Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.

In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In add...

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Autores principales:	Nedialko B Dimitrov, Sebastian Goll, Nathaniel Hupert, Babak Pourbohloul, Lauren Ancel Meyers
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5aeda352fb2f45fbb672acc4a1d92867
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spelling	oai:doaj.org-article:5aeda352fb2f45fbb672acc4a1d928672021-11-18T07:00:18ZOptimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.1932-620310.1371/journal.pone.0016094https://doaj.org/article/5aeda352fb2f45fbb672acc4a1d928672011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21283514/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In addition, aggressive antiviral treatment was recommended for certain patient subgroups to reduce the severity and duration of symptoms. To assist States and other localities meet these needs, the U.S. Government distributed a quarter of the antiviral medications in the Strategic National Stockpile within weeks of the pandemic's start. However, there are no quantitative models guiding the geo-temporal distribution of the remainder of the Stockpile in relation to pandemic spread or severity. We present a tactical optimization model for distributing this stockpile for treatment of infected cases during the early stages of a pandemic like 2009 pH1N1, prior to the wide availability of a strain-specific vaccine. Our optimization method efficiently searches large sets of intervention strategies applied to a stochastic network model of pandemic influenza transmission within and among U.S. cities. The resulting optimized strategies depend on the transmissability of the virus and postulated rates of antiviral uptake and wastage (through misallocation or loss). Our results suggest that an aggressive community-based antiviral treatment strategy involving early, widespread, pro-rata distribution of antivirals to States can contribute to slowing the transmission of mildly transmissible strains, like pH1N1. For more highly transmissible strains, outcomes of antiviral use are more heavily impacted by choice of distribution intervals, quantities per shipment, and timing of shipments in relation to pandemic spread. This study supports previous modeling results suggesting that appropriate antiviral treatment may be an effective mitigation strategy during the early stages of future influenza pandemics, increasing the need for systematic efforts to optimize distribution strategies and provide tactical guidance for public health policy-makers.Nedialko B DimitrovSebastian GollNathaniel HupertBabak PourbohloulLauren Ancel MeyersPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 1, p e16094 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Nedialko B Dimitrov Sebastian Goll Nathaniel Hupert Babak Pourbohloul Lauren Ancel Meyers Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
description	In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In addition, aggressive antiviral treatment was recommended for certain patient subgroups to reduce the severity and duration of symptoms. To assist States and other localities meet these needs, the U.S. Government distributed a quarter of the antiviral medications in the Strategic National Stockpile within weeks of the pandemic's start. However, there are no quantitative models guiding the geo-temporal distribution of the remainder of the Stockpile in relation to pandemic spread or severity. We present a tactical optimization model for distributing this stockpile for treatment of infected cases during the early stages of a pandemic like 2009 pH1N1, prior to the wide availability of a strain-specific vaccine. Our optimization method efficiently searches large sets of intervention strategies applied to a stochastic network model of pandemic influenza transmission within and among U.S. cities. The resulting optimized strategies depend on the transmissability of the virus and postulated rates of antiviral uptake and wastage (through misallocation or loss). Our results suggest that an aggressive community-based antiviral treatment strategy involving early, widespread, pro-rata distribution of antivirals to States can contribute to slowing the transmission of mildly transmissible strains, like pH1N1. For more highly transmissible strains, outcomes of antiviral use are more heavily impacted by choice of distribution intervals, quantities per shipment, and timing of shipments in relation to pandemic spread. This study supports previous modeling results suggesting that appropriate antiviral treatment may be an effective mitigation strategy during the early stages of future influenza pandemics, increasing the need for systematic efforts to optimize distribution strategies and provide tactical guidance for public health policy-makers.
format	article
author	Nedialko B Dimitrov Sebastian Goll Nathaniel Hupert Babak Pourbohloul Lauren Ancel Meyers
author_facet	Nedialko B Dimitrov Sebastian Goll Nathaniel Hupert Babak Pourbohloul Lauren Ancel Meyers
author_sort	Nedialko B Dimitrov
title	Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
title_short	Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
title_full	Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
title_fullStr	Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
title_full_unstemmed	Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.
title_sort	optimizing tactics for use of the u.s. antiviral strategic national stockpile for pandemic influenza.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/5aeda352fb2f45fbb672acc4a1d92867
work_keys_str_mv	AT nedialkobdimitrov optimizingtacticsforuseoftheusantiviralstrategicnationalstockpileforpandemicinfluenza AT sebastiangoll optimizingtacticsforuseoftheusantiviralstrategicnationalstockpileforpandemicinfluenza AT nathanielhupert optimizingtacticsforuseoftheusantiviralstrategicnationalstockpileforpandemicinfluenza AT babakpourbohloul optimizingtacticsforuseoftheusantiviralstrategicnationalstockpileforpandemicinfluenza AT laurenancelmeyers optimizingtacticsforuseoftheusantiviralstrategicnationalstockpileforpandemicinfluenza
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Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic influenza.

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