Multiple outbreaks and flu containment plans.
Multiple outbreaks and flu containment plans.
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多次爆发和流感遏制计划。
DOI：
10.1126/science.312.5775.845b
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Bergstrom,CarlT
中科院分区：
文献类型：
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作者：
Lipsitch,Marc;Robins,JamesM;Mills,ChristinaE;Bergstrom,CarlT
在报告我们最近关于多次爆发大流行性流感的风险的研究时，恩瑟林克先生引用了一些科学和政治上的反对意见，反对我们的结论，即一次大流行性流感的引入可能会紧随其后的是快速连续的其他引入（“新的研究对大流行性流感控制计划提出质疑，”每周新闻，2月24日，第1084页）。一些评论人士认为，不太可能出现多次引入，并将其与其他新出现的传染病（如SARS）进行了类比。事实上，SARS被认为在2003-04年曾多次进入人体（2,3）。HIV-1被认为存在多重感染(4)，埃博拉病毒被观察到聚集性引入(5)。评论员认为，流感大流行的可能性目前并不高于其每年3%的历史平均水平(6)，因此遏制措施将使大流行的时间延长10年或更长时间。我们的分析表明，只有当引入具有大流行能力的菌株的风险(i)较低，接近其历史平均水平，并且（ii）随时间保持不变时，控制才能产生这种规模的效益。两者似乎都不太可能。尽管人们对新的大流行毒株出现的过程知之甚少，但随着牲畜与人类接触的增加，风险必然会增加。据估计，自1968年以来，仅在中国，人、猪和家禽的数量就分别增长了60%、100倍和1000倍(7)。同样，过去十年H5N1流感和其他流感毒株在禽类中的地理传播必然会增加H5N1感染禽类与人类相遇的机会(8)。
In reporting on our recent study (1) On the risk of multiple outbreaks of pandemic influenza, M. Enserink cites several scientific and political objections to our conclusions that a single introduction of pandemic flu might be followed by additional introductions in quick succession (“New study casts doubt on plans for pandemic containment,” News of the Week, 24 Feb., p. 1084).Several commentators suggest that multiple introductions are unlikely, making analogies to other emerging infections, such as SARS. In fact, SARS is thought to have entered humans several times in 2003–04 (2, 3). Multiple infections have been suggested for HIV-1 (4), and clustered introductions have been observed for Ebola virus (5). The commentators suggest that the likelihood of a flu pandemic is not currently above its historical average of∼ 3% per year (6), so that containment will increase the time to a pandemic by a decade or more. Our analysis shows that containment will yield benefits on this scale only if the risk of introduction of a pandemic-capable strain is both (i) low, near its historical average, and (ii) constant over time. Neither seems likely. Although the process by which new pandemic strains emerge is poorly understood, the risk must increase with increasing encounters between livestock and humans, and populations of humans, pigs, and poultry have grown by an estimated 60%, 100-fold, and 1000-fold, respectively, in China alone since 1968 (7). Likewise, the past decade's geographic spread of H5N1 influenza and other influenza strains in birds must increase the opportunities for encounters between H5N1-infected birds and humans (8).