• 【在国家免疫计划和脊髓灰质炎终结策略中引入灭活的脊髓灰质炎疫苗。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP).,Vashishtha VM,Choudhary J,Yadav S,Unni JC,Jog P,Kamath SS,Sachdeva A,Srirampur S,Prajapati B,Parekh BJ
    BACKGROUND & AIMS: :The World Health Organization declared India among other 10 countries in South East Region - as 'polio-free' in 2014. Since then, the Government of India (GoI) has scaled up its initiatives against polio endgame which targets virus eradication and sequential withdrawal of type 2 virus from oral polio vaccine (OPV). However, prior to choosing the switch from trivalent OPV (t-OPV) to bivalent OPV (b-OPV), it was suggested to include inactivated poliovirus vaccine (IPV) in the national immunization schedule to protect vaccine naïve population against type 2 poliovirus. The GoI declared introduction of single dose of intramuscular IPV at 14 weeks since October 2015. In addition, anticipating the scarcity of IPV at present in India, GoI also recommended two intradermal doses of IPV in few states since April 2016. This review discusses the programmatic implications of these strategies along with recommendations by the Advisory Committee on Vaccines and Immunization Practices of Indian Academy of Pediatrics (IAP-ACVIP) on polio endgame strategy.
    背景与目标: :世界卫生组织宣布印度在东南地区的其他10个国家中-2014年为“无政治国家”。此后,印度政府(GoI)扩大了针对消灭小儿麻痹症的计划,该计划的目标是消灭病毒并顺序撤药口服脊髓灰质炎疫苗(OPV)感染2型病毒。但是,在选择从三价OPV(t-OPV)转换为二价OPV(b-OPV)之前,建议在国家免疫计划中包括灭活的脊髓灰质炎病毒疫苗(IPV),以保护未接种过疫苗的人群免受2型脊髓灰质炎病毒的侵害。 GoI宣布自2015年10月起第14周开始单剂IPV肌内注射。此外,由于预计印度目前IPV稀缺,GoI还建议自2016年4月以来在少数几个州推荐两次皮内注射IPV。这些策略的含义,以及印度儿科学会疫苗和免疫实践咨询委员会(IAP-ACVIP)关于小儿麻痹症最终策略的建议。
  • 2 Parasite plastids: approaching the endgame. 复制标题 收藏 收藏

    【寄生虫质体:接近尾声。】 复制标题 收藏 收藏
    DOI:10.1017/s1464793104006591 复制DOI
    作者列表:Wilson RJ
    BACKGROUND & AIMS: :Considerable work still needs to be done to understand more fully the basic processes going on inside the non-photosynthetic plastid organelle of Plasmodium spp., the causative agent of malaria. Following an explosion of genomic and transcriptional information in recent years, research workers are still analysing these data looking for new material relevant to the plastid. Several metabolic and housekeeping functions based on bacterial biochemistry have been elucidated and this has given impetus to finding lead inhibitors based on established anti-microbials. Structural investigations of plastid-associated enzymes identified as potential targets have begun. This review gives a perspective on the research to date and hopes to emphasize that a practical outcome for the clinic should be an important focus of future efforts. Malaria parasites have become resistant to front-line anti-malarials that are widely used and were formerly dependable. This has become a worrying problem in many regions where malaria is endemic. The time lag between hunting for new inhibitors and their application as pharmaceuticals is so long and costly that a steady stream of new ventures has to be undertaken to give a reasonable chance of finding affordable and appropriate anti-malarials for the future. Attempts to find inhibitors of the plastid organelle of the malaria parasite should be intensified in such programmes.
