Davey Victoria J, Glass Robert J, Min H Jason, Beyeler Walter E, Glass Laura M
Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
PLoS One. 2008 Jul 2;3(7):e2606. doi: 10.1371/journal.pone.0002606.
The US government proposes pandemic influenza mitigation guidance that includes isolation and antiviral treatment of ill persons, voluntary household member quarantine and antiviral prophylaxis, social distancing of individuals, school closure, reduction of contacts at work, and prioritized vaccination. Is this the best strategy combination? Is choice of this strategy robust to pandemic uncertainties? What are critical enablers of community resilience?
We systematically simulate a broad range of pandemic scenarios and mitigation strategies using a networked, agent-based model of a community of explicit, multiply-overlapping social contact networks. We evaluate illness and societal burden for alterations in social networks, illness parameters, or intervention implementation. For a 1918-like pandemic, the best strategy minimizes illness to <1% of the population and combines network-based (e.g. school closure, social distancing of all with adults' contacts at work reduced), and case-based measures (e.g. antiviral treatment of the ill and prophylaxis of household members). We find choice of this best strategy robust to removal of enhanced transmission by the young, additional complexity in contact networks, and altered influenza natural history including extended viral shedding. Administration of age-group or randomly targeted 50% effective pre-pandemic vaccine with 7% population coverage (current US H5N1 vaccine stockpile) had minimal effect on outcomes. In order, mitigation success depends on rapid strategy implementation, high compliance, regional mitigation, and rigorous rescinding criteria; these are the critical enablers for community resilience.
Systematic evaluation of feasible, recommended pandemic influenza interventions generally confirms the US community mitigation guidance yields best strategy choices for pandemic planning that are robust to a wide range of uncertainty. The best strategy combines network- and case-based interventions; network-based interventions are paramount. Because strategies must be applied rapidly, regionally, and stringently for greatest benefit, preparation and public education is required for long-lasting, high community compliance during a pandemic.
美国政府提出了大流行性流感缓解指南，包括对患病者进行隔离和抗病毒治疗、家庭成员自愿检疫和抗病毒预防、个人保持社交距离、学校关闭、减少工作场所接触以及优先接种疫苗。这是最佳的策略组合吗？这种策略的选择对大流行的不确定性是否具有稳健性？社区恢复力的关键促成因素是什么？
我们使用一个基于网络的、基于主体的模型，该模型包含明确的、多重重叠的社会接触网络，系统地模拟了广泛的大流行情景和缓解策略。我们评估社会网络、疾病参数或干预措施实施变化时的疾病和社会负担。对于类似1918年的大流行，最佳策略可将患病比例降至不到人口的1%，并结合基于网络的措施（如学校关闭、所有人保持社交距离，同时减少成年人的工作场所接触）和基于病例的措施（如对患病者进行抗病毒治疗和对家庭成员进行预防）。我们发现，选择这种最佳策略对于消除年轻人增强的传播、接触网络中增加的复杂性以及改变流感自然史（包括延长病毒 shedding）具有稳健性。接种针对年龄组或随机目标人群、效力为50%、覆盖率为7%的大流行前疫苗（美国目前的H5N1疫苗储备）对结果的影响极小。缓解成功依次取决于快速实施策略、高依从性、区域缓解和严格的解除标准；这些是社区恢复力的关键促成因素。
对可行的、推荐的大流行性流感干预措施进行系统评估，总体上证实美国社区缓解指南为大流行规划提供了最佳策略选择，这些选择对广泛的不确定性具有稳健性。最佳策略结合了基于网络和基于病例的干预措施；基于网络的干预措施至关重要。由于策略必须迅速、在区域内和严格地应用才能获得最大益处，因此需要进行准备和公众教育，以在大流行期间实现持久的、高社区依从性。
