title: Preparedness for pandemics: does variation among states affect the nation as a whole?
abstract: OBJECTIVE
  Since states' public health systems differ as to pandemic preparedness, this study explored whether such heterogeneity among states could affect the nation's overall influenza rate.
  
  
  METHODS
  The Centers for Disease Control and Prevention produced a uniform set of scores on a 100-point scale from its 2008 national evaluation of state preparedness to distribute materiel from the Strategic National Stockpile (SNS). This study used these SNS scores to represent each state's relative preparedness to distribute influenza vaccine in a timely manner and assumed that "optimal" vaccine distribution would reach at least 35% of the state's population within 4 weeks. The scores were used to determine the timing of vaccine distribution for each state: each 10-point decrement of score below 90 added an additional delay increment to the distribution time.
  
  
  METHODS
  A large-scale agent-based computational model simulated an influenza pandemic in the US population. In this synthetic population each individual or agent had an assigned household, age, workplace or school destination, daily commute, and domestic intercity air travel patterns.
  
  
  METHODS
  Simulations compared influenza case rates both nationally and at the state level under 3 scenarios: no vaccine distribution (baseline), optimal vaccine distribution in all states, and vaccine distribution time modified according to state-specific SNS score.
  
  
  RESULTS
  Between optimal and SNS-modified scenarios, attack rates rose not only in low-scoring states but also in high-scoring states, demonstrating an interstate spread of infections. Influenza rates were sensitive to variation of the SNS-modified scenario (delay increments of 1 day versus 5 days), but the interstate effect remained.
  
  
  CONCLUSIONS
  The effectiveness of a response activity such as vaccine distribution could benefit from national standards and preparedness funding allocated in part to minimize interstate disparities.
authors.affiliation: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. mapotter@pitt.edu
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Potter
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Grefenstette
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Keane
authors.forename: Chyongchiou J
authors.initials: CJ
authors.lastname: Lin
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Quinn
authors.forename: Samuel
authors.initials: S
authors.lastname: Stebbins
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Sweeney
authors.forename: Donald S
authors.initials: DS
authors.lastname: Burke
mesh_terms: D002959:Civil Defense; D003198:Computer Simulation; D006801:Humans; D007252:Influenza Vaccines / Q000600:supply & distribution*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D058873:Pandemics; D013219:State Government; D014481:United States / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines