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Diagnosis and Antiviral Intervention Strategies for Mitigating an Influenza Epidemic

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  • Robert Moss
  • James M McCaw
  • Jodie McVernon

Abstract

Background: Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies informed recommendations for liberal antiviral distribution in the pandemic phase, primarily to prevent infection, but failed to account for logistical constraints clearly evident during the 2009 H1N1 outbreaks. Methods and Findings: We extend an existing SEIR model to incorporate finite diagnostic and antiviral distribution capacities. We evaluate the impact of using different diagnostic strategies to decide to whom antivirals are delivered. We then determine what additional capacity is required to achieve optimal impact. We identify the importance of sensitive and specific case ascertainment in the early phase of a pandemic response, when the proportion of false-positive presentations may be high. Once a substantial percentage of ILI presentations are caused by the pandemic strain, identification of cases for treatment on syndromic grounds alone results in a greater potential impact than a laboratory-dependent strategy. Our findings reinforce the need for a decentralised system capable of providing timely prophylaxis. Conclusions: We address specific real-world issues that must be considered in order to improve pandemic preparedness policy in a practical and methodologically sound way. Provision of antivirals on the scale proposed for an effective response is infeasible using traditional public health outbreak management and contact tracing approaches. The results indicate to change the transmission dynamics of an influenza epidemic with an antiviral intervention, a decentralised system is required for contact identification and prophylaxis delivery, utilising a range of existing services and infrastructure in a “whole of society” response.

Suggested Citation

  • Robert Moss & James M McCaw & Jodie McVernon, 2011. "Diagnosis and Antiviral Intervention Strategies for Mitigating an Influenza Epidemic," PLOS ONE, Public Library of Science, vol. 6(2), pages 1-10, February.
  • Handle: RePEc:plo:pone00:0014505
    DOI: 10.1371/journal.pone.0014505
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    References listed on IDEAS

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    1. James M McCaw & James G Wood & Christopher T McCaw & Jodie McVernon, 2008. "Impact of Emerging Antiviral Drug Resistance on Influenza Containment and Spread: Influence of Subclinical Infection and Strategic Use of a Stockpile Containing One or Two Drugs," PLOS ONE, Public Library of Science, vol. 3(6), pages 1-10, June.
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    4. Sebastiaan J van Hal & Hong Foo & Christopher C Blyth & Kenneth McPhie & Paul Armstrong & Vitali Sintchenko & Dominic E Dwyer, 2009. "Influenza Outbreak during Sydney World Youth Day 2008: The Utility of Laboratory Testing and Case Definitions on Mass Gathering Outbreak Containment," PLOS ONE, Public Library of Science, vol. 4(9), pages 1-10, September.
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