Health and economic benefits of early vaccination and nonpharmaceutical interventions for a human influenza A (H7N9) pandemic: a modeling study.
BACKGROUND
Vaccination for the 2009 pandemic did not occur until late in the outbreak, which limited its benefits. Influenza A (H7N9) is causing increasing morbidity and mortality in China, and researchers have modified the A (H5N1) virus to transmit via aerosol, which again heightens concerns about pandemic influenza preparedness.


OBJECTIVE
To determine how quickly vaccination should be completed to reduce infections, deaths, and health care costs in a pandemic with characteristics similar to influenza A (H7N9) and A (H5N1).


METHODS
Dynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.


METHODS
Literature and expert opinion.


METHODS
Residents of a U.S. metropolitan city with characteristics similar to New York City.


METHODS
Lifetime.


CONCLUSIONS
Societal.


METHODS
Vaccination of 30% of the population at 4 or 6 months.


METHODS
Infections and deaths averted and cost-effectiveness.


RESULTS
In 12 months, 48 254 persons would die. Vaccinating at 9 months would avert 2365 of these deaths. Vaccinating at 6 months would save 5775 additional lives and $51 million at a city level. Accelerating delivery to 4 months would save an additional 5633 lives and $50 million.


RESULTS
If vaccination were delayed for 9 months, reducing contacts by 8% through nonpharmaceutical interventions would yield a similar reduction in infections and deaths as vaccination at 4 months.


CONCLUSIONS
The model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.


CONCLUSIONS
Vaccination in an influenza A (H7N9) pandemic would need to be completed much faster than in 2009 to substantially reduce morbidity, mortality, and health care costs. Maximizing non-pharmaceutical interventions can substantially mitigate the pandemic until a matched vaccine becomes available.


BACKGROUND
Agency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.
Nayer
N
Khazeni
David W
DW
Hutton
Cassandra I F
CI
Collins
Alan M
AM
Garber
Douglas K
DK
Owens
D002947:Cities; D003362:Cost-Benefit Analysis; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D006920:Hygiene; D064766:Influenza A Virus, H7N9 Subtype; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000191:economics; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D008962:Models, Theoretical; D009010:Monte Carlo Method; D058873:Pandemics / Q000517:prevention & control*; D010356:Patient Isolation
D007252:Influenza Vaccines