Assessing the role of basic control measures, antivirals and vaccine in curtailing pandemic influenza

Scenarios for the US, UK and the Netherlands

M. Nuño, G. Chowell, Abba Gumel

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

An increasing number of avian flu cases in humans, arising primarily from direct contact with poultry, in several regions of the world have prompted the urgency to develop pandemic preparedness plans worldwide. Leading recommendations in these plans include basic public health control measures for minimizing transmission in hospitals and communities, the use of antiviral drugs and vaccination. This paper presents a mathematical model for the evaluation of the pandemic flu preparedness plans of the United States (US), the United Kingdom (UK) and the Netherlands. The model is used to assess single and combined interventions. Using data from the US, we show that hospital and community transmission control measures alone can be highly effective in reducing the impact of a potential flu pandemic. We further show that while the use of antivirals alone could lead to very significant reductions in the burden of a pandemic, the combination of transmission control measures, antivirals and vaccine gives the most 'optimal' result. However, implementing such an optimal strategy at the onset of a pandemic may not be realistic. Thus, it is important to consider other plausible alternatives. An optimal preparedness plan is largely dependent on the availability of resources; hence, it is country-specific. We show that countries with limited antiviral stockpiles should emphasize their use therapeutically (rather than prophylactically). However, countries with large antiviral stockpiles can achieve greater reductions in disease burden by implementing them both prophylactically and therapeutically. This study promotes alternative strategies that may be feasible and attainable for the US, UK and the Netherlands. It emphasizes the role of hospital and community transmission control measures in addition to the timely administration of antiviral treatment in reducing the burden of a flu pandemic. The latter is consistent with the preparedness plans of the UK and the Netherlands. Our results indicate that for low efficacy and coverage levels of antivirals and vaccine, the use of a vaccine leads to the greatest reduction in morbidity and mortality compared with the singular use of antivirals. However, as these efficacy and coverage levels are increased, the use of antivirals is more effective.

Original languageEnglish (US)
Pages (from-to)505-521
Number of pages17
JournalJournal of the Royal Society Interface
Volume4
Issue number14
DOIs
StatePublished - Jun 22 2007
Externally publishedYes

Fingerprint

Vaccines
Pandemics
Netherlands
Human Influenza
Antiviral Agents
Poultry
Public health
Availability
Mathematical models
United Kingdom
State Hospitals
Influenza in Birds
Vaccination
Theoretical Models
Public Health
Morbidity
Mortality

Keywords

  • Antivirals
  • Basic control measures
  • Basic reproduction number, compartmental model
  • Influenza
  • Pandemic
  • Vaccination

ASJC Scopus subject areas

  • Biophysics
  • Biotechnology
  • Bioengineering
  • Biomedical Engineering
  • Biomaterials
  • Biochemistry

Cite this

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abstract = "An increasing number of avian flu cases in humans, arising primarily from direct contact with poultry, in several regions of the world have prompted the urgency to develop pandemic preparedness plans worldwide. Leading recommendations in these plans include basic public health control measures for minimizing transmission in hospitals and communities, the use of antiviral drugs and vaccination. This paper presents a mathematical model for the evaluation of the pandemic flu preparedness plans of the United States (US), the United Kingdom (UK) and the Netherlands. The model is used to assess single and combined interventions. Using data from the US, we show that hospital and community transmission control measures alone can be highly effective in reducing the impact of a potential flu pandemic. We further show that while the use of antivirals alone could lead to very significant reductions in the burden of a pandemic, the combination of transmission control measures, antivirals and vaccine gives the most 'optimal' result. However, implementing such an optimal strategy at the onset of a pandemic may not be realistic. Thus, it is important to consider other plausible alternatives. An optimal preparedness plan is largely dependent on the availability of resources; hence, it is country-specific. We show that countries with limited antiviral stockpiles should emphasize their use therapeutically (rather than prophylactically). However, countries with large antiviral stockpiles can achieve greater reductions in disease burden by implementing them both prophylactically and therapeutically. This study promotes alternative strategies that may be feasible and attainable for the US, UK and the Netherlands. It emphasizes the role of hospital and community transmission control measures in addition to the timely administration of antiviral treatment in reducing the burden of a flu pandemic. The latter is consistent with the preparedness plans of the UK and the Netherlands. Our results indicate that for low efficacy and coverage levels of antivirals and vaccine, the use of a vaccine leads to the greatest reduction in morbidity and mortality compared with the singular use of antivirals. However, as these efficacy and coverage levels are increased, the use of antivirals is more effective.",
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