    背景与目标: :仍需要做大量工作以更充分地了解疟疾的致病性疟原虫的非光合质体细胞器内部的基本过程。近年来,随着基因组和转录信息的爆炸式增长,研究人员仍在分析这些数据,以寻找与质体相关的新材料。阐明了基于细菌生物化学的几种代谢和内务处理功能,这推动了基于既定抗微生物剂的铅抑制剂的发现。被鉴定为潜在靶标的质体相关酶的结构研究已经开始。这篇综述为迄今为止的研究提供了一个观点,并希望强调临床的实际结果应该是未来工作的重要重点。疟原虫已经对一线抗疟疾产生了抵抗力,这些抗疟疾被广泛使用并且以前是可靠的。在疟疾流行的许多地区,这已成为令人担忧的问题。寻找新抑制剂与将其用作药物之间的时间间隔太长且成本高昂,因此必须进行源源不断的新投资,才能有合理的机会为将来找到负担得起且合适的抗疟药。在此类计划中应加强寻找疟原虫质体细胞器抑制剂的尝试。
  • 【减轻烟草负担:结局是什么?】 复制标题 收藏 收藏
    DOI:10.1186/2045-4015-3-36 复制DOI
    作者列表:Chaiton M,Schwartz R
    BACKGROUND & AIMS: :Tobacco use causes a tremendous amount of morbidity and mortality globally, with a staggering level of financial costs. In many countries, public health interventions have been able to reduce the prevalence of smoking and the associated burden. However, despite these successes, there is still much work left to be done. This commentary argues that the tobacco control interventions recommended by the World Health Organization are necessary but not sufficient to adequately address the consequences of tobacco use.
    背景与目标: :使用烟草在全球范围内会导致大量的发病和死亡,其财务成本却达到惊人的水平。在许多国家,公共卫生干预措施已经能够减少吸烟率和相关负担。但是,尽管取得了这些成功,但仍有许多工作要做。该评论认为,世界卫生组织建议的控烟干预措施是必要的,但不足以充分解决吸烟的后果。
  • 【抛弃意识形态:自然/养育的最终局面。】 复制标题 收藏 收藏
    DOI:10.1111/j.1744-6163.2003.00113.x 复制DOI
    作者列表:Mohr WK
    BACKGROUND & AIMS: TOPIC:The concepts and research that underpin our understanding of how the brain is the organ of the mind. PURPOSE:To describe the dynamic nature of nervous system functioning and development; to discuss how the nervous system changes anatomically throughout the lifespan; to examine the vital role and interaction of genetics and environment; and to discuss the relationship among the brain, neurotransmission, genes, and psychiatric illness. SOURCES:Published literature. CONCLUSIONS:The latest research from the neurosciences lays to rest any suggestion that psychiatric illnesses are psychologically induced.
    背景与目标: 主题:概念和研究奠定了我们对大脑如何成为大脑器官的理解的基础。
    目的:描述神经系统功能和发展的动态特性;讨论神经系统在整个生命周期中的解剖结构变化;研究遗传学与环境的重要作用及其相互作用;并讨论大脑,神经传递,基因和精神病之间的关系。
    资料来源:已出版的文献。
    结论:神经科学的最新研究搁置了关于精神疾病是由心理诱发的任何暗示。
  • 【国家选择与脊髓灰质炎灭活疫苗,创新和全球消灭脊髓灰质炎的终结有关。】 复制标题 收藏 收藏
    DOI:10.1586/14760584.2014.864563 复制DOI
    作者列表:Thompson KM,Duintjer Tebbens RJ
    BACKGROUND & AIMS: :Achieving the goal of a world free of poliomyelitis still requires significant effort. Although polio immunization represents a mature area, the polio endgame will require new tools and strategies, particularly as national and global health leaders coordinate the cessation of all three serotypes of oral poliovirus vaccine and increasingly adopt inactivated poliovirus vaccine (IPV). Poliovirus epidemiology and the global options for managing polioviruses continue to evolve, along with our understanding and appreciation of the resources needed and the risks that require management. Based on insights from modeling, we offer some perspective on the current status of plans and opportunities to achieve and maintain a world free of wild polioviruses and to successfully implement oral poliovirus vaccine cessation. IPV costs and potential wastage will represent an important consideration for national policy makers. Innovations may reduce future IPV costs, but the world urgently needs lower-cost IPV options.
