Strategies for containing an emerging influenza pandemic in Southeast Asia
Strategies for containing an emerging influenza pandemic in Southeast Asia
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DOI：
10.1038/nature04017
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发表时间：
2005-09-08
期刊：
影响因子：
64.8
通讯作者：
Burke, DS
中科院分区：
文献类型：
--
作者：
Ferguson, NM;Cummings, DAT;Burke, DS
高致病性H5N1甲型流感病毒目前在东南亚的禽类中流行，人类病例继续积累。虽然目前H5N1病毒不能持续在人与人之间传播，但由于突变或重组产生传播性增加的病毒的风险，它是一种严重的大流行病威胁。因此，确定可能能够在最早阶段阻止大流行的公共卫生干预措施是一个优先事项。在这里，我们使用东南亚流感传播的模拟模型来评估有针对性的大规模预防性使用抗病毒药物作为遏制策略的潜在有效性。还审查了旨在降低人口接触率的其他干预措施，以加强以抗病毒为基础的遏制政策。我们表明，消除一个新生的大流行可能是可行的，使用地理上有针对性的预防和社会距离的措施相结合，如果新病毒的基本繁殖数低于1.8。我们预测，300万疗程的抗病毒药物储备应足以消除。政策的有效性关键取决于临床病例的诊断速度以及抗病毒药物的分发速度。
Highly pathogenic H5N1 influenza A viruses are now endemic in avian populations in Southeast Asia, and human cases continue to accumulate. Although currently incapable of sustained human-to-human transmission, H5N1 represents a serious pandemic threat owing to the risk of a mutation or reassortment generating a virus with increased transmissibility. Identifying public health interventions that might be able to halt a pandemic in its earliest stages is therefore a priority. Here we use a simulation model of influenza transmission in Southeast Asia to evaluate the potential effectiveness of targeted mass prophylactic use of antiviral drugs as a containment strategy. Other interventions aimed at reducing population contact rates are also examined as reinforcements to an antiviral-based containment policy. We show that elimination of a nascent pandemic may be feasible using a combination of geographically targeted prophylaxis and social distancing measures, if the basic reproduction number of the new virus is below 1.8. We predict that a stockpile of 3 million courses of antiviral drugs should be sufficient for elimination. Policy effectiveness depends critically on how quickly clinical cases are diagnosed and the speed with which antiviral drugs can be distributed.