Mitigation strategies for pandemic influenza in the United States
Mitigation strategies for pandemic influenza in the United States
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DOI：
10.1073/pnas.0601266103
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发表时间：
2006-04-11
影响因子：
11.1
通讯作者：
Macken, CA
中科院分区：
文献类型：
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作者：
Germann, TC;Kadau, K;Macken, CA
最近由于高致病性（H5 N1）禽流感A病毒感染而导致的人类死亡已经引起了对像1917-1918年那样的毁灭性大流行的恐惧，如果这种禽流感病毒进化成容易在人类之间传播的话。我们引入并使用一个大规模随机模拟模型来研究流感病毒大流行株在美国2.81亿人口中的传播，R-0（基本生殖数）从1.6到2.4。我们模拟了各种水平和组合的流感抗病毒剂，疫苗和修改的社会流动性（包括学校关闭和旅行限制）对这种传播的时间和幅度的影响。我们的模拟表明，在高度移动的人群中，在检测到疫情后限制旅行可能会稍微延迟疫情的时间进程，而不会影响最终的患病人数。对于R-0 < 1.9，我们的模型表明，即使与流行菌株匹配不佳，疫苗的快速生产和分配也可以显着减缓疾病传播，并将患病人数限制在人口的10%以下，特别是如果儿童优先接种疫苗。或者，在有针对性的预防策略中积极部署数百万个疗程的流感抗病毒剂，如果有足够的接触者追踪和分发能力，可能会遏制R-0较低的新生疫情。对于更高的R-0，我们预测，将需要多种策略的组合（涉及社会和医疗干预），以实现类似的疾病率限制。
Recent human deaths due to infection by highly pathogenic (H5N1) avian influenza A virus have raised the specter of a devastating pandemic like that of 1917-1918, should this avian virus evolve to become readily transmissible among humans. We introduce and use a large-scale stochastic simulation model to investigate the spread of a pandemic strain of influenza virus through the U.S. population of 281 million individuals for R-0 (the basic reproductive number) from 1.6 to 2.4. We model the impact that a variety of levels and combinations of influenza antiviral agents, vaccines, and modified social mobility (including school closure and travel restrictions) have on the timing and magnitude of this spread. Our simulations demonstrate that, in a highly mobile population, restricting travel after an outbreak is detected is likely to delay slightly the time course of the outbreak without impacting the eventual number ill. For R-0 < 1.9, our model suggests that the rapid production and distribution of vaccines, even if poorly matched to circulating strains, could significantly slow disease spread and limit the number ill to < 10% of the population, particularly if children are preferentially vaccinated. Alternatively, the aggressive deployment of several million courses of influenza antiviral agents in a targeted prophylaxis strategy may contain a nascent outbreak with low R-0, provided adequate contact tracing and distribution capacities exist. For higher R-0, we predict that multiple strategies in combination (involving both social and medical interventions) will be required to achieve similar limits on illness rates.