    背景与目标: :要实现一个没有脊髓灰质炎的世界的目标,仍然需要付出巨大的努力。尽管小儿麻痹症免疫是一个成熟的领域,但消灭小儿麻痹症将需要新的工具和策略,尤其是随着国家和全球卫生领导人协调停止口服小儿麻痹症疫苗的所有三种血清型并越来越多地采用灭活的小儿麻痹症疫苗(IPV)。随着我们对所需资源和需要管理的风险的理解和理解,脊髓灰质炎病毒流行病学和管理脊髓灰质炎病毒的全球选择也在不断发展。基于建模的见解,我们对计划的现状以及实现和维持一个没有野生脊髓灰质炎病毒的世界以及成功实施口服脊髓灰质炎病毒疫苗戒烟的机会提供了一些看法。 IPV成本和潜在浪费将是国家决策者的重要考虑因素。创新可能会降低未来IPV的成本,但是世界迫切需要成本更低的IPV选项。
  • 6 The polio endgame. 复制标题 收藏 收藏

    【脊髓灰质炎的残局。】 复制标题 收藏 收藏
    DOI:10.4161/21645515.2014.981115 复制DOI
    作者列表:Minor P
    BACKGROUND & AIMS: :Paralytic poliomyelitis is a disease that became a public health issue at the beginning of the twentieth century and was more or less eliminated in developed countries by the early 1970s. The Global Polio Eradication Initiative of WHO has now eradicated endemic polio from all but three countries although re-introductions occur. The progress in polio eradication is striking and has accelerated over the last few years. It is likely that it will be finally eradicated from the world soon, the looming issue will then be how to stop vaccinating or modify immunization programs safely so that poliomyelitis does not re-emerge. This review article discusses the history and pathogenesis of poliomyelitis. The progress made, and challenges in sustaining the eradication of this debilitating infectious disease are considered.
    背景与目标: :麻痹性脊髓灰质炎是一种疾病,在20世纪初已成为公共卫生问题,并且在1970年代初期已在发达国家或多或少被消除。世卫组织全球根除脊髓灰质炎行动现已根除除三个国家外的所有国家根除脊髓灰质炎,尽管发生了重新介绍。在过去的几年中,根除脊髓灰质炎的工作取得了惊人的进展。可能很快将其从世界上彻底根除,那么迫在眉睫的问题将是如何安全地停止接种疫苗或修改免疫程序,以使脊髓灰质炎不会再次出现。这篇综述文章讨论了脊髓灰质炎的历史和发病机理。考虑了在消灭这种使人衰弱的传染病方面取得的进展和面临的挑战。
  • 【末期管理循环疫苗衍生的脊髓灰质炎病毒的风险:口服脊髓灰质炎病毒疫苗需求。】 复制标题 收藏 收藏
    DOI:10.1186/s12879-015-1114-6 复制DOI
    作者列表:Duintjer Tebbens RJ,Thompson KM
    BACKGROUND & AIMS: BACKGROUND:The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) use, beginning with serotype 2-containing OPV (i.e., OPV2 cessation) followed by the remaining two OPV serotypes (i.e., OPV13 cessation). The risk of circulating vaccine-derived poliovirus (cVDPV) outbreaks after OPV cessation of any serotype depends on the serotype-specific population immunity to transmission prior to its cessation. METHODS:Based on an existing integrated global model of poliovirus risk management policies, we estimate the serotype-specific OPV doses required to manage population immunity for a strategy of intensive supplemental immunization activities (SIAs) shortly before OPV cessation of each serotype. The strategy seeks to prevent any cVDPV outbreaks after OPV cessation, although actual events remain stochastic. RESULTS:Managing the risks of OPV cessation of any serotype depends on achieving sufficient population immunity to transmission to transmission at OPV cessation. This will require that countries with sub-optimal routine immunization coverage and/or conditions that favor poliovirus transmission conduct SIAs with homotypic OPV shortly before its planned coordinated cessation. The model suggests the need to increase trivalent OPV use in SIAs by approximately 40 % or more during the year before OPV2 cessation and to continue bOPV SIAs between the time of OPV2 cessation and OPV13 cessation. CONCLUSIONS:Managing the risks of cVDPVs in the polio endgame will require serotype-specific OPV SIAs in some areas prior to OPV cessation and lead to demands for additional doses of the vaccine in the short term that will affect managers and manufacturers.
