Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base.
Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base.
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DOI：
10.1186/1471-2458-7-208
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发表时间：
2007-08-15
影响因子：
4.5
通讯作者：
Bozzette SA
中科院分区：
文献类型：
--
作者：
Aledort JE;Lurie N;Wasserman J;Bozzette SA
在流感大流行中，疫苗和抗病毒药物的益处将受到供应和有效性的限制。因此，非药物公共卫生干预措施对于遏制疾病传播至关重要。然而，迄今为止对文献的最全面评估认识到，作为非药物大流行规划决策基础的证据质量普遍较差。尽管文献质量不佳，但鉴于需要为可能的大流行做好准备，将现有证据与关于大流行性流感非药物干预相对优点的专家意见相结合，可能会产生一套更明智和更广泛接受的建议。我们评估了非药物公共卫生干预措施的证据基础。然后，根据集体证据，我们确定了一套支持和反对干预措施的建议，这些建议既适用于可能使用干预措施的环境，也适用于大流行阶段，政策制定者可以使用这些建议来为大流行做准备，直到科学证据可以明确地满足规划者的需求。基于对过去流行病的回顾和最近的历史调查，我们通过将文献中的现有证据与定性和定量专家意见相结合，评估了非药物干预措施的相对优点。具体而言，我们回顾了最近有关预防大流行性流感人际传播的科学文献，召开了一次多学科专家会议，并就在各种情况下使用非药物公共卫生干预措施征求了专家建议（医疗设施;社区机构;私人家庭）和大流行阶段（无大流行;无美国大流行;早期局部美国大流行;晚期美国大流行）。文献中缺乏关于大多数非药物流感干预措施的疗效或有效性的证据。为了在缺乏强有力的科学证据的情况下为决策提供信息，专家们最终批准了在所有情况下和所有大流行阶段的手部卫生和呼吸礼仪、监测和病例报告以及快速病毒诊断。他们还鼓励病人和提供者在所有大流行阶段使用口罩和其他个人防护设备，并鼓励病人自愿自我隔离。其他非药物干预措施，包括为公众提供口罩和其他个人防护设备，在流行病早期关闭学校和工作场所，以及强制性旅行限制，因可能无效，不可行或公众无法接受而被拒绝。对流感非药物公共卫生干预措施的科学证据的需求是普遍的，目前的政策建议必须在很大程度上依赖于专家的判断。在缺乏明确的科学基础的情况下，我们对证据的评估确定了进一步调查的领域以及专家认为在流感大流行中可能有益、可行和广泛接受的非药物公共卫生干预措施。
In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs. Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households) and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic). The literature contained a dearth of evidence on the efficacy or effectiveness of most non-pharmaceutical interventions for influenza. In an effort to inform decision-making in the absence of strong scientific evidence, the experts ultimately endorsed hand hygiene and respiratory etiquette, surveillance and case reporting, and rapid viral diagnosis in all settings and during all pandemic phases. They also encouraged patient and provider use of masks and other personal protective equipment as well as voluntary self-isolation of patients during all pandemic phases. Other non-pharmaceutical interventions including mask-use and other personal protective equipment for the general public, school and workplace closures early in an epidemic, and mandatory travel restrictions were rejected as likely to be ineffective, infeasible, or unacceptable to the public. The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment. In the absence of a definitive science base, our assessment of the evidence identified areas for further investigation as well as non-pharmaceutical public health interventions that experts believe are likely to be beneficial, feasible and widely acceptable in an influenza pandemic.
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