title: Influenza pandemic intervention planning using InfluSim: pharmaceutical and non- pharmaceutical interventions.
abstract: BACKGROUND
  Influenza pandemic preparedness plans are currently developed and refined on national and international levels. Much attention has been given to the administration of antiviral drugs, but contact reduction can also be an effective part of mitigation strategies and has the advantage to be not limited per se. The effectiveness of these interventions depends on various factors which must be explored by sensitivity analyses, based on mathematical models.
  
  
  METHODS
  We use the freely available planning tool InfluSim to investigate how pharmaceutical and non-pharmaceutical interventions can mitigate an influenza pandemic. In particular, we examine how intervention schedules, restricted stockpiles and contact reduction (social distancing measures and isolation of cases) determine the course of a pandemic wave and the success of interventions.
  
  
  RESULTS
  A timely application of antiviral drugs combined with a quick implementation of contact reduction measures is required to substantially protract the peak of the epidemic and reduce its height. Delays in the initiation of antiviral treatment (e.g. because of parsimonious use of a limited stockpile) result in much more pessimistic outcomes and can even lead to the paradoxical effect that the stockpile is depleted earlier compared to early distribution of antiviral drugs.
  
  
  CONCLUSIONS
  Pharmaceutical and non-pharmaceutical measures should not be used exclusively. The protraction of the pandemic wave is essential to win time while waiting for vaccine development and production. However, it is the height of the peak of an epidemic which can easily overtax general practitioners, hospitals or even whole public health systems, causing bottlenecks in basic and emergency medical care.
authors.affiliation: Department of Medical Biometry, University of Tübingen, Germany. hans-peter.duerr@uni-tuebingen.de <hans-peter.duerr@uni-tuebingen.de>
authors.forename: Hans P
authors.initials: HP
authors.lastname: Duerr
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Brockmann
authors.forename: Isolde
authors.initials: I
authors.lastname: Piechotowski
authors.forename: Markus
authors.initials: M
authors.lastname: Schwehm
authors.forename: Martin
authors.initials: M
authors.lastname: Eichner
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods; D004196:Disease Outbreaks / Q000517:prevention & control*; D006285:Health Planning / Q000379:methods*; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D008962:Models, Theoretical; D011634:Public Health / Q000379:methods
chemical_list: D000998:Antiviral Agents