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Intervenciones no farmacéuticas implementadas por ciudades estadounidenses durante la pandemia de influenza de
Howard Markel1, Harvey B Lipman, J Alexander Navarro
1Center for the History of Medicine, University of Michigan Medical School, Ann Arbor, USA.
JAMA
|August 9, 2007
Resumen
Las intervenciones no farmacéuticas tempranas y sostenidas (IPN) redujeron significativamente la mortalidad durante la pandemia de influenza de 1918. La implementación de NPI como el cierre de escuelas y las prohibiciones de reuniones antes y por períodos más largos mitigó el impacto de la pandemia.
Área de la Ciencia:
- Epidemiología La epidemiología.
- Salud Pública La salud pública.
- Análisis histórico de las pandemias Análisis histórico de las pandemias
Sus antecedentes:
- Las intervenciones no farmacéuticas (IPN) son cruciales para la planificación de pandemias, ya que pueden retrasar la propagación y reducir la mortalidad.
- Las NPI podrían proporcionar tiempo crítico para el desarrollo y distribución de vacunas y antivirales.
- La implementación efectiva de NPI puede disminuir la presión sobre los servicios e infraestructura de atención médica.
Objetivo del estudio:
- Analizar la implementación de IPN en 43 ciudades estadounidenses durante la pandemia de influenza de 1918-1919.
- Determinar la asociación entre el momento, la duración y la combinación del IPN con las variaciones de la mortalidad.
- Evaluar la influencia de los factores de la población (susceptibilidad, demografía, densidad) en los resultados de las pandemias.
Principales métodos:
- Realizó investigaciones históricas de archivo combinadas con análisis estadísticos y epidemiológicos.
- NPI categorizados en cierre de escuelas, cancelación de reuniones públicas y aislamiento / cuarentena.
- Resultados medidos que incluyen tasas de mortalidad excesivas semanales (EDR) y tiempo hasta el pico de mortalidad.
Principales resultados:
- Un total de 115.340 muertes por neumonía y gripe en exceso ocurrieron en las 43 ciudades.
- El cierre simultáneo de escuelas y las prohibiciones de reuniones públicas, implementadas en el 79% de las ciudades, se asociaron con una reducción semanal de EDR.
- La implementación anterior del NPI se correlacionó con una mortalidad pico retrasada, tasas de pico más bajas y una mortalidad total reducida.
- El aumento de la duración de los NPI mostró una asociación significativa con una reducción de la carga total de mortalidad.
Conclusiones:
- Las IPN tempranas, sostenidas y en capas se asociaron fuertemente con la mitigación de las consecuencias de la pandemia de influenza de 1918-1919.
- Las NPI deben considerarse medidas de acompañamiento esenciales junto con las vacunas y los medicamentos para futuras pandemias graves de influenza.
- Los hallazgos apoyan el uso estratégico de NPI en la preparación de la salud pública para pandemias respiratorias graves.
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