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- Brouwers, Lisa, 1967-, et al.
(författare)
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Economic consequences to society of pandemic H1N1 influenza 2009 : preliminary results for Sweden
- 2009
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Ingår i: Eurosurveillance. - : European Centre for Disease Control and Prevention (ECDC). - 1025-496X .- 1560-7917. ; 14:37, s. 19333-
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Tidskriftsartikel (refereegranskat)abstract
- Experiments using a microsimulation platform show that vaccination against pandemic H1N1 influenza is highly cost-effective. Swedish society may reduce the costs of pandemic by about SEK 2.5 billion (approximately EUR 250 million) if at least 60 per cent of the population is vaccinated, even if costs related to death cases are excluded. The cost reduction primarily results from reduced absenteeism. These results are preliminary and based on comprehensive assumptions about the infectiousness and morbidity of the pandemic, which are uncertain in the current situation.
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- Holmberg, Martin, 1947-
(författare)
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The ghost of pandemics past : revisiting two centuries of influenza in Sweden
- 2017
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Ingår i: Medical Humanities. - : BMJ Publishing Group Ltd. - 1468-215X .- 1473-4265. ; 43:3, s. 141-147
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Tidskriftsartikel (refereegranskat)abstract
- Previous influenza pandemics are usually invoked in pandemic preparedness planning without a thorough analysis of the events surrounding them, what has been called the ‘configuration’ of epidemics. Historic pandemics are instead used to contrast them to the novelty of the coming imagined plague or as fear of a ghost-like repetition of the past. This view of pandemics is guided by a biomedical framework that is ahistorical and reductionist. The meaning of ‘pandemic’ influenza is in fact highly ambiguous in its partitioning of pandemic and seasonal influenza. The past 200 years of influenza epidemics in Sweden are examined with a special focus on key social structures—households, schools, transportations and the military. These are shown to have influenced the progression of influenza pandemics. Prevailing beliefs around influenza pandemics have also profoundly influenced intervention strategies. Measuring long-term trends in pandemic severity is problematic because pandemics are non-linear events where the conditions surrounding them constantly change. However, in a linearised view, the Spanish flu can be seen to represent a historical turning point and the H1N1 2009 pandemic not as an outlier, but following a 100-year trend of decreasing severity. Integrating seasonal and pandemic influenza, and adopting an ecosocial stance can deepen our understanding and bring the ghost-like pandemic past to life.
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- Järhult, Josef D., 1975-
(författare)
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Tamiflu® - Use It and Lose It?
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Influenza A viruses cause seasonal and pandemic outbreaks that range from mild infections to the disastrous Spanish Flu. Resistance to neuraminidase inhibitors (NAIs) is a growing problem as these drugs constitute a vital part of treatment strategies and pandemic preparedness plans worldwide. Oseltamivir (Tamiflu®) is the mostly used NAI. Its active metabolite, oseltamivir carboxylate (OC), is excreted from treated patients and degrades poorly in sewage treatment plants and surface water. Thus, OC can enter aquatic environments where the natural influenza reservoir, dabbling ducks, can be exposed to the substance and resistance could develop. If NAI resistance is established in influenza viruses circulating among wild birds, the resistance can form part of a virus re-entering the human population either by reassortment or by direct transmission. In this thesis, evidence is presented that OC is present in the waterways during a seasonal influenza outbreak in Japan, a country in which oseltamivir is liberally used. Furthermore, when mallards were infected with an influenza A/H1N1 virus and subjected to low, environmental-like concentrations of OC, resistance developed through acquisition of the well-known resistance mutation H274Y. The influenza infection in the mallards was mainly intestinal, had a rapid onset and was progressing in a longitudinal fashion in the intestine. Finally, influenza A viruses isolated from wild mallards in Sweden and containing resistance-related mutations were examined by a neuraminidase inhibition assay. The viruses did not have a decreased sensitivity to NAIs, but had mutations with a resistance-enhancing potential. Thus, OC is present in the environment and environmental-like concentrations of OC induce resistance in influenza viruses of dabbling ducks. The present resistance situation among wild birds is not well understood but the existence of H274Y among wild birds, though rare, and the spread of the former seasonal A/H1N1 virus containing H274Y among humans indicate that resistance mutations could establish themselves also among wild birds. An oseltamivir-resistant pandemic or a human-adapted highly-pathogenic avian influenza virus are frightening scenarios as oseltamivir is a cornerstone in the defense in those situations. There is a need for further studies, surveillance in wild birds and for a prudent use of antivirals.
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- Uhnoo, Ingrid, et al.
(författare)
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Antivirala läkemedel vid influensa - aktuella rekommendationer : Influensaläkemedel ersätter inte vaccination men är ett bra komplement
- 2005
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 102:49, s. 3802-3808
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Antivirala läkemedel är ett komplement till, men ersätter inte, influensavaccination. Neuraminidashämmarna har effekt mot både influensa A- och B-virus; oseltamivir kan användas för behandling eller profylax och zanamivir för behandling. Antiviral behandling måste sättas in senast inom 48 timmar och förkortar sjukdomen med 1–2 dagar. Behandling rekommenderas till patient med influensa som kräver sjukhusvård och till medicinska riskgrupper. Användning av medlen för postexponerings- eller säsongsprofylax ger 70–90-procentig skyddseffekt. Den viktigaste målgruppen för antiviral profylax är de medicinska riskgrupperna. Resistensutveckling har hittills påvisats i relativ låg frekvens men är ett potentiellt hot för framtiden. Initialt i en pandemi, innan vaccin hunnit utvecklas, är antivirala medel den enda specifika åtgärden mot influensan.
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