Field Emergency Medical Officer Program, Health Displan Victoria, Melbourne, VIC, Australia.
Med J Aust. 2010 Jan 18;192(2):87-9. doi: 10.5694/j.1326-5377.2010.tb03425.x.
Pandemic (H1N1) 2009 influenza has generated many controversies in Australia around case definitions, laboratory diagnosis, case management, medical logistics and travel restrictions. Our experience as clinical advisers in the Victorian Department of Human Services Emergency Operations Centre suggests the following: Case definitions may change frequently, and will tend to become more clinically specific over time. Early in a pandemic, laboratory diagnosis plays a critical role in case finding and pathogen identification. Later in the pandemic, standardised case management applied to well crafted case definitions should reduce reliance on the diagnostic laboratory in clinical management. The diagnostic laboratory will remain critical to monitoring disease surveillance, pathogen virulence, and drug susceptibility. Medical logistics will continue to challenge pandemic managers as the health sector struggles to do the most good for the greatest number of people. Travel restrictions remain scientifically controversial public health recommendations. Issues of scalability (escalation and de-escalation of the response) relating to virus lethality need to be resolved in current pandemic planning.
2009 年甲型 H1N1 流感大流行在澳大利亚引发了诸多争议，主要涉及病例定义、实验室诊断、病例管理、医疗后勤和旅行限制等方面。我们作为维多利亚州人类服务部应急行动中心的临床顾问的经验表明：病例定义可能会经常发生变化，并随着时间的推移趋于更加具体。在大流行早期，实验室诊断在病例发现和病原体识别方面发挥着关键作用。在大流行后期，针对精心制定的病例定义实施标准化的病例管理，应能减少对临床管理中诊断实验室的依赖。诊断实验室仍然是监测疾病监测、病原体毒力和药物敏感性的关键。医疗后勤将继续对大流行管理者构成挑战，因为卫生部门正在努力为尽可能多的人提供最大的帮助。旅行限制仍然是具有科学争议的公共卫生建议。与病毒致命性相关的可扩展性（应对措施的升级和降级）问题需要在当前的大流行规划中得到解决。
