Does the Effectiveness of Control Measures Depend on the Influenza Pandemic Profile?
Does the Effectiveness of Control Measures Depend on the Influenza Pandemic Profile?
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DOI：
10.1371/journal.pone.0001478
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发表时间：
2008-01-23
期刊：
影响因子：
3.7
通讯作者：
Vergu, Elisabeta
中科院分区：
文献类型：
--
作者：
Kerneis, Solen;Grais, Rebecca F.;Vergu, Elisabeta
背景。虽然对控制流感大流行的战略进行了充分的研究，但对流感大流行的不同地理和时间扩散模式的特征和影响的关注较少。方法/主要发现。利用一个包含52个世界主要城市之间航空旅行的记录良好的人口模型，我们确定了潜在的流感大流行扩散概况，并检查了这种异质性如何影响干预措施的影响。应用于一组大流行模拟的聚类方法确定了6个大流行概况，它们在全球负担方面表现出不同的特征，特别是在全球负担方面（从415到415）。1.6亿例)和持续时间（从26天到360天）。多变量敏感性分析表明，传播率和易感人群比例对大流行扩散有较大影响。针对两种具体情况分析了干预措施与大流行结果之间的相关性：一种是快速、大规模的大流行，另一种是缓慢形成、持久的大流行。在这两种情况下，采用五种控制措施（口罩、隔离、抗病毒药物的预防性或治疗性使用、疫苗接种）的日期与大流行结果密切相关。相反，在发生大规模流行病的情况下，这些干预措施的覆盖范围和效力与大流行结果仅存在适度相关性。大流行前接种疫苗对两种情况的大流行结果都有影响，而旅行限制是唯一对两种情况都没有任何可衡量影响的措施。结论。我们的研究强调：(i)未来流感大流行的可能概况存在很大的异质性；㈡各国做好充分准备的重要性，因为大流行病无论何时何地开始都可能造成严重后果；㈢需要迅速实施控制措施，甚至通过大流行前接种疫苗来预测大流行的出现；（iv）除了旅行限制外，将所有可用的控制措施结合起来的价值。
Background. Although strategies to contain influenza pandemics are well studied, the characterization and the implications of different geographical and temporal diffusion patterns of the pandemic have been given less attention. Methodology/Main Findings. Using a well-documented metapopulation model incorporating air travel between 52 major world cities, we identified potential influenza pandemic diffusion profiles and examined how the impact of interventions might be affected by this heterogeneity. Clustering methods applied to a set of pandemic simulations, characterized by seven parameters related to the conditions of emergence that were varied following Latin hypercube sampling, were used to identify six pandemic profiles exhibiting different characteristics notably in terms of global burden ( from 415 to.160 million of cases) and duration ( from 26 to 360 days). A multivariate sensitivity analysis showed that the transmission rate and proportion of susceptibles have a strong impact on the pandemic diffusion. The correlation between interventions and pandemic outcomes were analyzed for two specific profiles: a fast, massive pandemic and a slow building, long-lasting one. In both cases, the date of introduction for five control measures ( masks, isolation, prophylactic or therapeutic use of antivirals, vaccination) correlated strongly with pandemic outcomes. Conversely, the coverage and efficacy of these interventions only moderately correlated with pandemic outcomes in the case of a massive pandemic. Pre-pandemic vaccination influenced pandemic outcomes in both profiles, while travel restriction was the only measure without any measurable effect in either. Conclusions. Our study highlights: (i) the great heterogeneity in possible profiles of a future influenza pandemic; (ii) the value of being well prepared in every country since a pandemic may have heavy consequences wherever and whenever it starts; (iii) the need to quickly implement control measures and even to anticipate pandemic emergence through pre-pandemic vaccination; and (iv) the value of combining all available control measures except perhaps travel restrictions.