Can Antiviral Drugs Contain Pandemic Influenza Transmission 英文参考文献.docVIP

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Can Antiviral Drugs Contain Pandemic Influenza Transmission 英文参考文献.doc

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Can Antiviral Drugs Contain Pandemic Influenza Transmission 英文参考文献

CanAntiviralDrugsContainPandemicInfluenza Transmission? NielsG.Becker*,DingchengWang NationalCentreforEpidemiologyandPopulationHealth,TheAustralianNationalUniversity,Canberra,AustralianCapitalTerritory,Australia Abstract Antiviral drugs dispensed during the 2009 influenza pandemic generally failed to contain transmission. This poses the question of whether preparedness for a future pandemic should include plans to use antiviral drugs to mitigate transmission. Simulations using a standard transmission model that allows for infected arrivals and delayed vaccination showthatattemptstocontaintransmissionrequirerelativelyfewantiviraldoses.Incontrast,persistentuseofantiviraldrugs whenthereproductionnumberremainsabove1useverymanydosesandareunlikelytoreducetheeventualattackrate appreciablyunlessthestockpileisverylarge.Asecondmodel,inwhichthecommunityhasahouseholdstructure,shows thattheeffectivenessofastrategyofdispensingantiviraldrugstoinfectedhouseholdsdecreasesrapidlywithtimedelaysin dispensing the antivirals. Using characteristics of past pandemics it is estimated that at least 80% of primary household casesmustpresentuponshowofsymptomstohaveachanceofcontainingtransmissionbydispensingantiviraldrugsto households.Todeterminedataneeds,householdoutbreaksweresimulatedwith50%receivingantiviraldrugsearlyand 50% receiving antiviral drugs late. A test to compare the size of household outbreaks indicates that at least 100–200 householdoutbreaksneedtobemonitoredtofindevidencethatantiviraldrugscanmitigatetransmissionofthenewly emergedvirus. Useofantiviraldrugsinanearlyattempttocontaintransmissionshouldbepartofpreparednessplansfora futureinfluenzapandemic.Dataontheincidenceofthefirst350casesandtheeventualattackratesofthefirst200hundred householdoutbreaksshouldbeusedtoestimatetheinitialreproductionnumberRandtheeffectivenessofantiviraldrugs tomitigatetransmission.Useofantiviraldrugstomitigategeneraltransmissionshouldceaseiftheseestimatesindicatethat containmentoftransmissionisunlikel