OPTIMAL STRATEGIES OF SOCIAL DISTANCING AND VACCINATION AGAINST SEASONAL INFLUENZA
OPTIMAL STRATEGIES OF SOCIAL DISTANCING AND VACCINATION AGAINST SEASONAL INFLUENZA
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DOI：
10.3934/mbe.2013.10.1615
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发表时间：
2013-10-01
影响因子：
2.6
通讯作者：
Shim, Eunha
中科院分区：
文献类型：
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作者：
Shim, Eunha
由于流感的流行病学和经济负担，在美国控制季节性流感传播的最佳控制策略受到高度关注。为了评估疫苗接种和社交距离的最佳策略，我们使用了季节性流感的年龄结构动态模型。我们应用最优控制理论来确定以最小成本降低发病率和死亡率的最佳方法。结合Pontryagins最大值原理，我们计算了疫苗接种和社会距离的时间依赖性最优政策，以最大限度地减少与季节性流感相关的流行病学和经济负担。我们计算了最佳的年龄特异性干预策略，并在各种干预成本和疾病传播率下对其进行了分析。我们的研究结果表明，组合策略对减少最终的流行规模有更强的影响。我们的研究结果还表明，通过将大多数疫苗分配给学龄前儿童（5岁以下），然后是年轻人（20-39岁）和学龄儿童（6-19岁），可以实现最佳疫苗接种。我们发现，所有年龄组的最佳疫苗接种率在疫情爆发初期都是最高的，这就需要在疫情的早期阶段做出巨大努力。另一方面，临床病例的最佳社交距离往往持续整个疫情期间，其强度对所有年龄组都相对相等。此外，由于流感病毒的传播性更高（即R 0更高），最佳控制策略需要包括更多的努力来提高疫苗接种率，而不是努力鼓励社交距离。总之，公共卫生机构需要考虑病毒的传播性和鼓励早期接种疫苗的方法，以及有症状病例的自愿社交距离，以确定针对季节性流感的最佳干预策略。
Optimal control strategies for controlling seasonal influenza transmission in the US are of high interest, because of the significant epidemiological and economic burden of influenza. To evaluate optimal strategies of vaccination and social distancing, we used an age-structured dynamic model of seasonal influenza. We applied optimal control theory to identify the best way of reducing morbidity and mortality at a minimal cost. In combination with the Pontryagins maximum principle, we calculated time-dependent optimal policies of vaccination and social distancing to minimize the epidemiological and economic burden associated with seasonal influenza. We computed optimal age-specific intervention strategies and analyze them under various costs of interventions and disease transmissibility. Our results show that combined strategies have a stronger impact on the reduction of the final epidemic size. Our results also suggest that the optimal vaccination can be achieved by allocating most vaccines to preschool-age children (age under five) followed by young adults (age 20-39) and school age children (age 6-19). We find that the optimal vaccination rates for all age groups are highest at the beginning of the outbreak, requiring intense effort at the early phase of an epidemic. On the other hand, optimal social distancing of clinical cases tends to last the entire duration of an outbreak, and its intensity is relatively equal for all age groups. Furthermore, with higher transmissibility of the influenza virus (i.e. higher R0), the optimal control strategy needs to include more efforts to increase vaccination rates rather than efforts to encourage social distancing. Taken together, public health agencies need to consider both the transmissibility of the virus and ways to encourage early vaccination as well as voluntary social distancing of symptomatic cases in order to determine optimal intervention strategies against seasonal influenza.