Abstract
BackgroundIndividual strategies in pandemic preparedness plans may not reduce the impact of an influenza pandemic.MethodsWe searched modeling publications through PubMed and associated references from 1990 to 30 September 2009. Inclusion criteria were modeling papers quantifying the effectiveness of combination strategies, both pharmaceutical and non-pharmaceutical.ResultsNineteen modeling papers on combination strategies were selected. Four studies examined combination strategies on a global scale, 14 on single countries, and one on a small community. Stochastic individual-based modeling was used in nine studies, stochastic meta-population modeling in five, and deterministic compartmental modeling in another five. As part of combination strategies, vaccination was explored in eight studies, antiviral prophylaxis and/or treatment in 16, area or household quarantine in eight, case isolation in six, social distancing measures in 10 and air travel restriction in six studies. Two studies suggested a high probability of successful influenza epicenter containment with combination strategies under favorable conditions. During a pandemic, combination strategies delayed spread, reduced overall number of cases, and delayed and reduced peak attack rate more than individual strategies. Combination strategies remained effective at high reproductive numbers compared with single strategy. Global cooperative strategies, including redistribution of antiviral drugs, were effective in reducing the global impact and attack rates of pandemic influenza.ConclusionCombination strategies increase the effectiveness of individual strategies. They include pharmaceutical (antiviral agents, antibiotics and vaccines) and non-pharmaceutical interventions (case isolation, quarantine, personal hygiene measures, social distancing and travel restriction). Local epidemiological and modeling studies are needed to validate efficacy and feasibility.
Highlights
Individual strategies in pandemic preparedness plans may not reduce the impact of an influenza pandemic
The remaining 18 studies were included for analysis, together with one additional study identified from the snowball searches (Figure 1)
If global antiviral stockpiles are limited, non-cooperative strategies where countries keep their antiviral stockpiles for their own use can only contain a pandemic influenza virus with reproductive number (Ro) less than 1.5; in contrast, if redistribution of 25% of stockpiles from countries that have them to countries that do not, a pandemic with Ro up to 1.9 may be contained, and overall attack rate (AR) reduced by 25% at higher Ro [12]
Summary
Individual strategies in pandemic preparedness plans may not reduce the impact of an influenza pandemic. Many countries have developed pandemic preparedness plans in response to the threat from pandemic influenza [1], to attempt containment of the virus or to reduce the pandemic's impact. To ensure the success of these plans, it is necessary to adopt a combination of different strategies. Mathematical models provide a platform for the assessment of multiple interventions in an environment where individual parameters can be altered. The recent increase in mathematical modeling studies on pandemic interventions suggests the effectiveness of these strategies and provides guidance for policy makers. This systematic review aims to determine the individual components that constitute combination strategies, and the quantitative impact of these combination strategies in reducing pandemic spread and morbidity
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