Stamboulian D, Bonvehí P E, Nacinovich F M, Cox N
Department of Infectious Diseases, University of Buenos Aires, School of Medicine, Argentina.
Infect Dis Clin North Am. 2000 Mar;14(1):141-66. doi: 10.1016/s0891-5520(05)70222-1.
Influenza is an acute respiratory illness of global importance that causes considerable morbidity and mortality every year. At the beginning of the millennium, influenza will still be an emergent or re-emergent infection because of the viral ability to mutate. Global influenza surveillance indicates that influenza viruses may vary within a country and between countries and continents during an influenza season. Virologic surveillance is of critical importance in monitoring antigenic shift and drift. Disease surveillance is important in assessing the impact of the epidemics. Both types of information provide the basis of vaccine composition and the correct use of antivirals. Laboratory diagnosis is of critical importance for the global surveillance of influenza and may allow the timely use of antiviral drugs. Viral isolation remains the gold standard for laboratory diagnosis; however, several new rapid diagnostic tests are available or in development. The clinical spectrum of the disease varies from asymptomatic infection to the classic flu syndrome, and respiratory and nonrespiratory complications are observed particularly in high-risk groups. Current inactivated influenza vaccines have shown efficacy and effectiveness in preventing influenzalike illness, hospitalization for pneumonia, and death and in reducing health care costs. Because of the annual administration of the vaccine and the short period of time where it can be administered, strategies directed at improving vaccine coverage are of critical importance. In this sense, experiences obtained in different countries, such as with the National Immunization Campaigns developed in Argentina, provide one model of massive vaccine administration. In addition to current vaccines, new live attenuated vaccines will permit a most effective prevention of influenza in the community in the near future. A new type of antiviral, neuraminidase inhibitors, offers valuable benefits in the prevention and treatment of influenza A and B. A future pandemic of influenza seems inevitable. There is wide recognition that preparation for the next pandemic requires that infrastructure be in place during interpandemic periods for implementing preventive and therapeutic measures. The WHO has established a pandemic influenza task force, and a number of countries in Latin America have developed formal pandemic plans. These national and international efforts are essential to reduce the mortality and morbidity in the next influenza pandemic.
流感是一种具有全球重要性的急性呼吸道疾病，每年都会导致相当高的发病率和死亡率。在千年之交，由于病毒的变异能力，流感仍将是一种新出现或再次出现的感染性疾病。全球流感监测表明，在一个流感季节期间，流感病毒可能在一个国家内以及不同国家和各大洲之间发生变化。病毒学监测对于监测抗原转变和漂移至关重要。疾病监测对于评估疫情的影响很重要。这两类信息为疫苗成分和正确使用抗病毒药物提供了依据。实验室诊断对于全球流感监测至关重要，并且可能有助于及时使用抗病毒药物。病毒分离仍然是实验室诊断的金标准；然而，有几种新的快速诊断测试可供使用或正在研发中。该疾病的临床谱从无症状感染到典型的流感综合征不等，并且尤其在高危人群中会出现呼吸道和非呼吸道并发症。目前的灭活流感疫苗已显示出在预防流感样疾病、因肺炎住院和死亡以及降低医疗保健成本方面的有效性和效果。由于每年都要接种疫苗且接种时间较短，旨在提高疫苗接种覆盖率的策略至关重要。从这个意义上说，在不同国家获得的经验，例如阿根廷开展的国家免疫运动，提供了一种大规模疫苗接种的模式。除了现有的疫苗之外，新型减毒活疫苗将在不久的将来使社区能够更有效地预防流感。一种新型抗病毒药物——神经氨酸酶抑制剂，在预防和治疗甲型和乙型流感方面具有重要价值。未来流感大流行似乎不可避免。人们普遍认识到，为下一次大流行做准备需要在大流行间期建立基础设施，以便实施预防和治疗措施。世界卫生组织已经成立了大流行性流感特别工作组，拉丁美洲的一些国家也制定了正式的大流行计划。这些国家和国际层面的努力对于降低下一次流感大流行的死亡率和发病率至关重要。
