Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
复制标题
DOI：
10.1371/journal.pone.0016094
复制
发表时间：
2011-01-19
期刊：
影响因子：
3.7
通讯作者：
Meyers LA
中科院分区：
文献类型：
--
作者：
Dimitrov NB;Goll S;Hupert N;Pourbohloul B;Meyers LA
2009 年，全球公共卫生机构致力于减轻猪源甲型流感 (pH1N1) 病毒的影响。这些努力包括加强监测、保持社交距离、采取卫生措施以及有针对性地使用抗病毒药物来预防感染（预防）。此外，建议对某些患者亚组进行积极的抗病毒治疗，以减少症状的严重程度和持续时间。为了帮助各州和其他地方满足这些需求，美国政府在大流行开始后几周内分发了国家战略储备中四分之一的抗病毒药物。然而，没有定量模型指导剩余库存与大流行传播或严重程度相关的地时分布。我们提出了一种战术优化模型，用于在 2009 年 pH1N1 等大流行的早期阶段（在广泛使用毒株特异性疫苗之前）分配这些库存以治疗感染病例。我们的优化方法有效地搜索了应用于美国城市内部和城市之间大流行性流感传播的随机网络模型的大量干预策略。由此产生的优化策略取决于病毒的传播性以及抗病毒药物的吸收和浪费率（通过错误分配或丢失）。我们的结果表明，积极的、基于社区的抗病毒治疗策略，涉及早期、广泛、按比例向各州分发抗病毒药物，有助于减缓轻度传播病毒株（如 pH1N1）的传播。对于传播性较高的毒株，抗病毒药物的使用结果更容易受到分发间隔选择、每次装运的数量以及与大流行病传播相关的装运时间的影响。这项研究支持了之前的模型结果，表明适当的抗病毒治疗可能是未来流感大流行早期阶段的有效缓解策略，增加了系统性努力优化分配策略并为公共卫生政策制定者提供战术指导的需要。
In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In addition, aggressive antiviral treatment was recommended for certain patient subgroups to reduce the severity and duration of symptoms. To assist States and other localities meet these needs, the U.S. Government distributed a quarter of the antiviral medications in the Strategic National Stockpile within weeks of the pandemic's start. However, there are no quantitative models guiding the geo-temporal distribution of the remainder of the Stockpile in relation to pandemic spread or severity. We present a tactical optimization model for distributing this stockpile for treatment of infected cases during the early stages of a pandemic like 2009 pH1N1, prior to the wide availability of a strain-specific vaccine. Our optimization method efficiently searches large sets of intervention strategies applied to a stochastic network model of pandemic influenza transmission within and among U.S. cities. The resulting optimized strategies depend on the transmissability of the virus and postulated rates of antiviral uptake and wastage (through misallocation or loss). Our results suggest that an aggressive community-based antiviral treatment strategy involving early, widespread, pro-rata distribution of antivirals to States can contribute to slowing the transmission of mildly transmissible strains, like pH1N1. For more highly transmissible strains, outcomes of antiviral use are more heavily impacted by choice of distribution intervals, quantities per shipment, and timing of shipments in relation to pandemic spread. This study supports previous modeling results suggesting that appropriate antiviral treatment may be an effective mitigation strategy during the early stages of future influenza pandemics, increasing the need for systematic efforts to optimize distribution strategies and provide tactical guidance for public health policy-makers.
登录
查看更多内容
影响因子：
6.3
作者：
Doyle, A;Bonmarin, I;Desenclos, JC
通讯作者：
Desenclos, JC
影响因子：
7.5
作者：
Auer, P;Cesa-Bianchi, N;Fischer, P
通讯作者：
Fischer, P
影响因子：
15.8
作者：
Lipsitch M;Cohen T;Murray M;Levin BR
通讯作者：
Levin BR
影响因子：
3.7
作者：
Goldstein E;Cowling BJ;O'Hagan JJ;Danon L;Fang VJ;Hagy A;Miller JC;Reshef D;Robins J;Biedrzycki P;Lipsitch M
通讯作者：
Lipsitch M
影响因子：
11.8
作者：
Hota, Susy;McGeer, Allison
通讯作者：
McGeer, Allison