivity analysis. Most (84%, n=78) studies presented policy-relevant content including a) determining disease burden to call for policy intervention, b) determining risk-based threshold values for regulations, c) informing intervention and control strategies, and d) making recommendations and suggestions for QMRA application in policy. CONCLUSIONS We identified needs to further the development of QMRA frameworks for respiratory pathogens that prioritize appropriate aerosol exposure modeling approaches, consider trade-offs between model validity and complexity, and incorporate research that strengthens confidence in QMRA results. https://doi.org/10.1289/EHP12695.

中文翻译：

---

定量微生物风险评估在呼吸道病原体中的应用及其对政策的影响：最新科学回顾。


背景技术呼吸道感染是全球疾病负担的主要原因。定量微生物风险评估 (QMRA) 具有作为快速部署框架的潜力，可用于了解呼吸道病原体传播并为感染控制政策提供信息。目的 本文的目的是评估、激励 QMRA 作为快速工具的使用，以了解呼吸道病原体的传播并完善感染控制政策的证据基础，并为进一步开发提供信息。方法 我们进行了文献综述，以确定关于呼吸道病原体气溶胶吸入或接触传播的完整 QMRA 框架的同行评审研究。从每项已确定的研究中，我们提取并总结了有关所应用的暴露模型方法、剂量反应模型和参数值（包括风险特征）的信息。最后，我们回顾了模型结果与政策之间的联系。结果 我们确定了在 16 个不同国家进行的 93 项研究，这些研究具有针对不同呼吸道病原体的完整 QMRA 框架，包括 SARS-CoV-2、军团菌、金黄色葡萄球菌、流感和炭疽杆菌。在不同且复杂的传播途径中确定了六种不同的暴露模型。在 57 项研究中，暴露模型框架的依据是其模拟潜在干预措施功效的能力。在干预措施中，通常评估掩蔽、通风、社交距离和其他环境源控制。通过敏感性分析确定，病原体浓度、气溶胶浓度和分配系数是有影响的暴露参数。 大多数（84%，n=78）研究提出了与政策相关的内容，包括a）确定需要政策干预的疾病负担，b）确定基于风险的法规阈值，c）告知干预和控制策略，以及d）制定对QMRA在政策中应用的建议和建议。结论 我们确定需要进一步开发呼吸道病原体的 QMRA 框架，优先考虑适当的气溶胶暴露建模方法，考虑模型有效性和复杂性之间的权衡，并纳入增强 QMRA 结果信心的研究。 https://doi.org/10.1289/EHP12695。