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Effective, robust design of community mitigation for pandemic influenza: a systematic examination of proposed US guidance.
PLoS One. 2008 Jul 02; 3(7):e2606.Plos

Abstract

BACKGROUND

The US government proposes pandemic influenza mitigation guidance that includes isolation and antiviral treatment of ill persons, voluntary household member quarantine and antiviral prophylaxis, social distancing of individuals, school closure, reduction of contacts at work, and prioritized vaccination. Is this the best strategy combination? Is choice of this strategy robust to pandemic uncertainties? What are critical enablers of community resilience?

METHODS AND FINDINGS

We systematically simulate a broad range of pandemic scenarios and mitigation strategies using a networked, agent-based model of a community of explicit, multiply-overlapping social contact networks. We evaluate illness and societal burden for alterations in social networks, illness parameters, or intervention implementation. For a 1918-like pandemic, the best strategy minimizes illness to <1% of the population and combines network-based (e.g. school closure, social distancing of all with adults' contacts at work reduced), and case-based measures (e.g. antiviral treatment of the ill and prophylaxis of household members). We find choice of this best strategy robust to removal of enhanced transmission by the young, additional complexity in contact networks, and altered influenza natural history including extended viral shedding. Administration of age-group or randomly targeted 50% effective pre-pandemic vaccine with 7% population coverage (current US H5N1 vaccine stockpile) had minimal effect on outcomes. In order, mitigation success depends on rapid strategy implementation, high compliance, regional mitigation, and rigorous rescinding criteria; these are the critical enablers for community resilience.

CONCLUSIONS

Systematic evaluation of feasible, recommended pandemic influenza interventions generally confirms the US community mitigation guidance yields best strategy choices for pandemic planning that are robust to a wide range of uncertainty. The best strategy combines network- and case-based interventions; network-based interventions are paramount. Because strategies must be applied rapidly, regionally, and stringently for greatest benefit, preparation and public education is required for long-lasting, high community compliance during a pandemic.

Authors+Show Affiliations

Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America. victoria.davey@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

18596963

Citation

Davey, Victoria J., et al. "Effective, Robust Design of Community Mitigation for Pandemic Influenza: a Systematic Examination of Proposed US Guidance." PloS One, vol. 3, no. 7, 2008, pp. e2606.
Davey VJ, Glass RJ, Min HJ, et al. Effective, robust design of community mitigation for pandemic influenza: a systematic examination of proposed US guidance. PLoS One. 2008;3(7):e2606.
Davey, V. J., Glass, R. J., Min, H. J., Beyeler, W. E., & Glass, L. M. (2008). Effective, robust design of community mitigation for pandemic influenza: a systematic examination of proposed US guidance. PloS One, 3(7), e2606. https://doi.org/10.1371/journal.pone.0002606
Davey VJ, et al. Effective, Robust Design of Community Mitigation for Pandemic Influenza: a Systematic Examination of Proposed US Guidance. PLoS One. 2008 Jul 2;3(7):e2606. PubMed PMID: 18596963.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effective, robust design of community mitigation for pandemic influenza: a systematic examination of proposed US guidance. AU - Davey,Victoria J, AU - Glass,Robert J, AU - Min,H Jason, AU - Beyeler,Walter E, AU - Glass,Laura M, Y1 - 2008/07/02/ PY - 2008/02/07/received PY - 2008/03/08/accepted PY - 2008/7/4/pubmed PY - 2008/10/23/medline PY - 2008/7/4/entrez SP - e2606 EP - e2606 JF - PloS one JO - PLoS One VL - 3 IS - 7 N2 - BACKGROUND: The US government proposes pandemic influenza mitigation guidance that includes isolation and antiviral treatment of ill persons, voluntary household member quarantine and antiviral prophylaxis, social distancing of individuals, school closure, reduction of contacts at work, and prioritized vaccination. Is this the best strategy combination? Is choice of this strategy robust to pandemic uncertainties? What are critical enablers of community resilience? METHODS AND FINDINGS: We systematically simulate a broad range of pandemic scenarios and mitigation strategies using a networked, agent-based model of a community of explicit, multiply-overlapping social contact networks. We evaluate illness and societal burden for alterations in social networks, illness parameters, or intervention implementation. For a 1918-like pandemic, the best strategy minimizes illness to <1% of the population and combines network-based (e.g. school closure, social distancing of all with adults' contacts at work reduced), and case-based measures (e.g. antiviral treatment of the ill and prophylaxis of household members). We find choice of this best strategy robust to removal of enhanced transmission by the young, additional complexity in contact networks, and altered influenza natural history including extended viral shedding. Administration of age-group or randomly targeted 50% effective pre-pandemic vaccine with 7% population coverage (current US H5N1 vaccine stockpile) had minimal effect on outcomes. In order, mitigation success depends on rapid strategy implementation, high compliance, regional mitigation, and rigorous rescinding criteria; these are the critical enablers for community resilience. CONCLUSIONS: Systematic evaluation of feasible, recommended pandemic influenza interventions generally confirms the US community mitigation guidance yields best strategy choices for pandemic planning that are robust to a wide range of uncertainty. The best strategy combines network- and case-based interventions; network-based interventions are paramount. Because strategies must be applied rapidly, regionally, and stringently for greatest benefit, preparation and public education is required for long-lasting, high community compliance during a pandemic. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/18596963/Effective_robust_design_of_community_mitigation_for_pandemic_influenza:_a_systematic_examination_of_proposed_US_guidance_ L2 - https://dx.plos.org/10.1371/journal.pone.0002606 DB - PRIME DP - Unbound Medicine ER -