Public Health Strategies for the Next Influenza Pandemic

描述(申请人提供)：亚洲甲型H5N1流感病毒的大流行潜力是21世纪最重要的国际公共卫生问题之一。在过去的400年里发生了10次可能的大流行和3次可能的大流行，平均大流行间隔10到40年。我们上一次大流行发生在39年前。下一次大流行的确切时间仍不确定，但是否会发生大流行这一事实并不确定。在一个相互关联的现代世界里，传染病可以在几个小时内在全球范围内传播，世卫组织估计，H5N1大流行可能导致数亿人死亡，世界银行预测，可能会对全球经济造成持久而严重的影响，损失高达4.4万亿美元。虽然已有关于当前、流行和大流行性甲型H5N1流感感染情景的公共卫生战略的文献，但仍有几个重要的差距。这些措施包括评估应对大流行的潜在战略的安全性、有效性和成本效益。该项目旨在通过以下方式加强我在大流行性流感领域正在进行的工作：1.通过进行系统回顾和荟萃分析，检查神经氨酸酶抑制剂延长预防措施的长期安全性和有效性。2.评估应对大流行病的其他战略的健康结果、成本和成本效益，包括神经氨酸酶抑制剂预防、前景看好的新的初级强化疫苗接种战略的预防、口罩和N-95呼吸器的预防，以及不预防。我们今天的世界与1918年毁灭性的流感大流行的不同之处不仅在于我们的全球联系和流感病毒快速传播的可能性，而且还在于我们的科学进步、知识和国际合作。当我们观察到甲型H5N1流感在禽类、猪类、猫科动物和犬类中传播，并不断发生突变，增加其感染人类的能力时，我们有了1918年医生、科学家和公共卫生官员没有的机会。这些目标的结果将通过建立安全、有效和成本效益高的战略，帮助公共卫生官员为这一最终威胁做好准备，从而增加大流行性流感文献。

DESCRIPTION (provided by applicant): The pandemic potential of the Asian Influenza A H5N1 virus is one of the foremost international public health concerns of the 21st century. Ten probable and three possible pandemics have occurred in the past four-hundred years, with an average ten to forty year interpandemic interval. Our last pandemic occurred thirty-nine years ago. The exact timing of the next pandemic remains uncertain, but the fact that one will occur is not. In an interconnected modern world where infectious disease can be transmitted globally in a matter of hours, the WHO estimates that an H5N1 pandemic could cause hundreds of millions of deaths and the World Bank predicts a lasting and crippling impact on global economies could result, with losses of up to $4.4 trillion. While literature exists on public health strategies for current, epidemic, and pandemic Influenza A H5N1 infection scenarios, several important gaps remain. These include evaluating the safety, effectiveness and cost-effectiveness of potential strategies for responding to a pandemic. This project aims to build on my ongoing work in the field of pandemic influenza by: 1. Examining the long-term safety and effectiveness of extended prophylaxis with neuraminidase inhibitors by performing a systematic review and meta-analysis. 2. Assessing the health outcomes, costs and cost-effectiveness of alternative strategies of response in a pandemic, including prophylaxis with neuraminidase inhibitors, prophylaxis with a promising new primeboost vaccination strategy, prophylaxis with masks and N-95 respirators, and no prophylaxis. Our world today differs from that of the devastating 1918 influenza pandemic not only in our global connections and the potential for rapid spread of an influenza virus, but also in our scientific advancements, knowledge, and international cooperation. As we observe Influenza A H5N1 spreading among avian, swine, feline, and canine species, and developing ongoing mutations which increase its ability to infect humans, we have an opportunity that physicians, scientists, and public health officials of 1918 did not. The results of these aims will add to the pandemic influenza literature by establishing safe, effective, and cost-effective strategies which will assist public health officials in preparing for this eventual threat.