Oshitani Hitoshi
Tohoku University Graduate School of Medicine, Department of Virology, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
J Infect Chemother. 2006 Aug;12(4):167-71. doi: 10.1007/s10156-006-0453-z.
The recent avian influenza outbreaks underscore the importance of improving our preparedness for an impending influenza pandemic. Various strategies, including pharmaceutical interventions (such as vaccines and antivirals) and nonpharmaceutical interventions (such as quarantine, isolation, and social distancing) may be implemented to mitigate the impact of a pandemic. It is necessary to understand the potential benefits and limitations of each strategy to determine the most appropriate strategies to be implemented. In this article, each strategy is reviewed to define its potential benefits and limitations during a pandemic. Vaccines are probably the most effective measure to reduce morbidity and mortality. However, vaccines are not likely to be available at an early stage of a pandemic. The supply of vaccines is most likely to be insufficient due to limited worldwide production capacity. Antivirals, particularly neuraminidase inhibitors, are expected to be effective against a pandemic influenza strain and are the only available pharmaceutical intervention until enough vaccines are produced. Shortage of supply and high cost is still a major limiting factor in amassing large stockpiles of neuraminidase inhibitors. The possible emergence of resistant strains should also be considered. Nonpharmaceutical interventions can be effective in preventing the spread of the virus under certain conditions. The effectiveness of nonpharmaceutical interventions depends on how influenza viruses are transmitted. There are still significant gaps in the scientific evidence of the way in which influenza viruses are transmitted. Further studies should be conducted to define the basic transmission patterns of influenza viruses.
近期的禽流感疫情凸显了提高我们应对即将到来的流感大流行准备工作的重要性。可以实施各种策略，包括药物干预措施（如疫苗和抗病毒药物）和非药物干预措施（如检疫、隔离和保持社交距离），以减轻大流行的影响。有必要了解每种策略的潜在益处和局限性，以确定要实施的最合适策略。在本文中，对每种策略进行了综述，以界定其在大流行期间的潜在益处和局限性。疫苗可能是降低发病率和死亡率最有效的措施。然而，在大流行的早期阶段可能无法获得疫苗。由于全球生产能力有限，疫苗供应很可能不足。抗病毒药物，特别是神经氨酸酶抑制剂，预计对大流行性流感毒株有效，并且在生产出足够的疫苗之前是唯一可用的药物干预措施。供应短缺和成本高昂仍是大量储备神经氨酸酶抑制剂的主要限制因素。还应考虑耐药毒株可能出现的情况。非药物干预措施在某些条件下可有效预防病毒传播。非药物干预措施的有效性取决于流感病毒的传播方式。关于流感病毒传播方式的科学证据仍存在重大差距。应开展进一步研究以确定流感病毒的基本传播模式。