    背景与目标: 背景:全球根除脊髓灰质炎行动计划计划协调使用口服脊髓灰质炎疫苗(OPV),从含2型血清型OPV(即OPV2停止)开始,然后是其余两种OPV血清型(即OPV13停止)。停止任何血清型的原发性脊髓灰质炎疫苗后爆发循环疫苗源性脊髓灰质炎病毒(cVDPV)的风险取决于特定血清型的人群在其停止传播之前对传播的免疫力。
    方法:基于现有的脊髓灰质炎病毒风险管理政策的综合全球模型,我们估计在每种血清型OPV停止前不久进行密集补充免疫活动(SIA)的策略,以管理人群免疫所需的血清型特异性OPV剂量。该策略旨在防止OPV停止后发生任何cVDPV爆发,尽管实际事件仍然是随机的。
    结果:管理任何血清型正痘病毒停止的风险取决于在正痘病毒停止时获得足够的人群免疫力。这将要求常规免疫接种次优的国家和/或有利于脊髓灰质炎病毒传播的条件的国家在计划协调停止前不久就进行同型OPV的SIA。该模型表明,在OPV2停止之前的一年中,有必要将SIA中的三价OPV使用量增加约40%或更多,并在OPV2停止和OPV13停止之间继续使用bOPV SIA。
    结论:管理脊髓灰质炎终末期cVDPVs的风险将需要在停止OPV之前在某些地区进行针对血清型的OPV SIA,并导致短期内需要额外剂量的疫苗,这将影响管理者和制造商。
  • 【撼动烟草的残留控制力:出现残局策略。】 复制标题 收藏 收藏
    DOI:10.1093/jnci/djt262 复制DOI
    作者列表:Jenks S
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【残局:让烟草业自己消除。】 复制标题 收藏 收藏
    DOI:10.1111/eci.12172 复制DOI
    作者列表:Ioannidis JP,Henriksen L,Prochaska JJ
    BACKGROUND & AIMS: :A billion deaths from tobacco are expected by 2100. Many policy interventions such as increased taxation, restrictions on advertisement, smoking bans, as well as behavioral interventions, such as pharmacological and psychological treatments for smoking cessation, decrease tobacco use, but they reach their limits. Endgame scenarios focusing on tobacco supply rather than demand are increasingly discussed, but meet with resistance by the industry and even by many tobacco control experts. A main stumbling block that requires more attention is what to do with the tobacco industry in endgame scenarios. This industry has employed notoriously talented experts in law, business, organization, marketing, advertising, strategy, policy, and statistics and has tremendous lobbying power. Performance-based regulatory approaches can pose a legal obligation on manufacturers to decrease - and eventually - eliminate tobacco products according to specified schedules. Penalties and rewards can make such plans both beneficial for public health and attractive to the companies that do the job well. We discuss caveats and reality checks of engaging the tobacco industry to eliminate its current market and change focus. Brainstorming is warranted to entice the industry to abandon tobacco for other profit goals. To get the dialogue started, we propose the wild possibility of hiring former tobacco companies to reduce the costs of healthcare, thereby addressing concurrently two major challenges to public health.
