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Optimizing Tactics for Use of the U.S. Antiviral Strategic National Stockpile for Pandemic Influenza

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  • Nedialko B Dimitrov
  • Sebastian Goll
  • Nathaniel Hupert
  • Babak Pourbohloul
  • Lauren Ancel Meyers

Abstract

In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In addition, aggressive antiviral treatment was recommended for certain patient subgroups to reduce the severity and duration of symptoms. To assist States and other localities meet these needs, the U.S. Government distributed a quarter of the antiviral medications in the Strategic National Stockpile within weeks of the pandemic's start. However, there are no quantitative models guiding the geo-temporal distribution of the remainder of the Stockpile in relation to pandemic spread or severity. We present a tactical optimization model for distributing this stockpile for treatment of infected cases during the early stages of a pandemic like 2009 pH1N1, prior to the wide availability of a strain-specific vaccine. Our optimization method efficiently searches large sets of intervention strategies applied to a stochastic network model of pandemic influenza transmission within and among U.S. cities. The resulting optimized strategies depend on the transmissability of the virus and postulated rates of antiviral uptake and wastage (through misallocation or loss). Our results suggest that an aggressive community-based antiviral treatment strategy involving early, widespread, pro-rata distribution of antivirals to States can contribute to slowing the transmission of mildly transmissible strains, like pH1N1. For more highly transmissible strains, outcomes of antiviral use are more heavily impacted by choice of distribution intervals, quantities per shipment, and timing of shipments in relation to pandemic spread. This study supports previous modeling results suggesting that appropriate antiviral treatment may be an effective mitigation strategy during the early stages of future influenza pandemics, increasing the need for systematic efforts to optimize distribution strategies and provide tactical guidance for public health policy-makers.

Suggested Citation

  • Nedialko B Dimitrov & Sebastian Goll & Nathaniel Hupert & Babak Pourbohloul & Lauren Ancel Meyers, 2011. "Optimizing Tactics for Use of the U.S. Antiviral Strategic National Stockpile for Pandemic Influenza," PLOS ONE, Public Library of Science, vol. 6(1), pages 1-10, January.
    • Handle: RePEc:plo:pone00:0016094
    DOI: 10.1371/journal.pone.0016094
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    References listed on IDEAS

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    1. Joseph T Wu & Gabriel M Leung & Marc Lipsitch & Ben S Cooper & Steven Riley, 2009. "Hedging against Antiviral Resistance during the Next Influenza Pandemic Using Small Stockpiles of an Alternative Chemotherapy," PLOS Medicine, Public Library of Science, vol. 6(5), pages 1-11, May.
    2. Christina E. Mills & James M. Robins & Marc Lipsitch, 2004. "Transmissibility of 1918 pandemic influenza," Nature, Nature, vol. 432(7019), pages 904-906, December.
    3. Neil M. Ferguson & Derek A.T. Cummings & Simon Cauchemez & Christophe Fraser & Steven Riley & Aronrag Meeyai & Sopon Iamsirithaworn & Donald S. Burke, 2005. "Strategies for containing an emerging influenza pandemic in Southeast Asia," Nature, Nature, vol. 437(7056), pages 209-214, September.
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    2. Rubina Ali & Inamullah Jan & Muhammad Shoaib Malik, 2020. "Emerging Health Security Threats and Impact of Bioterrorism on the U.S. National Security," Global Political Review, Humanity Only, vol. 5(1), pages 94-103, March.
    3. Gregg S. Gonsalves & Forrest W. Crawford & Paul D. Cleary & Edward H. Kaplan & A. David Paltiel, 2018. "An Adaptive Approach to Locating Mobile HIV Testing Services," Medical Decision Making, , vol. 38(2), pages 262-272, February.
    4. Amy L Greer & Dena Schanzer, 2013. "Using a Dynamic Model to Consider Optimal Antiviral Stockpile Size in the Face of Pandemic Influenza Uncertainty," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-9, June.
    5. Gillis, Melissa & Urban, Ryley & Saif, Ahmed & Kamal, Noreen & Murphy, Matthew, 2021. "A simulation–optimization framework for optimizing response strategies to epidemics," Operations Research Perspectives, Elsevier, vol. 8(C).

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