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Rescinding community mitigation strategies in an influenza pandemic.

ABSTRACT: Using a networked, agent-based computational model of a stylized community, we evaluated thresholds for rescinding 2 community mitigation strategies after an influenza pandemic. We ended child sequestering or all-community sequestering when illness incidence waned to thresholds of 0, 1, 2, or 3 cases in 7 days in 2 levels of pandemic severity. An unmitigated epidemic or strategy continuation for the epidemic duration served as control scenarios. The 0-case per 7-day rescinding threshold was comparable to the continuation strategy on infection and illness rates but reduced the number of days strategies would be needed by 6% to 32% in mild or severe pandemics. If cases recurred, strategies were resumed at a predefined 10-case trigger, and epidemic recurrence was thwarted. Strategies were most effective when used with high compliance and when combined with stringent rescinding thresholds. The need for strategies implemented for control of an influenza pandemic was reduced, without increasing illness rates.

SUBMITTER: Davey VJ

PROVIDER: S-EPMC2570828 | biostudies-literature | 2008 Mar

REPOSITORIES: biostudies-literature

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Rescinding community mitigation strategies in an influenza pandemic.

Davey Victoria J VJ Glass Robert J RJ

Emerging infectious diseases 20080301 3

Using a networked, agent-based computational model of a stylized community, we evaluated thresholds for rescinding 2 community mitigation strategies after an influenza pandemic. We ended child sequestering or all-community sequestering when illness incidence waned to thresholds of 0, 1, 2, or 3 cases in 7 days in 2 levels of pandemic severity. An unmitigated epidemic or strategy continuation for the epidemic duration served as control scenarios. The 0-case per 7-day rescinding threshold was comp ...[more]

PMID: 18325247

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Project description:BackgroundThe threat of emergence of a human-to-human transmissible strain of highly pathogenic influenza A(H5N1) is very real, and is reinforced by recent results showing that genetically modified A(H5N1) may be readily transmitted between ferrets. Public health authorities are hesitant in introducing social distancing interventions due to societal disruption and productivity losses. This study estimates the effectiveness and total cost (from a societal perspective, with a lifespan time horizon) of a comprehensive range of social distancing and antiviral drug strategies, under a range of pandemic severity categories.MethodsAn economic analysis was conducted using a simulation model of a community of ~30,000 in Australia. Data from the 2009 pandemic was used to derive relationships between the Case Fatality Rate (CFR) and hospitalization rates for each of five pandemic severity categories, with CFR ranging from 0.1% to 2.5%.ResultsFor a pandemic with basic reproduction number R0 = 1.8, adopting no interventions resulted in total costs ranging from $441 per person for a pandemic at category 1 (CFR 0.1%) to $8,550 per person at category 5 (CFR 2.5%). For severe pandemics of category 3 (CFR 0.75%) and greater, a strategy combining antiviral treatment and prophylaxis, extended school closure and community contact reduction resulted in the lowest total cost of any strategy, costing $1,584 per person at category 5. This strategy was highly effective, reducing the attack rate to 5%. With low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, whereas higher severity pandemic costs are dominated by healthcare costs and costs arising from productivity losses due to death.ConclusionsFor pandemics in high severity categories the strategies with the lowest total cost to society involve rigorous, sustained social distancing, which are considered unacceptable for low severity pandemics due to societal disruption and cost.

Project description:Mitigation of a severe influenza pandemic can be achieved using a range of interventions to reduce transmission. Interventions can reduce the impact of an outbreak and buy time until vaccines are developed, but they may have high social and economic costs. The non-linear effect on the epidemic dynamics means that suitable strategies crucially depend on the precise aim of the intervention. National pandemic influenza plans rarely contain clear statements of policy objectives or prioritization of potentially conflicting aims, such as minimizing mortality (depending on the severity of a pandemic) or peak prevalence or limiting the socio-economic burden of contact-reducing interventions. We use epidemiological models of influenza A to investigate how contact-reducing interventions and availability of antiviral drugs or pre-pandemic vaccines contribute to achieving particular policy objectives. Our analyses show that the ideal strategy depends on the aim of an intervention and that the achievement of one policy objective may preclude success with others, e.g., constraining peak demand for public health resources may lengthen the duration of the epidemic and hence its economic and social impact. Constraining total case numbers can be achieved by a range of strategies, whereas strategies which additionally constrain peak demand for services require a more sophisticated intervention. If, for example, there are multiple objectives which must be achieved prior to the availability of a pandemic vaccine (i.e., a time-limited intervention), our analysis shows that interventions should be implemented several weeks into the epidemic, not at the very start. This observation is shown to be robust across a range of constraints and for uncertainty in estimates of both R(0) and the timing of vaccine availability. These analyses highlight the need for more precise statements of policy objectives and their assumed consequences when planning and implementing strategies to mitigate the impact of an influenza pandemic.

Project description:BackgroundThe 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 findingsWe 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.ConclusionsSystematic 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.

Project description:IntroductionCommunity mitigation strategies (CMS) have demonstrated to be effective in the reduction of transmission and incidence of COVID-19, especially in the population with symptoms associated with the disease. The aim of this study was to evaluate the association between the presence of COVID-19 symptoms and adherence to CMS in Latin American adults.MethodsWe carried out a secondary analysis of a database developed by the University of Maryland and Facebook social network during the COVID-19 pandemic. We included Latin American adults that used the Facebook platform and participated in a survey conducted from April 23 to May 23, 2020. The principal outcome variable was reported compliance with the three main CMS (physical distancing, use of face masks, and hand washing). The exposure variable included symptoms suspicious for COVID-19 defined as the presence of three or more symptoms of an acute clinical case of COVID-19. We performed generalized linear models of the Poisson family with a logarithmic link function to evaluate the association between the presence of COVID-19 symptoms and reported compliance with CMS. We calculated crude and adjusted prevalence ratios (PR) with their 95% confidence intervals (95%CI).ResultsWe analyzed 1,310,690 adults from Latin America; 48.1% were male and 42.9% were under 35 years of age. The prevalence of suspicious symptoms of COVID-19 was 18.5% and reported compliance with the three CMS was 45.3%. The countries with the highest proportion of reported compliance with the three CMS were Peru, Bolivia and Panama, while those with the lowest reported compliance were Costa Rica, Nicaragua and Honduras. In the adjusted model, people with suspicious symptoms for COVID-19 had a 14% lower compliance with the three CMS (aPR = 0.86; 95%CI: 0.85-0.87; p < 0.001).ConclusionsLess than half of the participants complied with the CMS, and those presenting suspicious symptoms for COVID-19 had lower reported compliance with the three CMS.

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Rescinding community mitigation strategies in an influenza pandemic.

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Rescinding community mitigation strategies in an influenza pandemic.

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