Aledort Julia E, Lurie Nicole, Wasserman Jeffrey, Bozzette Samuel A
RAND Center for Domestic and International Health Security, 1776 Main Street, Santa Monica, California, USA.
BMC Public Health. 2007 Aug 15;7:208. doi: 10.1186/1471-2458-7-208.
In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs.
Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households) and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic).
The literature contained a dearth of evidence on the efficacy or effectiveness of most non-pharmaceutical interventions for influenza. In an effort to inform decision-making in the absence of strong scientific evidence, the experts ultimately endorsed hand hygiene and respiratory etiquette, surveillance and case reporting, and rapid viral diagnosis in all settings and during all pandemic phases. They also encouraged patient and provider use of masks and other personal protective equipment as well as voluntary self-isolation of patients during all pandemic phases. Other non-pharmaceutical interventions including mask-use and other personal protective equipment for the general public, school and workplace closures early in an epidemic, and mandatory travel restrictions were rejected as likely to be ineffective, infeasible, or unacceptable to the public.
The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment. In the absence of a definitive science base, our assessment of the evidence identified areas for further investigation as well as non-pharmaceutical public health interventions that experts believe are likely to be beneficial, feasible and widely acceptable in an influenza pandemic.
在流感大流行期间，疫苗和抗病毒药物的益处将受到供应和有效性限制的制约。因此，非药物公共卫生干预措施对于遏制疾病传播至关重要。然而，迄今为止对文献的最全面评估认识到，用于非药物大流行规划决策的证据质量普遍较差。鉴于尽管对文献质量有所担忧，但仍有必要为可能的大流行做好准备，将现有证据与关于非药物干预措施对大流行性流感相对优点的专家意见相结合，可能会得出一套更明智且被广泛接受的建议。我们评估了非药物公共卫生干预措施的证据基础。然后，基于汇总的证据，我们针对特定干预措施使用场景和大流行阶段确定了一套支持和反对干预措施的建议，政策制定者可利用这些建议为大流行做准备，直至科学证据能够明确满足规划者的需求。
基于对过去大流行的回顾和近期历史调查，我们通过将文献中的现有证据与定性和定量专家意见相结合，评估了非药物干预措施的相对优点。具体而言，我们查阅了近期关于预防大流行性流感人际传播的科学文献，召开了一次多学科专家会议，并就非药物公共卫生干预措施在各种场景（医疗机构；社区机构；私人家庭）和大流行阶段（无大流行；美国无大流行；美国局部早期大流行；美国大流行后期）的使用征求了专家建议。
文献中缺乏关于大多数非药物流感干预措施疗效或有效性的证据。为了在缺乏有力科学证据的情况下为决策提供信息，专家们最终认可在所有场景和所有大流行阶段都要进行手部卫生和呼吸道礼仪、监测和病例报告以及快速病毒诊断。他们还鼓励患者和医护人员在所有大流行阶段使用口罩及其他个人防护设备，以及患者自愿自我隔离。其他非药物干预措施，包括为公众使用口罩及其他个人防护设备、在疫情早期关闭学校和工作场所，以及强制旅行限制，因可能无效、不可行或不被公众接受而被否决。
对流感非药物公共卫生干预措施科学证据的需求普遍存在，当前的政策建议必须严重依赖专家判断。在缺乏确凿科学依据的情况下，我们对证据的评估确定了需要进一步调查的领域，以及专家认为在流感大流行中可能有益、可行且被广泛接受的非药物公共卫生干预措施。
