人感染 H7N9 流感大流行的早期疫苗接种和非药物干预的健康和经济效益：建模研究。
Health and economic benefits of early vaccination and nonpharmaceutical interventions for a human influenza A (H7N9) pandemic: a modeling study.
出版信息
Ann Intern Med. 2014 May 20;160(10):684-94. doi: 10.7326/M13-2071.
BACKGROUND
Vaccination for the 2009 pandemic did not occur until late in the outbreak, which limited its benefits. Influenza A (H7N9) is causing increasing morbidity and mortality in China, and researchers have modified the A (H5N1) virus to transmit via aerosol, which again heightens concerns about pandemic influenza preparedness.
OBJECTIVE
To determine how quickly vaccination should be completed to reduce infections, deaths, and health care costs in a pandemic with characteristics similar to influenza A (H7N9) and A (H5N1).
DESIGN
Dynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.
DATA SOURCES
Literature and expert opinion.
TARGET POPULATION
Residents of a U.S. metropolitan city with characteristics similar to New York City.
TIME HORIZON
Lifetime.
PERSPECTIVE
Societal.
INTERVENTION
Vaccination of 30% of the population at 4 or 6 months.
OUTCOME MEASURES
Infections and deaths averted and cost-effectiveness.
RESULTS OF BASE-CASE ANALYSIS: In 12 months, 48 254 persons would die. Vaccinating at 9 months would avert 2365 of these deaths. Vaccinating at 6 months would save 5775 additional lives and $51 million at a city level. Accelerating delivery to 4 months would save an additional 5633 lives and $50 million.
RESULTS OF SENSITIVITY ANALYSIS
If vaccination were delayed for 9 months, reducing contacts by 8% through nonpharmaceutical interventions would yield a similar reduction in infections and deaths as vaccination at 4 months.
LIMITATION
The model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.
CONCLUSION
Vaccination in an influenza A (H7N9) pandemic would need to be completed much faster than in 2009 to substantially reduce morbidity, mortality, and health care costs. Maximizing non-pharmaceutical interventions can substantially mitigate the pandemic until a matched vaccine becomes available.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.
背景
2009 年大流行期间的疫苗接种直到疫情后期才开始，这限制了其效益。甲型流感（H7N9）在中国导致发病率和死亡率不断上升，研究人员已经对甲型流感（H5N1）病毒进行了改造，使其能够通过气溶胶传播，这再次引发了人们对大流行性流感防范的担忧。
目的
确定在具有类似于甲型流感（H7N9）和甲型流感（H5N1）特征的大流行中，完成疫苗接种需要多快的速度，以减少感染、死亡和医疗保健成本。
设计
用于估计大都市中严重流感大流行的健康和经济后果的动态传播模型。
数据来源
文献和专家意见。
目标人群
具有类似于纽约市特征的美国大都市居民。
时间范围
终生。
观点
社会。
干预措施
对 30%的人群进行 4 或 6 个月的疫苗接种。
结果衡量指标
避免的感染和死亡人数以及成本效益。
基础分析结果
在 12 个月内，将有 48254 人死亡。在 9 个月时进行疫苗接种将避免其中 2365 人死亡。在城市层面上，6 个月的疫苗接种将挽救 5775 条额外的生命和 5100 万美元。加速交付至 4 个月将额外挽救 5633 条生命和 5000 万美元。
敏感性分析结果
如果疫苗接种推迟 9 个月，则通过非药物干预措施将接触减少 8%，则可获得与 4 个月时接种疫苗相同的感染和死亡人数减少。
局限性
该模型并非旨在评估针对特定人群（如儿童或患有合并症的人群）的计划。
结论
在甲型流感（H7N9）大流行中，疫苗接种速度需要比 2009 年快得多，才能大大降低发病率、死亡率和医疗保健成本。最大限度地利用非药物干预措施可以在匹配疫苗可用之前大大减轻大流行的影响。
主要资金来源
美国医疗保健研究与质量局、美国国立卫生研究院和美国退伍军人事务部。
Zotero 插件