Opstelten W, van Steenbergen J E, van Essen G A, Van der Sande M A B
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Postbus 3231, 3502 GE Utrecht.
Ned Tijdschr Geneeskd. 2007 May 5;151(18):1008-12.
The preventive and therapeutic principles during an (impending) influenza pandemic differ fundamentally from those prevailing during the annual episodes ofinfluenza. Pending the availability of an effective pandemic vaccine, neuraminidase inhibitors are the only effective agents for the prevention and treatment of infections caused by a pandemic influenza virus. The development of an influenza pandemic has 6 phases: phases 3-5 reflect an increasing threat; phase 6 represents a manifest pandemic. During phases 3-5, a maximum effort is made to prevent or delay a pandemic. Neuraminidase inhibitors should be given not only to patients but also to their close contacts (post-exposure prophylaxis). During phase 6, post-exposure prophylaxis is no longer indicated and neuraminidase inhibitors are prescribed for all patients with symptoms ofpandemic influenza. Prophylaxis without preceding close contact with an influenza patient (primary prophylaxis) is recommended only in exceptional cases. Physicians should not prescribe antiviral drugs on demand to concerned citizens for stockpiling.
（即将发生的）流感大流行期间的预防和治疗原则与每年季节性流感流行期间的原则有根本区别。在有效大流行疫苗可用之前，神经氨酸酶抑制剂是预防和治疗大流行性流感病毒感染的唯一有效药物。流感大流行的发展有6个阶段：3-5阶段反映威胁不断增加；第6阶段代表大流行已明显出现。在3-5阶段，应尽最大努力预防或推迟大流行。不仅要给患者使用神经氨酸酶抑制剂，还要给其密切接触者（暴露后预防）使用。在第6阶段，不再进行暴露后预防，而是为所有出现大流行性流感症状的患者开神经氨酸酶抑制剂。仅在特殊情况下才建议在没有与流感患者密切接触史的情况下进行预防（一级预防）。医生不应应相关民众要求开具抗病毒药物用于囤货。