    背景与目标: :到2100年,预计将有10亿人死于烟草。许多政策干预措施,例如增加税收,限制广告,禁止吸烟,以及行为干预措施,例如戒烟的药物和心理治疗,都减少了烟草使用,但这些措施可以达到目的。限制。越来越多地讨论了以烟草供应而不是需求为重点的残局情景,但最终结果受到了业界甚至许多烟草控制专家的抵制。需要更多关注的主要绊脚石是在终端游戏场景中如何处理烟草业。这个行业雇用了法律,商业,组织,市场营销,广告,战略,政策和统计方面的著名专家,并具有巨大的游说能力。基于绩效的监管方法可能对制造商构成法律义务,要求其按照指定的时间表减少并最终淘汰烟草产品。罚款和奖励可以使这样的计划既有益于公共卫生又可以吸引做得好的公司。我们讨论了吸引烟草业以消除其当前市场并改变重点的注意事项和现实检查。头脑风暴是诱使该行业放弃烟草以实现其他利润目标的诱因。为了开始对话,我们建议雇用前烟草公司以降低医疗保健成本的巨大可能性,从而同时解决公共卫生方面的两个主要挑战。
  • 【烟草新产品和尼古丁的终结:强有力的法规以及全面烟草控制和预防的作用:美国心脏协会的总统咨询。】 复制标题 收藏 收藏
    DOI:10.1161/CIR.0000000000000669 复制DOI
    作者列表:Bhatnagar A,Whitsel LP,Blaha MJ,Huffman MD,Krishan-Sarin S,Maa J,Rigotti N,Robertson RM,Warner JJ
    BACKGROUND & AIMS: :The advent of new tobacco products such as electronic cigarettes and the dramatic rise in their use, especially by adolescents and young adults, are significant public health concerns. Electronic cigarettes have become the most popular tobacco products for youth and adolescents in the United States and are attracting youth to new avenues for nicotine addiction. Although these products may have benefit by helping some smokers quit or to move to a less harmful product, the long-term health effects of these products and the net public health effect associated with their use remain unclear and widely debated. There is increasing concern that the use of newer tobacco products may catalyze transition to the use of other tobacco products or recreational drugs, particularly in young adults. Therefore, there is urgent need for robust US Food and Drug Administration regulation of all tobacco products to avoid the significant economic and population health consequences of continued tobacco use. Although the American Heart Association acknowledges that the ultimate endgame would be an end to all tobacco and nicotine addiction in the United States, it supports first minimizing the use of all combustible tobacco products while ensuring that other products do not addict the next generation of youth and adolescents. The endgame strategy needs to be coordinated with the long-standing, evidence-based tobacco control strategies that have significantly reduced tobacco use and initiation in the United States.
    背景与目标: :电子烟等新烟草产品的问世以及其使用的急剧增加,尤其是青少年和年轻人的使用,是引起公众健康的重大问题。电子烟已成为美国青少年和青少年中最受欢迎的烟草产品,并且正在吸引年轻人进入尼古丁成瘾的新途径。尽管这些产品可以通过帮助某些吸烟者戒烟或转而使用危害较小的产品而受益,但这些产品的长期健康影响以及与使用这些产品有关的净公共健康影响仍然不清楚,并且引起了广泛的争论。人们越来越关注使用较新的烟草产品可能会促使向使用其他烟草产品或休闲药物的使用过渡,特别是在年轻人中。因此,迫切需要美国食品药品管理局对所有烟草制品进行有力的监管,以避免持续使用烟草对经济和人口健康产生重大影响。尽管美国心脏协会承认最终的最终结果将是结束美国所有烟草和尼古丁成瘾,但它支持首先最大程度地减少所有可燃烟草产品的使用,同时确保其他产品不会使下一代年轻人和青少年上瘾。青少年。残局策略需要与长期的循证烟草控制策略相协调,该策略已大大减少了美国的烟草使用和启动。
  • 【到2020年消除淋巴丝虫病:末期治疗的更新和影响评估。】 复制标题 收藏 收藏
    DOI:10.1586/14787210.2013.811841 复制DOI
    作者列表:Rebollo MP,Bockarie MJ
    BACKGROUND & AIMS: :Lymphatic filariasis (LF) is an important public health problem endemic in 73 countries, where it is a major cause of acute and chronic morbidity and a significant impediment to socioeconomic development. It is targeted for elimination by 2020, through preventive chemotherapy using albendazole in combination with either ivermectin or diethylcarbamazine citrate. Preventive chemotherapy enables the regular and coordinated administration of safe, single-dose medications delivered through mass drug administration (MDA). Many countries are now scaling down MDA activities after achieving 100% geographic coverage and instituting monitoring and evaluation procedures to establish the impact of several consecutive rounds of MDA and determine if transmission has been interrupted. At the same time, countries yet to initiate MDA for elimination of LF will adopt improved mapping and coverage assessment protocols to accelerate the efforts for achieving global elimination by 2020. This review provides an update on treatment for LF and describes the current global status of the elimination efforts, transmission control processes and strategies for measuring impact and continuing surveillance after MDA has ceased.
