Emerging infections: Pandemic influenza
Emerging infections: Pandemic influenza
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DOI：
10.1093/oxfordjournals.epirev.a017917
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发表时间：
1996-01-01
影响因子：
5.5
通讯作者：
Glezen, WP
中科院分区：
文献类型：
--
作者：
Glezen, WP
1992年发表的美国医学研究所新出现的微生物对健康威胁委员会的报告将流感病毒定义为新出现的感染的原型(1)。流感大流行早在有记录的历史中就已被认识到，由于病毒的变异性，它仍然是对国家健康的巨大威胁。尽管在描述病毒的分子方面、阐明流行病学和传播方式以及开发预防和治疗方法方面取得了很大进展，但尚未建立合理的控制策略。现代社会的趋势，包括快速人类交通工具的日益普及和人口迅速膨胀的都市化，往往会助长流感的传播并增加发病率。现代医学可以降低早期流行期间流感病毒感染并发症造成的死亡率，但医疗干预的成本已经增加到应该考虑有效的疫情控制方法的程度。这一挑战为在下一次大流行之前制定、测试和制定控制大流行间流感的战略提供了机会。大流行是由甲型流感病毒的出现引起的，这种病毒对人类来说是新的。在1957年出现亚型H_2N_2和1968年出现亚型H_3N_2之前，通过测定老年人群中的抗体流行率，得出了甲型流感亚型在相隔60年或更长时间后循环的证据(2，3)。一个更不祥的威胁是在禽类宿主中持续存在的14种甲型流感亚型。正如1957年和1968年发生的那样，禽流感病毒可以与人类病毒重新配对，从而产生具有在人类人口中传播潜力的新表面抗原的后代。
The report of the Institute of Medicine's Committee on Emerging Microbial Threats to Health in the United States, published in 1992, defines influenza virus as the prototype emerging infection (1). Pandemics of influenza have been recognized since earliest recorded history and, because of the mutability of the virus, still represent a formidable threat to the health of the nation. Although much progress has been made in describing the molecular aspects of the virus, in elucidating the epidemiology and modes of spread, and in developing methods for prevention and treatment, a rational strategy for control has not been established. The trends of modern society, including the increasing availability of rapid human transportation and the urbanization of the rapidly expanding human population, tend to facilitate the spread of influenza and increase morbidity. Modern medicine can reduce the mortality that resulted from complications of infection with influenza virus during earlier epidemics, but the cost of medical interventions has increased to the point that effective methods of epidemic control should be considered. This challenge provides an opportunity to develop, test, and have in place a strategy for control of interpandemic influenza before the next pandemic. Pandemics result from the emergence of an influenza A virus that is novel for the human population. Evidence for recycling of subtypes of influenza A after intervals of 60 years or more has been derived by determining antibody prevalence in elderly populations prior to the emergence of subtypes H2N2 in 1957 and H3N2 in 1968 (2, 3). A more ominous threat is the reservoir of 14 influenza A subtypes that persist in avian hosts (4). An avian virus can reassort with a human virus, as occurred in 1957 and 1968, to allow the creation of progeny that possess novel surface antigens with the potential to spread in human popu-