Influenza.
Influenza.
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DOI：
10.1016/s0140-6736(03)14854-4
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发表时间：
2003-11-22
期刊：
影响因子：
--
通讯作者：
Zambon M
中科院分区：
文献类型：
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作者：
Nicholson KG;Wood JM;Zambon M
虽然大多数流感感染是自限性的，但很少有其他疾病造成如此巨大的痛苦和经济损失。尽管流感很重要，但自从金刚烷胺在近40年前获得许可以来，直到最近，在控制流感方面进展甚微。在过去十年中，关于灭活疫苗提供的保护以及流感病毒活疫苗在儿童中的安全性和有效性的证据越来越多。疫苗技术有了许多新的发展。此外，对病毒神经氨酸酶的研究已导致有效的选择性抗病毒药物获得许可，经济决策模型为每年接种疫苗提供了进一步的理由，并为使用神经氨酸酶抑制剂提供了框架。在开发近患者流感检测方面也取得了进展，这可能有助于个体诊断或识别广泛的病毒传播，从而优化临床管理。尽管取得了这些进展，但禽H5N1、H9N2和H7N7流感在人类中的发生以及严重急性呼吸系统综合征在全球的迅速传播提醒我们，我们容易受到新出现的大流行病的影响。最近的H5N1感染病例与高死亡率相关，而人类感染H7N7和H9N2禽流感通常是温和的、自限性的，这两者之间的对比表明，我们对致病性的分子相关性的理解存在差距，并强调需要继续对大流行性流感进行国际研究。改善动物和人类监测，新的疫苗接种方法，以及增加疫苗和抗病毒药物的使用，以应对每年的流感爆发，对于减少全球大流行和大流行间流感的死亡人数至关重要。
Although most influenza infections are self-limited, few other diseases exert such a huge toll of suffering and economic loss. Despite the importance of influenza, there had been, until recently, little advance in its control since amantadine was licensed almost 40 years ago. During the past decade, evidence has accrued on the protection afforded by inactivated vaccines and the safety and efficacy in children of live influenza-virus vaccines. There have been many new developments in vaccine technology. Moreover, work on viral neuraminidase has led to the licensing of potent selective antiviral drugs, and economic decision modelling provides further justification for annual vaccination and a framework for the use of neuraminidase inhibitors. Progress has also been made on developing near-patient testing for influenza that may assist individual diagnosis or the recognition of widespread virus circulation, and so optimise clinical management. Despite these advances, the occurrence of avian H5N1, H9N2, and H7N7 influenza in human beings and the rapid global spread of severe acute respiratory syndrome are reminders of our vulnerability to an emerging pandemic. The contrast between recent cases of H5N1 infection, associated with high mortality, and the typically mild, self-limiting nature of human infections with avian H7N7 and H9N2 influenza shows the gaps in our understanding of molecular correlates of pathogenicity and underlines the need for continuing international research into pandemic influenza. Improvements in animal and human surveillance, new approaches to vaccination, and increasing use of vaccines and antiviral drugs to combat annual influenza outbreaks are essential to reduce the global toll of pandemic and interpandemic influenza.