Effectiveness of Public Health Measures in Mitigating Pandemic Influenza Spread: A Prospective Sero-Epidemiological Cohort Study
Effectiveness of Public Health Measures in Mitigating Pandemic Influenza Spread: A Prospective Sero-Epidemiological Cohort Study
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DOI：
10.1086/656480
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发表时间：
2010-11-01
影响因子：
6.4
通讯作者：
Seet, Benjamin
中科院分区：
文献类型：
--
作者：
Lee, Vernon J.;Yap, Jonathan;Seet, Benjamin
背景很少有研究证实公共卫生干预措施在减少现实生活中流感传播方面的有效性。我们的目标是验证这些措施在2009年大流行期间使用。从2009年6月22日至10月9日，我们在3组新加坡军人中进行了一项前瞻性观察性队列研究，使用配对血清样本和症状回顾。“正常”单位须遵守现行的流行病应对政策。“基本”单位和卫生保健工作者有额外的公共卫生干预措施（例如，通过隔离、隔离、个人防护设备加强监测）。通过血凝抑制试验检测样本;主要结果为2009年甲型H1N1流感血清转化。总共有14个单位的1015人完成了研究，总体血清转化率为29%。基本单位（17%）和卫生保健工作者（11%）的血清转化率明显低于正常单位（44%）（P <0.001）。流感引起的症状性疾病在基本单位（5%）和卫生保健工作者（2%）也低于正常单位（12%）（P = 0.06）。调整混杂因素后，单位类型是影响总体血清转换的唯一显著变量（P < .05）。从每个单位的多变量分析来看，年龄（P <0.001）和基线抗体滴度（P = 0.012）与血清转换风险呈负相关。公共卫生措施可有效限制流感在封闭环境中的传播。
Background. Few studies have validated the effectiveness of public health interventions in reducing influenza spread in real-life settings. We aim to validate these measures used during the 2009 pandemic.Methods. From 22 June to 9 October 2009, we performed a prospective observational cohort study using paired serum samples and symptom review among 3 groups of Singapore military personnel. "Normal" units were subjected to prevailing pandemic response policies. "Essential" units and health care workers had additional public health interventions (eg, enhanced surveillance with isolation, segregation, personal protective equipment). Samples were tested by hemagglutination inhibition; the principal outcome was seroconversion to 2009 influenza A(H1N1).Results. In total, 1015 individuals in 14 units completed the study, with 29% overall seroconversion. Seroconversion among essential units (17%) and health care workers (11%) was significantly lower than that in normal units (44%) (P < .001). Symptomatic illness attributable to influenza was also lower in essential units (5%) and health care workers (2%) than in normal units (12%) (P = .06). Adjusted for confounders, unit type was the only significant variable influencing overall seroconversion (P < .05). From multivariate analysis within each unit, age (P < .001) and baseline antibody titer (P = .012) were inversely related to seroconversion risk.Conclusions. Public health measures are effective in limiting influenza transmission in closed environments.