On the relative role of different age groups in influenza epidemics.
On the relative role of different age groups in influenza epidemics.
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DOI：
10.1016/j.epidem.2015.04.003
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发表时间：
2015-12
期刊：
影响因子：
3.8
通讯作者：
Goldstein E
中科院分区：
文献类型：
--
作者：
Worby CJ;Chaves SS;Wallinga J;Lipsitch M;Finelli L;Goldstein E
确定流感流行中的关键“驱动”群体对于实施有效的公共卫生应对策略（包括疫苗接种计划）具有重要意义。然而，不同年龄组在传播流行病方面的相对重要性是不确定的。在传染病爆发期间，由于易感性和/或接触率增加，一些群体在爆发上升期间可能不成比例地代表。这些群体或亚群可以通过考虑亚群中在流行高峰之前（Bp）和之后（Ap）发生的病例比例来确定，以计算亚群的相对风险，RR=Bp/Ap。我们使用2009-2014年流行期间实验室确认的美国流感住院数据估计了几个亚群（年龄组）的RR。此外，我们模拟了不同的流感爆发在一个年龄分层的人口，与RR的影响，在每个亚群的疫苗接种的流行病的初始有效再生数R_e（0）。我们发现，5-17岁的儿童在五次最大的甲型流感爆发期间的RR估计值最高，尽管与其他年龄组相比，该年龄组的RR相对大小各不相同，2009年A/H1N1大流行最高。对于2010-2011年和2012-2013年的B型流感流行，18-49岁的成年人和0-4岁的人分别具有最高的RR估计值。在83%的模拟流行中，RR最高的群体也是初始分配一定数量疫苗将导致Re（0）最大降低的群体。在最大的40%的模拟疫情中，RR最高和疫苗接种影响最大的群体是5-17岁的儿童。虽然不同年龄组在传播流感疫情方面的相对重要性各不相同，但5-17岁的儿童在最大规模的甲型流感疫情中发挥了主导作用。为这一群体开展额外的疫苗接种工作可能有助于减少该流行病对整个社区的影响。
The identification of key “driver” groups in influenza epidemics is of much interest for the implementation of effective public health response strategies, including vaccination programs. However, the relative importance of different age groups in propagating epidemics is uncertain. During a communicable disease outbreak, some groups may be disproportionately represented during the outbreak’s ascent due to increased susceptibility and/or contact rates. Such groups or subpopulations can be identified by considering the proportion of cases within the subpopulation occurring before (Bp) and after the epidemic peak (Ap) to calculate the subpopulation’s relative risk, RR=Bp/Ap. We estimated RR for several subpopulations (age groups) using data on laboratory-confirmed US influenza hospitalizations during epidemics between 2009–2014. Additionally, we simulated various influenza outbreaks in an age-stratified population, relating the RR to the impact of vaccination in each subpopulation on the epidemic’s initial effective reproductive number R_e(0). We found that children aged 5–17 had the highest estimates of RR during the five largest influenza A outbreaks, though the relative magnitude of RR in this age group compared to other age groups varied, being highest for the 2009 A/H1N1 pandemic. For the 2010–2011 and 2012–2013 influenza B epidemics, adults aged 18–49, and 0–4 year-olds had the highest estimates of RR respectively. For 83% of simulated epidemics, the group with the highest RR was also the group for which initial distribution of a given quantity of vaccine would result in the largest reduction of R_e(0). In the largest 40% of simulated outbreaks, the group with the highest RR and the largest vaccination impact was children 5–17. While the relative importance of different age groups in propagating influenza outbreaks varies, children aged 5–17 play the leading role during the largest influenza A epidemics. Extra vaccination efforts for this group may contribute to reducing the epidemic’s impact in the whole community.
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DOI：
10.1056/nejmoa0905498
发表时间：
2009-12-31
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cauchemez S;Donnelly CA;Reed C;Ghani AC;Fraser C;Kent CK;Finelli L;Ferguson NM
通讯作者：
Ferguson NM
影响因子：
5
作者：
Schanzer D;Vachon J;Pelletier L
通讯作者：
Pelletier L
影响因子：
158.5
作者：
Reichert, TA;Sugaya, N;Tashiro, M
通讯作者：
Tashiro, M
影响因子：
3.9
作者：
Goldstein, E.;Apolloni, A.;Wallinga, J.
通讯作者：
Wallinga, J.
影响因子：
5
作者：
Wallinga, Jacco;Teunis, Peter;Kretzschmar, Mirjam
通讯作者：
Kretzschmar, Mirjam