Beer Ellen, Boyd Simon, Wongnak Phrutsamon, Ngamprasertchai Thundon, White Nicholas J
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Nuffield Department of Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom.
PLOS Glob Public Health. 2025 Apr 28;5(4):e0004468. doi: 10.1371/journal.pgph.0004468. eCollection 2025.
Seasonal influenza leads to 2-3 million infections and up to 650,000 global deaths annually, with particularly high mortality in Asia and relatively low annual vaccination rates for prevention. Relatively lower attention is paid to antiviral treatment as a facet of influenza response strategy both in research and national policy. This study compares national influenza treatment guidelines across countries in the Asia Pacific region, and assesses the antiviral recommendations, comprehensiveness, availability, and quality, compared with World Health Organisation (WHO) guidelines. Ministry of Health websites were searched, and key stakeholders were contacted to obtain national influenza treatment guidelines. Official guidelines detailing pharmacologic treatment for seasonal influenza were included. Key data for comparison were extracted and quality appraisal was conducted using the AGREE II instrument. Out of 49 countries and areas in the World Health Organisation Western Pacific and South-East Asia regions, under half (14/49; 28.6%) had established national influenza treatment guidelines. Nine (9/49; 18.4%) reported no seasonal flu guidelines at all, and information could not be obtained for 25 (51.0%). All guidelines recommend oseltamivir in line with WHO recommendations, although rationale and evidence reviews were often missing. There was variation in recommendations for other antivirals, indications for treatment, definitions of severity and recency of publication. The AGREE II tool quality assessments revealed the highest average scores were observed in the 'presentation' domain and lowest scores in 'editorial independence' and 'rigour of development' domains, demonstrating limited evidence-based guideline development. The variability in recommendations and definitions highlight the need for a stronger evidence base with direct comparisons of antiviral treatment for hard and soft endpoints, and improvements in systematic guideline development. Established treatment guidelines are a key component of national influenza response strategy and in the post-covid pandemic era, renewed attention to seasonal influenza management is surely warranted.
季节性流感每年导致200万至300万例感染，全球死亡人数高达65万，在亚洲死亡率尤其高，而预防流感的年度疫苗接种率相对较低。在研究和国家政策方面，作为流感应对策略的一个方面，抗病毒治疗受到的关注相对较少。本研究比较了亚太地区各国的国家流感治疗指南，并与世界卫生组织（WHO）指南相比，评估了抗病毒治疗建议、全面性、可及性和质量。检索了各国卫生部网站，并联系了主要利益相关者以获取国家流感治疗指南。纳入了详细说明季节性流感药物治疗的官方指南。提取了用于比较的关键数据，并使用AGREE II工具进行了质量评估。在世界卫生组织西太平洋和东南亚区域的49个国家和地区中，不到一半（14/49；28.6%）制定了国家流感治疗指南。9个国家（9/49；18.4%）完全没有报告季节性流感指南，25个国家（51.0%）无法获取相关信息。所有指南均按照WHO的建议推荐使用奥司他韦，不过通常缺少理论依据和证据综述。在其他抗病毒药物的推荐、治疗指征、严重程度定义和出版时效性方面存在差异。AGREE II工具质量评估显示，“呈现”领域的平均得分最高，“编辑独立性”和“制定严谨性”领域的得分最低，这表明基于证据的指南制定有限。建议和定义的差异凸显了需要有更强的证据基础，对抗病毒治疗的硬性和软性终点进行直接比较，并改进系统性指南制定。既定的治疗指南是国家流感应对策略的关键组成部分，在新冠疫情后的时代，确实有必要重新关注季节性流感的管理。
