Li Yang, Hsu Edbert B, Links Jonathan M
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Biosecur Bioterror. 2010 Jun;8(2):119-28. doi: 10.1089/bsp.2009.0050.
Healthcare workers need to be protected during a severe influenza outbreak; therefore, we evaluated 4 different antiviral strategies: (1) using antiviral medication for outbreak prophylaxis of all hospital employees; (2) using antiviral medication for postexposure prophylaxis (PEP) or treatment of all hospital employees; (3) using a combination of antiviral medication for outbreak prophylaxis of high-risk clinical staff and postexposure prophylaxis or treatment for all other staff; and (4) using antiviral medication for postexposure prophylaxis or treatment of high-risk clinical staff only. Three different purchasing options were applied to each of the 4 antiviral strategies: (1) just-in-time purchase during a severe influenza outbreak, (2) prepandemic stockpiling, or (3) stockpiling through contracts with pharmaceutical manufacturers to reserve a predetermined antiviral supply. Although outbreak prophylaxis of all hospital employees would offer the maximum protection, the large costs associated with such a purchase make this option unrealistic and impractical. In addition, even though postexposure prophylaxis or treatment of only high-risk clinical staff would incur the least expense, the assumed level of protection if these options were offered only to high-risk clinical staff may not be sufficient to maintain routine hospital operations, since needed non-high-risk staff would not be protected. Considering the potential benefits and drawbacks of stockpiling antiviral medication from a cost perspective, it does not appear feasible for hospitals to stockpile antiviral medication in large quantities prior to a severe influenza outbreak. This article focuses on the financial viability of stockpiling antiviral medication, but the potential impact of other factors on the decision to stockpile was also considered and will be explored in future analyses. While legal hurdles related to prescribing, storing, and dispensing antiviral medication can be addressed, unavailability of a suitable vaccine supply may strongly support a decision to stockpile antiviral medication. Other issues to be addressed include antiviral resistance specifically related to the efficacy of oseltamivir, coupled with a high frequency of secondary bacterial infections; uncertainties about the degree of government assistance; potential government seizures of stockpiled assets; and legal and ethical concerns related to fair access to stockpiled medication. These issues may all be perceived as barriers to the feasibility of stockpiling antiviral medication.
在严重流感爆发期间，医护人员需要得到保护；因此，我们评估了4种不同的抗病毒策略：（1）使用抗病毒药物对所有医院员工进行爆发预防；（2）使用抗病毒药物对所有医院员工进行暴露后预防（PEP）或治疗；（3）联合使用抗病毒药物对高风险临床工作人员进行爆发预防，对所有其他工作人员进行暴露后预防或治疗；（4）仅对高风险临床工作人员使用抗病毒药物进行暴露后预防或治疗。对这4种抗病毒策略中的每一种都应用了3种不同的采购方案：（1）在严重流感爆发期间即时采购；（2）大流行前储备；或（3）通过与制药商签订合同储备预定数量的抗病毒药物。虽然对所有医院员工进行爆发预防能提供最大程度的保护，但这种采购相关的巨大成本使其不切实际且不可行。此外，尽管仅对高风险临床工作人员进行暴露后预防或治疗的费用最低，但如果仅向高风险临床工作人员提供这些方案，假定的保护水平可能不足以维持医院的日常运营，因为所需的非高风险工作人员将得不到保护。从成本角度考虑储备抗病毒药物的潜在利弊，医院在严重流感爆发前大量储备抗病毒药物似乎不可行。本文重点关注储备抗病毒药物的财务可行性，但也考虑了其他因素对储备决策的潜在影响，并将在未来分析中进行探讨。虽然与抗病毒药物的处方、储存和分发相关的法律障碍可以解决，但合适疫苗供应的短缺可能有力地支持储备抗病毒药物的决定。其他需要解决的问题包括与奥司他韦疗效特别相关的抗病毒耐药性，以及继发细菌感染的高发生率；政府援助程度的不确定性；政府可能没收储备资产；以及与公平获取储备药物相关的法律和伦理问题。这些问题都可能被视为储备抗病毒药物可行性的障碍。
