Optimizing infectious disease interventions during an emerging epidemic
Optimizing infectious disease interventions during an emerging epidemic
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DOI：
10.1073/pnas.0908491107
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发表时间：
2010-01-12
影响因子：
11.1
通讯作者：
Lipsitch, Marc
中科院分区：
文献类型：
--
作者：
Wallinga, Jacco;van Boven, Michiel;Lipsitch, Marc
新颖的流感A（H1N1）V的出现和全球影响突出了对动物和人类的新型和意外的感染性疾病爆发的持续威胁。一旦发现了新兴流行病，公共卫生当局将尝试通过尽可能多地减少进一步传播来缓解流行病。稀缺和/或昂贵的控制措施，例如疫苗，抗感染药物和社会疏远，必须分配疾病的流行病学特征。在这里，我们提出了用有限的数据分配稀缺资源的第一原则。我们表明，在广泛的假设下，针对该组的干预措施的简单规则规则，每个人的感染风险最高，将实现新型感染的传播潜力的最大降低。对于易感人的疫苗接种，适当的风险措施是感染力；对于社会距离，适当的风险措施是感染的发生率。与依赖于群体特异性传输率的详细知识的现有方法不同，此处描述的方法只能使用在流行病期间容易获得的数据来实施，并随着流行病的进展而准备就绪适应。观察感染风险的需求有助于集中于新的传染病监测计划的持续计划和设计；从分配稀缺资源的提出的第一原则中，当对新兴流行病的新观察结果可用时，我们可以调整小组的优先级。
The emergence and global impact of the novel influenza A(H1N1) v highlights the continuous threat to public health posed by a steady stream of new and unexpected infectious disease outbreaks in animals and humans. Once an emerging epidemic is detected, public health authorities will attempt to mitigate the epidemic by, among other measures, reducing further spread as much as possible. Scarce and/or costly control measures such as vaccines, anti-infective drugs, and social distancing must be allocated while epidemiological characteristics of the disease remain uncertain. Here we present first principles for allocating scarce resources with limited data. We show that under a broad class of assumptions, the simple rule of targeting intervention measures at the group with the highest risk of infection per individual will achieve the largest reduction in the transmission potential of a novel infection. For vaccination of susceptible persons, the appropriate risk measure is force of infection; for social distancing, the appropriate risk measure is incidence of infection. Unlike existing methods that rely on detailed knowledge of group-specific transmission rates, the method described here can be implemented using only data that are readily available during an epidemic, and allows ready adaptation as the epidemic progresses. The need to observe risk of infection helps to focus the ongoing planning and design of new infectious disease surveillance programs; from the presented first principles for allocating scarce resources, we can adjust the prioritization of groups for intervention when new observations on an emerging epidemic become available.