Prisons show prophylaxis for close contacts may indeed help in next flu pandemic
http://www.100md.com
《英国医生杂志》
EDITOR—Balicer et al's editorial on tackling the next influenza pandemic highlights the potential of chemoprophylaxis of close contacts in managing community based influenza pandemics.1 One setting in which such a strategy shows promise is prisons.
The influenza epidemic in San Quentin prison in April and May 1918, which presumably struck 26% of the 1900 prisoners, is thought to be one of the primary foci of the 1918-20 pandemic.2 Documented outbreaks of flu in prisons have been rare since then.3 However, our modelling studies and the limited experience with managing such a prison outbreak indicate that quarantining clinically ill inmates in their cells or a health facility and giving antiviral prophylaxis to inmates and frontline staff in the same "wing" of the prison in which the outbreak occurred provide a more favourable cost benefit than annual mass vaccination, or a "do nothing" approach.3
In estimating such cost benefits, we took into consideration the rarity of influenza outbreaks in prisons (which means "wasteful" vaccination in the non-epidemic years), the high costs of maintaining prisoners' security in off site settings, the relative "worthlessness" of prisoners vis à vis economic valuations of epidemics,4 and the probably very low mortality among inmates because of average younger age.
While the World Health Organization has developed formal strategies for managing diseases such as tuberculosis in prisons, currently no formal WHO endorsed guidelines exist for influenza. This issue requires urgent attention.
Niyi Awofeso, conjoint associate professor of public health
University of New South Wales, Sydney, Australia, Population Health Unit, NSW Corrections Health Service, PO Box 150, NSW 2036, Australia niyiawofeso@hotmail.com
Competing interests: None declared.
References
Balicer RD, Huerta M, Grotto I. Tackling the next influenza pandemic. BMJ 2004;328: 1391-2. (12 June.)
Kolata G. Flu: the story of the great influenza pandemic of 1918 and the search for the virus that caused it. New York: Farar, Strauss, Giroux, 1999: 10.
Awofeso N, Fennell M, Walizzaman Z, O'Connor C, Pittam D, Boonwaat L, et al. Influenza outbreak in a correctional facility. Austr N Z J Public Health 2001;25: 443-6.
Nichol KL, Mallon KP, Mendelman PM. Cost-benefit of influenza vaccination in healthy, working adults: an economic analysis of a clinical trial of trivalent live attenuated influenza virus vaccine. Vaccine 2003;16: 2216-26.
The influenza epidemic in San Quentin prison in April and May 1918, which presumably struck 26% of the 1900 prisoners, is thought to be one of the primary foci of the 1918-20 pandemic.2 Documented outbreaks of flu in prisons have been rare since then.3 However, our modelling studies and the limited experience with managing such a prison outbreak indicate that quarantining clinically ill inmates in their cells or a health facility and giving antiviral prophylaxis to inmates and frontline staff in the same "wing" of the prison in which the outbreak occurred provide a more favourable cost benefit than annual mass vaccination, or a "do nothing" approach.3
In estimating such cost benefits, we took into consideration the rarity of influenza outbreaks in prisons (which means "wasteful" vaccination in the non-epidemic years), the high costs of maintaining prisoners' security in off site settings, the relative "worthlessness" of prisoners vis à vis economic valuations of epidemics,4 and the probably very low mortality among inmates because of average younger age.
While the World Health Organization has developed formal strategies for managing diseases such as tuberculosis in prisons, currently no formal WHO endorsed guidelines exist for influenza. This issue requires urgent attention.
Niyi Awofeso, conjoint associate professor of public health
University of New South Wales, Sydney, Australia, Population Health Unit, NSW Corrections Health Service, PO Box 150, NSW 2036, Australia niyiawofeso@hotmail.com
Competing interests: None declared.
References
Balicer RD, Huerta M, Grotto I. Tackling the next influenza pandemic. BMJ 2004;328: 1391-2. (12 June.)
Kolata G. Flu: the story of the great influenza pandemic of 1918 and the search for the virus that caused it. New York: Farar, Strauss, Giroux, 1999: 10.
Awofeso N, Fennell M, Walizzaman Z, O'Connor C, Pittam D, Boonwaat L, et al. Influenza outbreak in a correctional facility. Austr N Z J Public Health 2001;25: 443-6.
Nichol KL, Mallon KP, Mendelman PM. Cost-benefit of influenza vaccination in healthy, working adults: an economic analysis of a clinical trial of trivalent live attenuated influenza virus vaccine. Vaccine 2003;16: 2216-26.