在1918-1919年流感大流行期间,美国城市实施的非药物干预措施
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
概括
早期和持续的非药物干预 (NPI) 在1918年流感大流行期间显著降低了死亡率. 实施NPI,如学校关闭和集会禁令,更早,更长时间地减轻了流行病的影响.
科学领域:
- 流行病学 流行病学
- 公共卫生 公共卫生
- 历史流行病分析分析
背景情况:
- 非药物干预 (NPI) 对于疫情规划至关重要,有可能延迟传播并降低死亡率.
- 无毒疫苗可以为疫苗和抗病毒药物开发和分发提供关键时间.
- 有效的NPI实施可以减轻医疗保健服务和基础设施的压力.
研究的目的:
- 在1918-1919年流感大流行期间,分析美国43个城市的NPI实施情况.
- 为了确定NPI时间,持续时间和与死亡率变化结合的关联.
- 评估人口因素 (易感性,人口统计,人口密度) 对流行病结果的影响.
主要方法:
- 进行历史档案研究与统计和流行病学分析相结合.
- 将NPI分类为学校关闭,公共集会取消和隔离/隔离.
- 测量结果包括每周过度死亡率 (EDR) 和死亡率达到峰值的时间.
主要成果:
- 在43个城市中,共发生了115,340例过度肺炎和流感死亡.
- 在79%的城市实施的同时关闭学校和禁止公共集会,与每周EDR的减少有关.
- 早些时候的NPI实施与延迟的峰值死亡率,较低的峰值率和减少的总死亡率相关.
- 增加NPI的持续时间显示与减少总死亡负担有显著的关联.
结论:
- 早期,持续和分层的NPI与缓解1918-1919年流感大流行后果密切相关.
- 对于未来的严重流感大流行,NPI应该被视为与疫苗和药物一起的必要伴随措施.
- 这些发现支持在公共卫生准备中战略性地使用NPI来应对严重的呼吸道流行病.
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