大流行性流感暴发的非药物干预策略设计
Design of non-pharmaceutical intervention strategies for pandemic influenza outbreaks.
作者信息
Martinez Dayna L, Das Tapas K
机构信息
Department of Mechanical and Industrial Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA, USA, 02115.
Industrial and Management Systems Engineering, University of South Florida, 4202 East Fowler Avenue, ENB 118, Tampa, FL, USA, 33620.
出版信息
BMC Public Health. 2014 Dec 29;14:1328. doi: 10.1186/1471-2458-14-1328.
BACKGROUND
As seen during past pandemic influenza outbreaks, pharmaceutical interventions (PHIs) with vaccines and antivirals are the most effective methods of mitigation. However, availability of PHIs is unlikely to be adequate during the early stages of a pandemic. Hence, for early mitigation and possible containment, non-pharmaceutical interventions (NPIs) offer a viable alternative. Also, NPIs may be the only available interventions for most underdeveloped countries. In this paper we present a comprehensive methodology for design of effective NPI strategies.
METHODS
We develop a statistical ANOVA-based design approach that uses a detailed agent-based simulation as an underlying model. The design approach obtains the marginal effect of the characteristic parameters of NPIs, social behavior, and their interactions on various pandemic outcome measures including total number of contacts, infections, and deaths. We use the marginal effects to establish regression equations for the outcome measures, which are optimized to obtain NPI strategies. Efficacy of the NPI strategies designed using our methodology is demonstrated using simulated pandemic influenza outbreaks with different levels of virus transmissibility.
RESULTS
Our methodology was able to design effective NPI strategies, which were able to contain outbreaks by reducing infection attack rates (IAR) to below 10% in low and medium virus transmissibility scenarios with 33% and 50% IAR, respectively. The level of reduction in the high transmissibility scenario (with 65% IAR) was also significant. As noted in the published literature, we also found school closure to be the single most effective intervention among all NPIs.
CONCLUSIONS
If harnessed effectively, NPIs offer a significant potential for mitigation of pandemic influenza outbreaks. The methodology presented here fills a gap in the literature, which, though replete with models on NPI strategy evaluation, lacks a treatise on optimal strategy design.
背景
正如在过去的大流行性流感爆发期间所看到的那样，使用疫苗和抗病毒药物进行药物干预（PHIs）是最有效的缓解方法。然而，在大流行的早期阶段，药物干预的供应不太可能充足。因此，为了早期缓解和可能的控制，非药物干预（NPIs）提供了一种可行的替代方案。此外，对于大多数不发达国家来说，非药物干预可能是唯一可用的干预措施。在本文中，我们提出了一种设计有效的非药物干预策略的综合方法。
方法
我们开发了一种基于方差分析的统计设计方法，该方法使用详细的基于主体的模拟作为基础模型。该设计方法获得了非药物干预、社会行为的特征参数及其相互作用对各种大流行结果指标的边际效应，这些指标包括接触总数、感染数和死亡数。我们使用边际效应来建立结果指标的回归方程，并对其进行优化以获得非药物干预策略。使用具有不同病毒传播水平的模拟大流行性流感爆发来证明使用我们的方法设计的非药物干预策略的有效性。
结果
我们的方法能够设计出有效的非药物干预策略，在低和中等病毒传播率的情况下，分别将感染攻击率（IAR）降低到10%以下，在低传播率情况下IAR为33%，中等传播率情况下为50%。在高传播率情况（IAR为65%）下的降低水平也很显著。正如已发表的文献中所指出的，我们还发现关闭学校是所有非药物干预中最有效的单一干预措施。
结论
如果得到有效利用，非药物干预对于缓解大流行性流感爆发具有巨大潜力。本文提出的方法填补了文献中的一个空白，尽管文献中充斥着关于非药物干预策略评估的模型，但缺乏关于最优策略设计的论述。
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