    背景与目标: 淋巴丝虫病(LF)是73个国家/地区的重要公共卫生问题,是急性和慢性发病的主要原因,也是社会经济发展的重大障碍。通过使用阿苯达唑与伊维菌素或柠檬酸二乙基卡巴嗪合用的预防性化学疗法,到2020年消除该病的目标。预防性化学疗法可以通过药物大规模管理(MDA)定期和协调地管理安全的单剂量药物。在实现100%的地理覆盖率并建立监视和评估程序以确定连续几轮MDA的影响并确定传输是否被中断之后,许多国家现在正在缩减MDA活动。同时,尚未启动消除LF的MDA的国家将采用改进的制图和覆盖率评估协议,以加速为在2020年之前实现全球消除而努力。这项审查提供了有关LF治疗的最新信息,并描述了LF的当前全球状况。在MDA停止后,采取消除措施,传输控制程序以及衡量影响和持续监视的策略。
  • 【烟草控制终局计划的政策选择:模拟建模研究。】 复制标题 收藏 收藏
    DOI:10.1136/tobaccocontrol-2019-055126 复制DOI
    作者列表:Skinner A,Walker P,Atkinson JA,Whitehead R,Roselli T,West M,Bright M,Heffernan M,McDonnell G,Veerman L,Prodan A,Thomas DP,Burton S
    BACKGROUND & AIMS: OBJECTIVE:To investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model codeveloped with local and national stakeholders.

    METHODS:Eight intervention scenarios were simulated and compared with a reference scenario (business as usual), in which all tobacco control measures currently in place are maintained unchanged until the end of the simulation period (31 December 2037).

    FINDINGS:Under the business as usual scenario, adult daily smoking prevalence is projected to decline from 11.8% in 2017 to 5.58% in 2037. A sustained 50% increase in antismoking advertising exposure from 2018 reduces projected prevalence in 2037 by 0.80 percentage points. Similar reductions are projected with the introduction of tobacco wholesaler and retailer licensing schemes that either permit or prohibit tobacco sales by alcohol-licensed venues (0.65 and 1.73 percentage points, respectively). Increasing the minimum age of legal supply of tobacco products substantially reduces adolescent initiation, but has minimal impact on smoking prevalence in the adult population over the simulation period. Sustained reductions in antismoking advertising exposure of 50% and 100% from 2018 increase projected adult daily smoking prevalence in 2037 by 0.88 and 1.98 percentage points, respectively.

    CONCLUSIONS:These results suggest that any prudent approach to endgame planning should seek to build on rather than replace existing tobacco control measures that have proved effective to date. Additional interventions that can promote cessation are expected to be more successful in reducing smoking prevalence than interventions focussing exclusively on preventing initiation.

