Strategies for containing an emerging influenza pandemic in Southeast Asia.
Highly pathogenic H5N1 influenza A viruses are now endemic in avian populations in Southeast Asia, and human cases continue to accumulate. Although currently incapable of sustained human-to-human transmission, H5N1 represents a serious pandemic threat owing to the risk of a mutation or reassortment generating a virus with increased transmissibility. Identifying public health interventions that might be able to halt a pandemic in its earliest stages is therefore a priority. Here we use a simulation model of influenza transmission in Southeast Asia to evaluate the potential effectiveness of targeted mass prophylactic use of antiviral drugs as a containment strategy. Other interventions aimed at reducing population contact rates are also examined as reinforcements to an antiviral-based containment policy. We show that elimination of a nascent pandemic may be feasible using a combination of geographically targeted prophylaxis and social distancing measures, if the basic reproduction number of the new virus is below 1.8. We predict that a stockpile of 3 million courses of antiviral drugs should be sufficient for elimination. Policy effectiveness depends critically on how quickly clinical cases are diagnosed and the speed with which antiviral drugs can be distributed.
Ferguson
Neil M
NM
Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK. neil.ferguson@imperial.ac.uk
Cummings
Derek A T
DA
Cauchemez
Simon
S
Fraser
Christophe
C
Riley
Steven
S
Meeyai
Aronrag
A
Iamsirithaworn
Sopon
S
Burke
Donald S
DS
D017677:Age Distribution; D000818:Animals; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000600:supply & distribution / Q000627:therapeutic use; D001210:Asia, Southeastern / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods* / Q000592:standards; D003198:Computer Simulation; D016358:Contact Tracing; D006801:Humans; D009980:Influenza A virus / Q000145:classification / Q000235:genetics / Q000472:pathogenicity / Q000502:physiology; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D008954:Models, Biological; D009154:Mutation / Q000235:genetics; D011156:Population Density; D011336:Probability; D011790:Quarantine; D016865:Reassortant Viruses / Q000235:genetics / Q000472:pathogenicity / Q000502:physiology; D012680:Sensitivity and Specificity; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D014195:Travel; D014779:Virus Replication / Q000502:physiology; D017201:Virus Shedding / Q000502:physiology
D000998:Antiviral Agents