1918年から1919年のインフルエンザ大流行の間,米国の都市で実施された非医薬品介入
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
まとめ
早期の持続的な非医薬品介入 (NPI) は,1918年のインフルエンザ大流行中に死亡率を大幅に低下させた. 学校の閉鎖や集会禁止などのNPIを早期に実施し,長期にわたって実施することで,パンデミックの影響を軽減しました.
科学分野:
- エピデミオロジー エピデミオロジー
- 公衆衛生は公衆衛生である.
- 歴史的なパンデミック分析
背景:
- 非医薬品介入 (NPI) は,パンデミック計画において極めて重要であり,感染拡大を遅らせ,死亡率を下げる可能性がある.
- NPIは,ワクチンおよび抗ウイルス薬の開発および配布に重要な時間を提供する可能性があります.
- NPIの効果的な実施は,医療サービスとインフラストラクチャの負担を軽減することができます.
研究 の 目的:
- 1918年から1919年のインフルエンザ大流行の間,米国の43の都市でNPIの実施を分析する.
- NPIのタイミング,持続時間,および組み合わせと死亡率の変動との関連を決定する.
- パンデミックアウトカムに対する人口要因 (感受性,人口統計,密度) の影響を評価する.
主な方法:
- 歴史的アーカイブ調査を統計的,疫学的な分析と組み合わせた.
- NPIを学校閉鎖,公共集会のキャンセル,隔離/隔離に分類した.
- 週間の過剰死亡率 (EDR) とピーク死亡率までの時間を含む測定されたアウトカム.
主要な成果:
- 43の都市で合計115,340人の肺炎やインフルエンザによる死者が発生した.
- 79%の都市で実施された学校閉鎖と公共集会禁止の同時実施は,週間のEDRの減少と関連していました.
- NPIの早期実施は,ピーク死亡率の遅延,ピーク率の低下,全死亡率の低下と相関していた.
- NPIの持続時間増加は,全死亡負担の減少と有意な関連性を示した.
結論:
- 早期の,持続的な,そして階層的なNPIは,1918-1919年のインフルエンザ大流行の影響を軽減することと強く関連していました.
- NPIは,将来の重篤なインフルエンザのパンデミックに対するワクチンや薬剤と並行して不可欠な付随措置と見なされるべきである.
- 発見は,重度の呼吸器系パンデミックに対する公衆衛生の準備において,NPIの戦略的使用を支持する.
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