    背景与目标: 目标:使用与地方和国家利益相关者共同开发的系统动力学模型,调查几种烟草控制干预措施对澳大利亚昆士兰州成年人每日吸烟流行的潜在影响。

    < strong>方法:对八个干预方案进行了模拟,并与参考方案(照常营业)进行了比较,在参考方案中,当前所有的烟草控制措施都保持不变,直到模拟期结束(2037年12月31日)。

    发现:在一切照旧的情况下,成年人的每日吸烟率预计将从2017年的11.8%下降到2037年的5.58%。反吸烟广告的曝光率将持续增长50%从2018年开始,预计2037年的患病率将降低0.80个百分点。预计将通过引入烟草批发商和零售商许可计划来实现类似的减少,该计划允许或禁止在酒精许可的场所销售烟草(分别为0.65和1.73个百分点)。增加合法的烟草制品最低供应年龄可以大大减少青春期的萌生,但是在模拟期间对成年人口吸烟率的影响却很小。从2018年开始,持续减少50%和100%的反吸烟广告曝光量,预计2037年成人每日吸烟率分别增加0.88和1.98个百分点。

    结论:这些结果表明,采取任何谨慎的残局计划方法,都应力求建立而不是取代迄今已证明有效的现有烟草控制措施。与专门专注于预防吸烟的干预措施相比,其他可以促进戒烟的干预措施在减少吸烟流行方面有望取得更大的成功。

  • 【小儿麻痹症残局的教训:克服疫苗接种失败以及亚群在维持传播中的作用。】 复制标题 收藏 收藏
    DOI:10.1093/infdis/jix108 复制DOI
    作者列表:Thompson KM,Duintjer Tebbens RJ
    BACKGROUND & AIMS: Background:Recent detections of circulating serotype 2 vaccine-derived poliovirus in northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public health emergencies that require aggressive response. Methods:We demonstrate the importance of undervaccinated subpopulations, using an existing dynamic poliovirus transmission and oral poliovirus vaccine evolution model. We review the lessons learned during the polio endgame about the role of subpopulations in sustaining transmission, and we explore the implications of subpopulations for other vaccine-preventable disease eradication efforts. Results:Relatively isolated subpopulations benefit little from high surrounding population immunity to transmission and will sustain transmission as long as they do not attain high vaccination coverage. Failing to reach such subpopulations with high coverage represents the root cause of polio eradication delays. Achieving and maintaining eradication requires addressing the weakest links, which includes immunizing populations in insecure areas and/or with disrupted or poor-performing health systems and managing the risks of individuals with primary immunodeficiencies who can excrete vaccine-derived poliovirus long-term. Conclusions:Eradication efforts for vaccine-preventable diseases need to create performance expectations for countries to immunize all people living within their borders and maintain high coverage with appropriate interventions.Keywords. Polio; eradication; transmission; heterogeneity.
    背景与目标: 背景:最近在尼日利亚北部(博尔诺州和索科托州)和巴基斯坦(巴洛克希斯坦省)检测到循环的血清型2疫苗源性脊髓灰质炎病毒,在巴基斯坦,阿富汗和尼日利亚(博尔诺)发现了血清型1型野生脊髓灰质炎病毒,这代表了需要紧急响应的公共卫生紧急情况。
    方法:我们使用现有的动态脊髓灰质炎病毒传播和口服脊髓灰质炎病毒疫苗进化模型证明了接种不足的亚群的重要性。我们回顾了在小儿麻痹症终末期中学到的有关亚群在维持传播中的作用的经验教训,并探讨了亚群对其他疫苗可预防的疾病消除工作的影响。
    结果:相对分离的亚群受益于周围人群对传播的高度免疫力,只要他们没有获得较高的疫苗接种覆盖率,它们就会维持传播。未能以较高的覆盖率到达此类亚群是根除脊髓灰质炎根除延误的根本原因。要实现和保持根除工作,必须解决最薄弱的环节,其中包括对不安全地区和/或卫生系统受到破坏或运行不佳的人群进行免疫接种,以及管理具有主要免疫缺陷的人的风险,这些人可以长期排出疫苗衍生的脊髓灰质炎病毒。
    结论:根除疫苗可预防疾病的努力需要为各国创造绩效期望,以使所有居住在其境内的人们获得免疫,并通过适当的干预措施保持较高的覆盖率。脊髓灰质炎;消灭;传播;异质性。
  • 【小儿麻痹症:从免疫系统管理小组学到的教训。】 复制标题 收藏 收藏
    DOI:10.1093/infdis/jiw592 复制DOI
    作者列表:Zipursky S,Vandelaer J,Brooks A,Dietz V,Kachra T,Farrell M,Ottosen A,Sever JL,Zaffran MJ
    BACKGROUND & AIMS: :The Immunization Systems Management Group (IMG) was established to coordinate and oversee objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018, namely, (1) introduction of ≥1 dose of inactivated poliovirus vaccine in all 126 countries using oral poliovirus vaccine (OPV) only as of 2012, (2) full withdrawal of OPV, starting with the withdrawal of its type 2 component, and (3) using polio assets to strengthen immunization systems in 10 priority countries. The IMG's inclusive, transparent, and partnership-focused approach proved an effective means of leveraging the comparative and complementary strengths of each IMG member agency. This article outlines 10 key factors behind the IMG's success, providing a potential set of guiding principles for the establishment and implementation of other interagency collaborations and initiatives beyond the polio sphere.
