Antivirals and the control of influenza outbreaks
Antivirals and the control of influenza outbreaks
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DOI：
10.1086/522661
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发表时间：
2007-11-15
影响因子：
11.8
通讯作者：
McGeer, Allison
中科院分区：
文献类型：
--
作者：
Hota, Susy;McGeer, Allison
在每年的流感流行期间，在封闭的机构中爆发流感是常见的。在健康的儿童或年轻人中，这种暴发通常与严重的发病率或死亡率有关;然而，在医院和疗养院，据报道，发病率高达60%，病死率高达50%。每年对患者或居民以及医院和疗养院工作人员进行流感疫苗接种对死亡率产生了重大影响，并减少了疫情的数量。非药物干预（E。例如，在一个实施例中，洗手和隔离接触者）可能会减少流感的传播，但缺乏证据证明其有效性。尽管如此，疫苗接种率高、感染控制计划优于平均水平的老年人长期护理机构每年发生流感爆发的可能性为25%-50%，预计居民发病率为35%-40%。因此，抗病毒药物已越来越多地用于减轻流感爆发的影响。有两类抗病毒药物对流感有效：金刚烷类和神经氨酸酶抑制剂。这两类药物似乎对治疗和预防易感甲型流感病毒株同样有效。然而，金刚烷对B型流感病毒没有活性，并且越来越多的甲型流感分离株对金刚烷具有抗性。金刚烷类药物的不良事件发生率高于神经氨酸酶抑制剂。有大量证据表明，抗病毒预防措施可有效终止封闭机构中的季节性流感爆发。如果库存充足，抗病毒药物在下一次流感大流行期间可能对减轻医疗机构流感传播的影响更为重要。
During annual influenza epidemics, outbreaks of influenza in closed institutions are common. Among healthy children or young adults, such outbreaks are uncommonly associated with serious morbidity or mortality; however, in hospitals and nursing homes, attack rates as high as 60% and case-fatality rates as high as 50% have been reported. Annual influenza vaccination of both patients or residents and hospital and nursing home staff has had a substantial impact on mortality and has reduced the number of outbreaks. Nonpharmacologic interventions (e. g., handwashing and contact isolation of case patients) may reduce the spread of influenza, although evidence for their efficacy is lacking. Nonetheless, long-term care facilities for the elderly population with high vaccination rates and better-than-average infection-control programs have a 25%-50% chance of experiencing an influenza outbreak each year, with an expected resident attack rate of 35%-40%. Thus, antiviral drugs have been increasingly used to mitigate the impact of influenza outbreaks. There are 2 classes of antiviral drugs that are active against influenza: adamantanes and neuraminidase inhibitors. Drugs of the 2 classes appear to be equally effective for the treatment and prophylaxis of susceptible influenza A virus strains. However, adamantanes are not active against influenza B virus, and an increasing proportion of influenza A isolates are resistant to adamantanes. Adamantanes are associated with higher rates of adverse events than are neuraminidase inhibitors. There is substantial evidence that antiviral prophylaxis is effective in terminating outbreaks of seasonal influenza in closed institutions. If stockpiles are adequate, antiviral drugs are likely to be even more important in mitigating the impact of influenza transmission in health care institutions during the next influenza pandemic.