Influenza pandemic preparedness in France:: modelling the impact of interventions
Influenza pandemic preparedness in France:: modelling the impact of interventions
复制标题
DOI：
10.1136/jech.2005.034082
复制
发表时间：
2006-05-01
影响因子：
6.3
通讯作者：
Desenclos, JC
中科院分区：
文献类型：
--
作者：
Doyle, A;Bonmarin, I;Desenclos, JC
背景：流感大流行导致死亡率过高和社会混乱。为了协助卫生当局更新法国大流行计划，作者估计了大流行中的健康事件（病例、住院和死亡）数量，并比较了干预措施的影响和效率。方法：蒙特卡罗模拟模型结合了关键变量的概率分布，提供了按年龄和风险组划分的健康事件（HE）的估计。输入变量是在文献和专家咨询后设定的。比较了针对性流感疫苗接种和抗病毒预防/治疗（奥司他韦）对高危人群（老年人、慢性病）、优先人群（必要专业人员）和总人群的影响。结果指标包括避免 HE 、所需剂量以及每次避免 HE 的直接成本。结果：如果不进行干预，流感大流行可能会在法国导致 1,490 万例病例、12 万人死亡和 60 万人住院。 24% 的死亡和 40% 的住院病例属于高危人群。如果发病率为 25%，则可以避免 2000-86000 人死亡，具体取决于目标人群和干预措施。如果最初可以的话，最好对全体人口进行疫苗接种。如果没有，对于重点人群来说，季节性预防似乎是最好的策略。对于高危人群，抗病毒治疗虽然效果较差，但似乎比预防更可行且更具成本效益（分别避免 29% 死亡；避免 1800 剂/死亡和避免 56% 死亡；避免 18 500 剂/死亡），并且应该选择，特别是在药物供应有限的情况下。 结论：结果表明抗病毒药物在流感大流行中发挥着强大作用。虽然该模型可以比较不同干预策略的影响，但关键变量仍然存在不确定性。
Background: Influenza pandemics result in excess mortality and social disruption. To assist health authorities update the French pandemic plan, the authors estimated the number of health events (cases, hospitalisations, and deaths) in a pandemic and compared interventions in terms of impact and efficiency.Method: A Monte Carlo simulation model, incorporating probability distributions of key variables, provided estimates of health events (HE) by age and risk group. Input variables were set after literature and expert consultation. The impact of targeted influenza vaccination and antiviral prophylaxis/treatment (oseltamivir) in high risk groups (elderly, chronic diseases), priority (essential professionals), and total populations was compared. Outcome measures were HE avoided, number of doses needed, and direct cost per HE avoided.Results: Without intervention, an influenza pandemic could result in 14.9 million cases, 0.12 million deaths, and 0.6 million hospitalisations in France. Twenty four per cent of deaths and 40% of hospitalisations would be among high risk groups. With a 25% attack rate, 2000-86000 deaths could be avoided, depending on population targeted and intervention. If available initially, vaccination of the total population is preferred. If not, for priority populations, seasonal prophylaxis seems the best strategy. For high risk groups, antiviral treatment, although less effective, seems more feasible and cost effective than prophylaxis (respectively 29% deaths avoided; 1800 doses/death avoided and 56% deaths avoided; 18 500 doses/death avoided) and should be chosen, especially if limited drug availability.Conclusion: The results suggest a strong role for antivirals in an influenza pandemic. While this model can compare the impact of different intervention strategies, there remains uncertainty surrounding key variables.