Reactive strategies for containing developing outbreaks of pandemic influenza.
Reactive strategies for containing developing outbreaks of pandemic influenza.
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DOI：
10.1186/1471-2458-11-s1-s1
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发表时间：
2011-02-25
影响因子：
4.5
通讯作者：
Nizam A
中科院分区：
文献类型：
--
作者：
Andradóttir S;Chiu W;Goldsman D;Lee ML;Tsui KL;Sander B;Fisman DN;Nizam A
2009年和2010年初，北半球不得不应对新的甲型H1N1流感大流行的第一波。尽管在许多国家开展了高调的疫苗接种活动，但疫苗接种计划的管理延误是常见的，而且没有达到高疫苗覆盖率水平。这一经验表明，有必要探索抗击大流行性流感的其他反应性战略的流行病学和经济效果。我们使用大流行性流感的随机模型来研究可用于应对不断发展的疫情的现实策略。该模型被校准为记录的疾病发病率和基本生殖数量(R0)估计，并被构建为代表典型的北美中型城市。我们的模型预测，在没有干预的情况下，平均疾病发病率为34.1%，这样一个城市与发病率和死亡率相关的总成本为8100万美元。如果将低覆盖率反应性疫苗接种和有限的抗病毒使用与实际的、破坏性最小的社会距离策略相结合，即使在疫苗供应链相关延误的情况下，也可以根据需要短期关闭个别学校，从而将发病率和经济成本分别降低至5.4%和3700万美元。结果随着疫苗接种率的提高和疫苗效力的提高，疫苗接种率不断提高。从流行病学和经济角度来看，这种组合策略可能比单独接种疫苗更有效，公共卫生当局在应对未来大流行性流感暴发时应予以大力考虑。
In 2009 and the early part of 2010, the northern hemisphere had to cope with the first waves of the new influenza A (H1N1) pandemic. Despite high-profile vaccination campaigns in many countries, delays in administration of vaccination programs were common, and high vaccination coverage levels were not achieved. This experience suggests the need to explore the epidemiological and economic effectiveness of additional, reactive strategies for combating pandemic influenza. We use a stochastic model of pandemic influenza to investigate realistic strategies that can be used in reaction to developing outbreaks. The model is calibrated to documented illness attack rates and basic reproductive number (R0) estimates, and constructed to represent a typical mid-sized North American city. Our model predicts an average illness attack rate of 34.1% in the absence of intervention, with total costs associated with morbidity and mortality of US$81 million for such a city. Attack rates and economic costs can be reduced to 5.4% and US$37 million, respectively, when low-coverage reactive vaccination and limited antiviral use are combined with practical, minimally disruptive social distancing strategies, including short-term, as-needed closure of individual schools, even when vaccine supply-chain-related delays occur. Results improve with increasing vaccination coverage and higher vaccine efficacy. Such combination strategies can be substantially more effective than vaccination alone from epidemiological and economic standpoints, and warrant strong consideration by public health authorities when reacting to future outbreaks of pandemic influenza.