Public health interventions and epidemic intensity during the 1918 influenza pandemic
Public health interventions and epidemic intensity during the 1918 influenza pandemic
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DOI：
10.1073/pnas.0610941104
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发表时间：
2007-05-01
影响因子：
11.1
通讯作者：
Lipsitch, Marc
中科院分区：
文献类型：
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作者：
Hatchett, Richard J.;Mecher, Carter E.;Lipsitch, Marc
旨在减少人与人之间传染性接触的非药物干预措施 (NPI) 是减轻下一次流感大流行影响的计划的组成部分。尽管数学模型支持非营利机构的潜在好处，但此类干预措施对过去流行病影响的历史证据尚未得到系统检验。我们获得了 1918 年大流行期间美国 17 个城市 19 类 NPI 的时间数据，并检验了早期实施多种干预措施与减少疾病传播相关的假设。与这一假设相一致的是，在疫情早期阶段实施多种干预措施的城市，其峰值死亡率比未实施多种干预措施的城市低约 50%，且疫情曲线也较不那么陡峭。在疫情早期实施多种干预措施的城市也呈现出累积超额死亡率较低的趋势，但差异较小（约20%），且统计显着性低于峰值死亡率。这一发现并不出人意料，因为 1918 年，很少有城市将 NPL 维持时间超过 6 周。早期实施某些干预措施，包括关闭学校、教堂和剧院，与较低的峰值死亡率相关，但没有任何一项干预措施表明与 1918 年大流行阶段的总体结果改善有关。这些发现支持这样的假设：快速实施多项 NPI 可以显着减少流感传播，但放松此类措施后，病毒传播将会重新出现。
Nonpharmaceutical interventions (NPIs) intended to reduce infectious contacts between persons form an integral part of plans to mitigate the impact of the next influenza pandemic. Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined. We obtained data on the timing of 19 classes of NPI in 17 U.S. cities during the 1918 pandemic and tested the hypothesis that early implementation of multiple interventions was associated with reduced disease transmission. Consistent with this hypothesis, cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates approximate to 50% lower than those that did not and had less-steep epidemic curves. Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (approximate to 20%) and less statistically significant than that for peak death rates. This finding was not unexpected, given that few cities maintained NPls longer than 6 weeks in 1918. Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic. These findings support the hypothesis that rapid implementation of multiple NPIs can significantly reduce influenza transmission, but that viral spread will be renewed upon relaxation of such measures.