[转移贴]英国卫报评点甲型HIN1流感经验教训
原帖由论坛会员Walkundersky发表于 2009-5-12 11:19 |环球时报2009年05月11日：据英国《卫报》10日报道，随着甲型HIN1流感的幕后故事逐步被披露，人们可以从中吸取一些重要的经验教训。在禽流感于近年暴发后，政府对应对疫情准备和应急计划投入了巨资，改善了监控和反应系统、储存了大量的药物和疫苗。但我们是否已拥有一个可以防止灾难发生的疾病监控系统？
在潜在的疫情面前，媒体根据非常可疑的数据和假设情况得出了可能有众多人员死于流感的结论，这引发了惊慌局面和荒诞的估计。另一种与此相反的行为是保持沉默，掩盖真实情况，告诉人们无需担心。这两种方法都无助于公众了解疫情，因为我们不知道接下来会发生什么。在公共辩论中承认不确定性和无知是一件困难的事情，但它至关重要，否则就会采取不适当的公共政策，发出错误的信号。
为应对疫情作准备意味着为应对意外情况作好准备，在不确定的情况下作好快速和灵活地应对疫情的准备工作需要公共部门具备新的技能、行政常规、激励系统。在面对一个潜在的全球疫情时，全球评估是根据全球数据作出的，但事实上结构的重大失衡影响了疾病快速传播的可能结果。我们不知道甲型HIN1流感在墨西哥导致众多死亡病例但在其它地方只造成少量死亡病例的原因，这可能是因为复杂的医学、病毒原因，但它也可能与人们是否能获得治疗、反应的有效性有关。
媒体曾称，英国是作好应对甲型HIN1流感准备最充分的国家，但作好准备意味着储存足够的药物、一个有效的监控系统、一个正常运作的国家卫生系统。这样的条件并不是在所有地方都具备，其它疾病和贫穷会影响人们的健康和抵抗新病毒的能力。欠发达和不平等局面在疾病传播方面起了很大的作用，人们在就甲型HIN1流感作出全球反应时不应忘记这一点。
应对甲型HIN1流感的情况也表明糟糕的监控和报告制度意味着疫情会很快失控，现在的监控和报告状况与二月份相比已发生了重大变化，墨西哥当地人知道这一疾病，并对疾病的来源提出了很有根据的怀疑。首例已知甲型HIN1流感病例发生地拉格洛里亚的居民阿马多尔称：“我们不是医生，但我们认为拉格洛尼亚附近的猪场与疾病有关。”拉格洛尼亚居民称，当地的山坡使猪场的恶臭没有被扩散至村庄以外的地方。墨西哥卫生部长和猪场所属公司否认了这样的解释，但政府为什么不对这样的线索进行调查，为什么这样的早期预警没有成为标准监控系统的一部分？为什么如此轻易地否定当地居民们的观点？
在东南亚，当地民众对禽流感及其传播途径的了解对于防控禽流感起到了至关重要的作用。医生、病毒学家、流行病学家、兽医和其它专业人士需要与当地民众一起合作才能使监控工作有效。防控禽流感的另一个重要经验教训是畜牧业的结构变化对于了解疾病是如何产生和扩散非常重要。虽然人们可以指责大企业和工业化养殖技术，但实际情况要复杂的多。虽然“畜牧业革命”在发展中国家被认为是经济增长的一个来源，但畜牧业的快速结构重组对于如何管理畜牧业和控制疾病有重大负面影响。个人养殖模式被工业化模式所取代，工业化养殖机构旨在实现利润的最大化，但对安全性、疾病控制或者环境污染漠不关心。
独立、透明、有效和及时的信息流对于国际社会控制不断出现的疾病至关重要。随着甲型HIN1流感的细节开始被披露，人们应对农业尤其对墨西哥的猪养殖业进行一个更加全面的评估，这对于为未来吸取经验教训至关重要。当然，人们目前的注意力集中在国际社会公共卫生反应，为疫情作准备意味着为意外作准备，在不确定的情况下作出快速和有效的反应。正如应对禽流感的经验教训所表明的那样，这可能需要采取更多的措施，而不只是从上至下的“积极和有力”的技术应对措施。
摘自：http://news.sina.com.cn/w/2009-05-11/140917789931.shtml kousyouki发表于 2009-5-12 19:40 |
Early findings about H1N1 pandemic potential
Early findings about the emerging pandemic of a new strain of influenza A (H1N1) in Mexico are published in Science.
Researchers from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, working in collaboration with the World Health Organisation and public health agencies in Mexico, have assessed the epidemic using data to the end of April. Their key findings are as follows:
The data so far is very consistent with what researchers would expect to find in the early stages of a pandemic.
The researchers' best estimate is that in Mexico, influenza A (H1N1) is fatal in around 4 in 1,000 cases, which would make this strain of influenza as lethal as the one found in the 1957 pandemic. The researchers stress that healthcare has greatly improved in most countries since 1957 and the world is now better prepared.
The epidemic of influenza A (H1N1) is thought to have started in Mexico on 15 February 2009. The data suggests that by the end of April, around 23,000 people were infected with the virus in Mexico and 91 of these died as a result of infection. However, the figures are uncertain - for example, some mild cases may have gone unreported. The numbers infected could be as low as 6,000 people or as high as 32,000 people.
The uncertainty around the numbers of people who have been infected with influenza A (H1N1) in Mexico means that the case fatality ratio (CFR) of 0.4% (4 deaths per 1000) cannot be definitely established. The CFR is in the range of 0.3% to 1.5%, but at this stage the researchers believe that 0.4% is the most likely.
For every person infected, it is likely that there will be between 1.2 and 1.6 secondary cases. This is high compared to normal seasonal influenza, where around 10-15 percent of the population are likely to become infected. However, it is lower than would be expected for pandemic influenza, where 20-30 percent of the population are likely to become infected.
In an outbreak in an isolated village called La Gloria, Mexico, children were twice as likely to become infected as adults, with 61% of those aged under 15 becoming infected, compared with 29% of those over 15. This may suggest that adults have some degree of immunity against infection, because of having been previously infected with a related strain of influenza, or it may mean that children are more susceptible to infection because they interact much more closely together, for example in school, than adults.
Professor Neil Ferguson, the corresponding author of today's research from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, said: "Our study shows that this virus is spreading just as we would expect for the early stages of a flu pandemic. So far, it has been following a very similar pattern to the flu pandemic in 1957, in terms of the proportion of people who are becoming infected and the percentage of potentially fatal cases that we are seeing.
"What we're seeing is not the same as seasonal flu and there is still cause for concern - we would expect this pandemic to at least double the burden on our healthcare systems. However, this initial modelling suggests that the H1N1 virus is not as easily transmitted or as lethal as that found in the flu pandemic in 1918," added Professor Ferguson.
http://www.imperial.ac.uk/
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