Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.

<h4>Background</h4>Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies inf...

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Autores principales:	Robert Moss, James M McCaw, Jodie McVernon
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/991c8f7ca1d440ba9320c98969296a86
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spelling	oai:doaj.org-article:991c8f7ca1d440ba9320c98969296a862021-11-18T06:59:11ZDiagnosis and antiviral intervention strategies for mitigating an influenza epidemic.1932-620310.1371/journal.pone.0014505https://doaj.org/article/991c8f7ca1d440ba9320c98969296a862011-02-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21346794/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies informed recommendations for liberal antiviral distribution in the pandemic phase, primarily to prevent infection, but failed to account for logistical constraints clearly evident during the 2009 H1N1 outbreaks. Here we identify optimal delivery strategies for antiviral interventions accounting for logistical constraints, and so determine how to improve a strategy's impact.<h4>Methods and findings</h4>We extend an existing SEIR model to incorporate finite diagnostic and antiviral distribution capacities. We evaluate the impact of using different diagnostic strategies to decide to whom antivirals are delivered. We then determine what additional capacity is required to achieve optimal impact. We identify the importance of sensitive and specific case ascertainment in the early phase of a pandemic response, when the proportion of false-positive presentations may be high. Once a substantial percentage of ILI presentations are caused by the pandemic strain, identification of cases for treatment on syndromic grounds alone results in a greater potential impact than a laboratory-dependent strategy. Our findings reinforce the need for a decentralised system capable of providing timely prophylaxis.<h4>Conclusions</h4>We address specific real-world issues that must be considered in order to improve pandemic preparedness policy in a practical and methodologically sound way. Provision of antivirals on the scale proposed for an effective response is infeasible using traditional public health outbreak management and contact tracing approaches. The results indicate to change the transmission dynamics of an influenza epidemic with an antiviral intervention, a decentralised system is required for contact identification and prophylaxis delivery, utilising a range of existing services and infrastructure in a "whole of society" response.Robert MossJames M McCawJodie McVernonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 2, p e14505 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Robert Moss James M McCaw Jodie McVernon Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
description	<h4>Background</h4>Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies informed recommendations for liberal antiviral distribution in the pandemic phase, primarily to prevent infection, but failed to account for logistical constraints clearly evident during the 2009 H1N1 outbreaks. Here we identify optimal delivery strategies for antiviral interventions accounting for logistical constraints, and so determine how to improve a strategy's impact.<h4>Methods and findings</h4>We extend an existing SEIR model to incorporate finite diagnostic and antiviral distribution capacities. We evaluate the impact of using different diagnostic strategies to decide to whom antivirals are delivered. We then determine what additional capacity is required to achieve optimal impact. We identify the importance of sensitive and specific case ascertainment in the early phase of a pandemic response, when the proportion of false-positive presentations may be high. Once a substantial percentage of ILI presentations are caused by the pandemic strain, identification of cases for treatment on syndromic grounds alone results in a greater potential impact than a laboratory-dependent strategy. Our findings reinforce the need for a decentralised system capable of providing timely prophylaxis.<h4>Conclusions</h4>We address specific real-world issues that must be considered in order to improve pandemic preparedness policy in a practical and methodologically sound way. Provision of antivirals on the scale proposed for an effective response is infeasible using traditional public health outbreak management and contact tracing approaches. The results indicate to change the transmission dynamics of an influenza epidemic with an antiviral intervention, a decentralised system is required for contact identification and prophylaxis delivery, utilising a range of existing services and infrastructure in a "whole of society" response.
format	article
author	Robert Moss James M McCaw Jodie McVernon
author_facet	Robert Moss James M McCaw Jodie McVernon
author_sort	Robert Moss
title	Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
title_short	Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
title_full	Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
title_fullStr	Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
title_full_unstemmed	Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
title_sort	diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/991c8f7ca1d440ba9320c98969296a86
work_keys_str_mv	AT robertmoss diagnosisandantiviralinterventionstrategiesformitigatinganinfluenzaepidemic AT jamesmmccaw diagnosisandantiviralinterventionstrategiesformitigatinganinfluenzaepidemic AT jodiemcvernon diagnosisandantiviralinterventionstrategiesformitigatinganinfluenzaepidemic
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Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.

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