title: Containing pandemic influenza at the source.
abstract: Highly pathogenic avian influenza A (subtype H5N1) is threatening to cause a human pandemic of potentially devastating proportions. We used a stochastic influenza simulation model for rural Southeast Asia to investigate the effectiveness of targeted antiviral prophylaxis, quarantine, and pre-vaccination in containing an emerging influenza strain at the source. If the basic reproductive number (R0) was below 1.60, our simulations showed that a prepared response with targeted antivirals would have a high probability of containing the disease. In that case, an antiviral agent stockpile on the order of 100,000 to 1 million courses for treatment and prophylaxis would be sufficient. If pre-vaccination occurred, then targeted antiviral prophylaxis could be effective for containing strains with an R0 as high as 2.1. Combinations of targeted antiviral prophylaxis, pre-vaccination, and quarantine could contain strains with an R(0) as high as 2.4.
authors.affiliation: Department of Biostatistics, The Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, USA. longini@sph.emory.edu
authors.forename: Ira M
authors.initials: IM
authors.lastname: Longini
authors.forename: Azhar
authors.initials: A
authors.lastname: Nizam
authors.forename: Shufu
authors.initials: S
authors.lastname: Xu
authors.forename: Kumnuan
authors.initials: K
authors.lastname: Ungchusak
authors.forename: Wanna
authors.initials: W
authors.lastname: Hanshaoworakul
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Halloran
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001210:Asia, Southeastern / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D009980:Influenza A virus / Q000276:immunology; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D015233:Models, Statistical; D011790:Quarantine; D013269:Stochastic Processes; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D014611:Vaccination
chemical_list: D000998:Antiviral Agents; D007252:Influenza Vaccines