[转移贴]-The WHO research agenda for influenza: two years later

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The WHO research agenda for influenza: two years later

Michael L Perdue a & Tim Nguyen b

a FluSolutions Consulting, LLC, Hilo, HI 96720, United States of America.
b World Health Organization, Geneva, Switzerland.

Correspondence to Michael Perdue (e-mail: mlpatlarge@gmail.com).

Bulletin of the World Health Organization 2012;90:246-246. doi: 10.2471/BLT.11.090175

In November 2009, the Global Influenza Programme of the World Health Organization (WHO) hosted a consultation among investigators, funding agencies, health policy-makers and other public-health officials from 35 countries to evaluate ongoing influenza research and its impact on public health and recommend high-priority research. Five research areas or “streams” were identified and background documents were commissioned and published on WHO’s web site.1 The streams identified were given short, convenient titles: reducing risk; limiting spread; minimizing impact; optimizing treatment and promoting tools. In each stream, numerous “substreams” covered the existing and proposed landscape of influenza research efforts. A summary research agenda with recommendations was published in early 2010.2

Two years after the 2009 A(H1N1) pandemic, a review of published works and their relevance to the research agenda was warranted. Furthermore, a report presented to the Sixty-fourth World Health Assembly in May 2011 specifically recommended that WHO “pursue a comprehensive influenza research and evaluation programme”.3 In response, WHO commissioned over 20 literature reviews covering the high-priority research recommendations in the original agenda. An expert group met informally in November 2011 to present the findings of the reviews and prepare a full progress report. It found more than 4000 relevant publications from 2010 and 2011.

The reviews revealed important progress in each of the 16 research substreams of WHO’s original agenda,2 evidence that the agenda accurately reflected the global landscape of ongoing and needed influenza research. The progress report, still in preparation, will summarize the major findings, but the important topics discussed under each stream are outlined below:

Reducing risk. Research in this area seeks to mitigate the risk that novel influenza strains will affect humans and cause a pandemic. Discussions centred on the need to increase surveillance activities and biosecurity wherever food animals such as poultry and swine are in contact with humans. Studies directed at understanding the molecular changes that promote zoonotic transmission of influenza viruses were also evaluated.

Limiting spread. Once a new human influenza virus emerges, research questions revolve around transmission dynamics and prevention. Current research centres on the physical factors facilitating viral spread in humans, although molecular markers within viral transmissibility genes are also under study. Research has advanced knowledge on the survival of viruses in the environment and the role of close contact and aerosol in transmission. New data from the 2009 pandemic cast new light on other factors affecting transmission.

Minimizing impact. Studies on limiting spread were discussed under this research stream since limiting the spread of the influenza virus would reduce a pandemic’s overall impact. Because vaccination is the cornerstone of efforts to minimize impact, research on new influenza vaccines, vaccination approaches and vaccination policies was discussed. The development of “universal”, recombinant and advanced cell-based vaccines, the use of adjuvants for dose sparing and enhanced protection, and the transfer of new and existing technologies to low-resource countries are novel approaches. However, gaps exist in our capacity to effectively deliver these vaccines.

Optimizing treatment. The wide range of clinical presentations, coupled with the influence of patient age and immune status, the variable use of diagnostics, and resistance to antiviral drugs, complicate the treatment of influenza. In addition, health system capacity varies across countries and regions. Scores of studies have been published on the clinical features of the 2009 A(H1N1) pandemic and more than 60 on the comparative validity of different point-of-care diagnostic tests. Hundreds of studies have dealt with the development of new antivirals, drug resistance and pharmacokinetics. However, gaps remain in our capacity to readily recognize and treat influenza.

Promoting tools. Expanded use of modern tools and the development of new tools could greatly improve early outbreak detection and influenza control. The original research agenda recommended studies on advanced case surveillance and reporting, disease and transmission modelling, and novel strategic communications. Many modelling studies have been published, primarily on disease transmission and how vaccination or previous infection modifies it. Other studies have focused on risk communication by the media and by public health officials during public health crises.

WHO’s 2011 research agenda consultation provided an informed discussion forum to examine the huge amount of research conducted since November 2009 and assess accomplishments and future directions. Several of the reviews commissioned will soon be published and the progress report will appear on WHO’s website. It is hoped that this ongoing research review process will help researchers and funding agencies to effectively apply resources for influenza research.

http://www.who.int/bulletin/volumes/90/4/11-090175/en/index.html  


总结下来5点：
降低风险。这一领域的研究试图缓解新的流感菌株感染人类并引发大流行的风险。讨论侧重于需要在食用动物，例如家禽和猪与人的所有接触之处，加强监测活动和生物安全。还评估了有关的研究报告，这些报告旨在理解加剧流感病毒人畜传播的分子变化。

限制传播。一旦出现新的人流感病毒，研究问题即围绕传播动向和预防来提出。目前的研究是以便利病毒在人群中传播的物理因素为中心的，虽然也在研究病毒传播基因的分子标记。研究工作拓展了人们关于环境中病毒生存以及密切接触和雾气在传播中作用的知识。来自2009年大流行的新数据也进一步揭示了影响传播的其他因素。

影响最小化。在这一研究系列中，对关于限制传播问题的研究也作了讨论，因为限制流感病毒的传播将减少大流行的整体影响。由于免疫接种是影响最小化努力的基石，讨论了新的流感疫苗、免疫接种方针和免疫接种政策等问题。研制“广效”、重组和以细胞为基础的疫苗，使用辅助剂以节省剂量和加强保护，以及向资源匮乏国家转让新的和现有技术，都是一些新的方针。不过，我们有效交付这些疫苗的能力仍然存在差距。

治疗最优化。一系列临床表现，连同患者年龄和免疫状况的影响，各种诊断方法，以及对抗病毒药物的耐药性，使得流感治疗错综复杂。此外，卫生系统能力也因国家和地区的不同而有所不同。 就2009年甲型（H1N1）流感大流行的临床特征发表了大量研究报告，60多份报告涉及不同医护站点诊断测试的相对有效性。数百份报告涉及新的抗病毒药物的研制、耐药性和药物代谢动力学。然而，我们即时辨认和治疗流感的能力仍然存在差距。

推广工具。扩大使用现代工具和开发新的工具，可大大促进早期暴发检测和流感控制。最初的研究议程建议就先进的病例监测和报告制度、制作疾病与传播模式，以及新颖的战略沟通进行研究。发表了许多模式问题研究报告，主要涉及疾病传播以及免疫接种或以往的感染如何对之加以校正。其他研究报告侧重于在公共卫生危机期间媒体和公共卫生官员的风险沟通。