Comparative Effectiveness of Mitigation Strategies for Pandemic Influenza

描述(申请人提供)：流感大流行是21世纪最重要的国际公共卫生挑战之一。在过去的400年里，发生了11次可能的大流行和3次可能的大流行。2009年4月在墨西哥城爆发的一种新型甲型H1N1流感病毒表明，感染可以在几天内在全球传播，并在年轻人、孕妇和少数族裔中造成不成比例的发病率和死亡率。2009年甲型H1N1流感大流行根据其传播性和病例死亡比例被定义为“轻度”大流行；世卫组织估计，更严重的大流行可能导致数亿人死亡，并使医疗保健能力不堪重负。即使在这场轻微的大流行期间，医院和重症监护室在传播高峰期也在接近或达到高峰。公共卫生官员在规划或防止未来流感大流行中医疗保健利用率激增方面的决策支持技术有限。尽管对目前的大流行采取了适当的公共卫生应对措施，但几种甲型流感病毒仍然对大流行构成威胁。下一次流感大流行的确切时间尚不确定，但毫无疑问，另一场大流行将会发生。在过去的三年里，我通过设计流感疾病传播模型来比较替代大流行缓解策略的有效性和成本效益，从而培养了成本效益分析和传染病建模方面的技能。我的几个模型参数是基于季节性流感流行或20世纪大流行的假设或数据，我的模型仅限于大流行流感在城市内的传播。我想提高模型参数的准确性并扩大其地理范围，以便比较卫生保健利用激增准备战略的有效性，并为大流行卫生保健决策支持提供信息。要做到这一点，我需要在一个经验丰富的多学科导师和顾问团队的指导下，通过完成课程作业和项目来发展大型数据库分析和多变量统计建模方面的额外技能。结合我现有的方法背景，这些技能将使我能够作为传染病卫生政策的独立调查员进行研究。2009年H1N1流感大流行发生在一个医疗保健数据库收集先进的时代，它为我提供了一个独特的机会，通过以下方式实现所有这些目标：(1)衡量与流感相关的医疗成本和大流行期间的利用；(2)将目标1的住院时间结果纳入多变量分析，以预测流感医疗利用高峰的时间传播；(3)将目标1和目标2的结果输入我的大流行流感传播模型，以比较各种大流行严重程度下替代激增准备策略的有效性和成本效益；(4)通过疾控中心传播目标1、目标2和目标3的结果，以更新医疗决策支持技术。 公共卫生意义：流感大流行在有记录的历史中都曾发生过；未来的大流行可能比2009年的H1N1大流行严重得多，仍然是严重的威胁。公共卫生官员在规划或防止未来流感大流行中医疗保健利用率激增方面的决策支持技术有限。这些项目将审查替代大流行防备和缓解战略的相对有效性，并更新决策支持技术，以协助公共卫生官员进行激增防备和应对。

DESCRIPTION (provided by applicant): Influenza pandemics are among the foremost international public health challenges of the 21st century. Eleven probable and three possible pandemics have occurred in the past four-hundred years. The April, 2009 outbreak of a novel strain of influenza A (H1N1) in Mexico City demonstrated that infection can be transmitted globally in days and cause disproportionate morbidity and mortality in young adults, pregnant women, and minorities. The 2009 (H1N1) Pandemic has been defined by its transmissibility and case- fatality proportion as a "mild" pandemic; the WHO estimates that a more severe pandemic could cause hundreds of millions of deaths, and overwhelm healthcare capacity. Even during this mild pandemic, hospitals and ICUs were operating near or at surge capacity during peaks of transmission. Public health officials have limited decision support technology to plan for or prevent healthcare utilization surge in future influenza pandemics. Despite an appropriate public health response to the ongoing pandemic, several influenza A viruses remain pandemic threats. The exact timing of the next influenza pandemic is uncertain, but there is no doubt that another one will occur. Over the past three years, I have developed skills in cost-effectiveness analysis and infectious disease modeling by designing an influenza disease transmission model to compare the effectiveness and cost- effectiveness of alternative pandemic mitigation strategies. Several of my model parameters are based on assumptions or data from seasonal influenza epidemics or 20th century pandemics, and my model is limited to the spread of pandemic influenza within a city. I would like to improve the accuracy of the model parameters and expand its geographical scope in order to compare the effectiveness of healthcare utilization surge preparation strategies and to inform pandemic healthcare decision support. To do so, I need to develop additional skills in large database analysis and multivariable statistical modeling by completing coursework and projects under the guidance of an experienced, multi-disciplinary team of mentors and advisors. Combined with my existing methodological background, these skills will enable me to perform research as an independent investigator in infectious disease health policy. The 2009 (H1N1) Pandemic, occurring in an era with advanced healthcare database collection, has provided a unique opportunity for me to meet all of these objectives by: (1) Measuring influenza-related healthcare costs and utilization during a pandemic; (2) Incorporating length-of-stay results from Aim 1 into multivariate analyses to predict the temporal spread of peak influenza healthcare utilization; (3) Inputting results of Aims 1 and 2 into my pandemic influenza transmission model to compare the effectiveness and cost-effectiveness of alternative surge preparation strategies over a range of pandemic severities; and (4) Disseminating results of Aims 1, 2, and 3 through CDC to update healthcare decision support technology. PUBLIC HEALTH RELEVANCE: Influenza pandemics have occurred throughout recorded history; future pandemics, potentially far more severe than the 2009 (H1N1) Pandemic, continue to be serious threats. Public health officials have limited decision support technology to plan for or prevent healthcare utilization surge in future influenza pandemics. These projects will examine the comparative effectiveness of alternative pandemic preparedness and mitigation strategies, and update decision support technologies to assist public health officials for surge preparedness and response.