Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic
Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic
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DOI：
10.1001/jama.298.6.644
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发表时间：
2007-08-08
影响因子：
120.7
通讯作者：
Cetron, Martin S.
中科院分区：
文献类型：
--
作者：
Markel, Howard;Lipman, Harvey B.;Cetron, Martin S.
背景大流行流感规划中的一个关键问题是非药物干预在延迟大流行的时间影响、降低总体和高峰发病率以及减少累积死亡人数方面可能发挥的作用。这些措施可能会为大流行毒株疫苗和抗病毒药物的生产和分发提供宝贵的时间。目的检查1918年9月8日至1919年2月22日美国大陆43个城市实施非药物干预以缓解疫情的情况，并确定城市之间死亡率的差异是否与非药物干预的时间、持续时间和组合有关；与先前大流行浪潮相关的人口易感性改变；年龄和性别分布；以及人口规模和密度。设计和设置历史档案研究以及统计和流行病学分析。非药物干预措施分为3大类：学校停课、公众集会取消和隔离隔离。主要结果指标每周超额死亡率(EDR)；从启动非药物干预到第一个EDR高峰的时间；每周EDR的第一个高峰；以及整个24周研究期间的累计EDR。结果在分析的24周内，43个城市发生了115 340例超额肺炎和流感死亡(EDR，500/10万人口)。每个城市至少采用了三大类非药物干预中的一种。学校关闭和公众集会禁令同时启动是34个城市(79%)实施的最常见的组合；这种组合的中位数持续时间为4周(范围为1-10周)，与每周EDR的减少显著相关。较早实施非药物干预的城市在达到死亡率峰值方面有更大的延迟(Spearman r=-0.74，P
Context A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.Objectives To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density.Design and Setting Historical archival research, and statistical and epidemiological analyses. Nonpharmaceutical interventions were grouped into 3 major categories: school closure; cancellation of public gatherings; and isolation and quarantine.Main Outcome Measures Weekly excess death rate (EDR); time from the activation of nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative EDR during the entire 24-week study period.Results There were 115 340 excess pneumonia and influenza deaths ( EDR, 500/ 100 000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks ( range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality ( Spearman r=- 0.74, P