title: Influenza H3N2 variant viruses with pandemic potential: preventing catastrophe in remote and isolated Canadian communities.
abstract: OBJECTIVE
  To evaluate the impact of age-specific cross-reactive antibody protection levels on the outcomes of a pandemic outbreak of new variants of H3N2 influenza A viruses (H3N2v).
  
  
  METHODS
  We calibrated a previously validated agent-based model of human-to-human transmission of influenza viruses to project the outcomes of various protection levels in a remote and isolated Canadian community, when demographics are drawn from the Statistics Canada census data. We then compared the outcomes with a scenario in which demographic variables were shifted to resemble an urban structure. This comparative evaluation was conducted using in-silico computer simulations, where the epidemiological data were drawn from relevant estimates in published literature.
  
  
  RESULTS
  Simulations, using estimates of transmissibility for the 2009 H1N1 pandemic strain in the study population, show that the epidemic size is primarily affected by the cross-reactive protection levels of young children. A lower number of secondary infections at the early stages of an outbreak does not necessarily correspond to a lower epidemic size.
  
  
  CONCLUSIONS
  Demographic variables could play a significant role in determining the outcomes of an outbreak. The findings strongly suggest that, when an H3N2v-specific vaccine becomes available, children below the age of 17 should be prioritized for vaccination. This prioritization is essential in population settings with a low average age, including aboriginal communities in northern latitudes.
authors.affiliation: Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada.
authors.forename: Marek
authors.initials: M
authors.lastname: Laskowski
authors.forename: Venkata R
authors.initials: VR
authors.lastname: Duvvuri
authors.forename: David L
authors.initials: DL
authors.lastname: Buckeridge
authors.forename: Gillian
authors.initials: G
authors.lastname: Wu
authors.forename: Jianhong
authors.initials: J
authors.lastname: Wu
authors.forename: Seyed M
authors.initials: SM
authors.lastname: Moghadas
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D056738:Cross Protection; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D053122:Influenza A Virus, H3N2 Subtype; D007251:Influenza, Human / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D058873:Pandemics / Q000517:prevention & control*; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult
keywords: Agent-based modeling; Cross-reactive antibody protection; Pandemic influenza; Remote and isolated communities; Vaccination