Compliance to oseltamivir among two populations in Oxfordshire, United Kingdom affected by influenza A(H1N1)pdm09, November 2009--a waste water epidemiology study.
Compliance to oseltamivir among two populations in Oxfordshire, United Kingdom affected by influenza A(H1N1)pdm09, November 2009--a waste water epidemiology study.
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DOI：
10.1371/journal.pone.0060221
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Söderström H
中科院分区：
文献类型：
--
作者：
Singer AC;Järhult JD;Grabic R;Khan GA;Fedorova G;Fick J;Lindberg RH;Bowes MJ;Olsen B;Söderström H
抗病毒供应仍然是许多大流行防备计划的重点，然而，关于抗病毒遵从率仍存在相当大的不确定性。在这里，我们使用废水流行病学方法来评估奥司他韦(达菲)的依从性。奥司他韦羧酸盐(奥司他韦的活性代谢物)是在2009年甲型H1N1流感pdm09大流行秋季高峰期从联合王国两个废水处理厂的集水区回收的。根据检测到的水平对奥司他韦消费量的预测与两个国家政府统计数据来源进行了比较，以得出遵从率。情景和敏感性分析表明，在研究期间，在两个污水处理厂的集水区，有3-4到120-154人在使用奥司他韦，遵从率在45-60%之间。由于大约一半收集的抗病毒药物没有使用，显然有必要改变公共卫生信息，以提高遵从性。我们认为，在废水处理厂(数亿至数百万人)的规模上近乎实时地了解药物依从性，可能有助于公共卫生信息变得更及时、更有针对性和对人口统计学更敏感，同时可能导致更少的误用和未使用的抗病毒药物，更少的浪费，最终形成更强大和更有效的大流行预防计划。
Antiviral provision remains the focus of many pandemic preparedness plans, however, there is considerable uncertainty regarding antiviral compliance rates. Here we employ a waste water epidemiology approach to estimate oseltamivir (Tamiflu®) compliance. Oseltamivir carboxylate (oseltamivir's active metabolite) was recovered from two waste water treatment plant (WWTP) catchments within the United Kingdom at the peak of the autumnal wave of the 2009 Influenza A (H1N1)pdm09 pandemic. Predictions of oseltamivir consumption from detected levels were compared with two sources of national government statistics to derive compliance rates. Scenario and sensitivity analysis indicated between 3–4 and 120–154 people were using oseltamivir during the study period in the two WWTP catchments and a compliance rate between 45–60%. With approximately half the collected antivirals going unused, there is a clear need to alter public health messages to improve compliance. We argue that a near real-time understanding of drug compliance at the scale of the waste water treatment plant (hundreds to millions of people) can potentially help public health messages become more timely, targeted, and demographically sensitive, while potentially leading to less mis- and un-used antiviral, less wastage and ultimately a more robust and efficacious pandemic preparedness plan.
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