Mann J M, Hull H F
Pediatrics. 1983 Jul;72(1):118-21.
Recent promulgation of an official policy on prevention of secondary cases of Haemophilus influenzae type b disease illustrates the challenges and frustrations inherent in the policy-making process. Despite evidence that H influenzae type b disease is "contagious" in households and probably also in day care centers and despite demonstration that rifampin eradicates nasopharyngeal H influenzae type b carriage, the single field study of rifampin use to prevent secondary cases of H influenzae type b disease remains unpublished and has yet to receive broad critical scrutiny. Promulgation of the rifampin strategy prior to publication of this critical study is unfortunate, as public and private providers are now committed to a policy that will be difficult to evaluate or alter. Now that the strategy has been issued, the central question regarding rifampin prophylaxis has changed from "Is this strategy effective?" to "Can this strategy be shown to be ineffective?" When policies are issued prior to publication of key supporting data, or when such studies are either missing or highly controversial, the policy-making committee might publish, along with its recommendations, explicit criteria for continuation, modification, or withdrawal of the new policy. This structured reassessment approach could accommodate the critical need to proceed with disease control recommendations--even though based on incomplete information--yet underscore the policy's tentative nature and provide direction for future assessment and study.
最近发布的一项关于预防b型流感嗜血杆菌疾病继发病例的官方政策，体现了决策过程中固有的挑战和挫折。尽管有证据表明b型流感嗜血杆菌疾病在家庭中具有“传染性”，在日托中心可能也具有传染性，并且尽管已证明利福平可消除鼻咽部b型流感嗜血杆菌携带，但关于使用利福平预防b型流感嗜血杆菌疾病继发病例的唯一一项现场研究仍未发表，也尚未受到广泛的严格审查。在这项关键研究发表之前就发布利福平策略是不幸的，因为公共和私人医疗机构现在已致力于一项难以评估或更改的政策。既然该策略已经发布，关于利福平预防的核心问题已从“该策略是否有效？”变为“能否证明该策略无效？”当在关键支持数据发表之前发布政策，或者当此类研究缺失或极具争议时，决策委员会可能会在发布建议的同时，公布继续、修改或撤销新政策的明确标准。这种结构化的重新评估方法可以满足即使基于不完整信息也要推进疾病控制建议的迫切需求，但同时强调该政策的暂定性质，并为未来的评估和研究提供方向。