    背景与目标: :成立了免疫系统管理小组(IMG),以协调和监督《 2013-2018年消灭脊灰和残局战略计划》的目标2,即(1)在所有126个国家中使用口服脊髓灰质炎病毒引入≥1剂灭活脊髓灰质炎疫苗仅从2012年起开始使用疫苗(OPV),(2)从其2型成分的退出开始全面撤消OPV,(3)在10个优先国家/地区使用脊髓灰质炎资产来加强免疫系统。 IMG的包容性,透明性和以伙伴关系为重点的方法证明是一种有效的手段,可以利用每个IMG成员机构的比较优势和互补优势。本文概述了IMG成功背后的10个关键因素,为在脊髓灰质炎领域之外建立和实施其他机构间合作和倡议提供了一组潜在的指导原则。
  • 【加利福尼亚州倡导者对推进烟草残局的挑战和风险的观点。】 复制标题 收藏 收藏
    DOI:10.1057/s41271-020-00230-5 复制DOI
    作者列表:Smith EA,McDaniel PA,Malone RE
    BACKGROUND & AIMS: :In the USA, California's highly-regarded Tobacco Control Program (CTCP) has defined its goal as "ending the tobacco epidemic for all population groups" by 2035. To understand local advocates' perceptions of endgame-oriented policies, we interviewed 28 advocates from California communities that had recently adopted tobacco control policies. There was no consensus among participants on which specific policies would constitute the tobacco endgame in California. There was an agreement, however, that policymakers should promote policies that would impact communities with the highest tobacco use prevalence and that policies should be 'clean', avoiding exemptions. Participants were cognizant of California's history of tobacco control policy innovations beginning locally and eventually being adopted at the state level. Many commented that recent policy innovations in the state had begun a conversation that made more 'radical' ideas seem possible. California tobacco control advocates are engaged in local endgame policy discussions and prepared to advance California's endgame goal.
    背景与目标: :在美国,加利福尼亚州备受推崇的烟草控制计划(CTCP)将其目标定义为“到2035年消除所有人群的烟草流行”。为了了解当地倡导者对以禁毒为导向的政策的看法,我们采访了来自28个倡导者最近采用了烟草控制政策的加利福尼亚社区。参与者之间没有达成共识,即哪些具体政策将构成加利福尼亚的烟草终结游戏。但是,达成了一项协议,政策制定者应提倡对烟草使用率最高的社区产生影响的政策,并且政策应“干净”,避免豁免。参与者认识到加利福尼亚的烟草控制政策创新历史始于本地,并最终在州一级被采用。许多人评论说,该州最近的政策创新已经开始了对话,使更多“激进”的想法似乎成为可能。加州烟草控制倡导者正在参与当地的禁毒政策讨论,并准备推进加利福尼亚的禁毒目标。

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