Abstract
BackgroundAs seen during past pandemic influenza outbreaks, pharmaceutical interventions (PHIs) with vaccines and antivirals are the most effective methods of mitigation. However, availability of PHIs is unlikely to be adequate during the early stages of a pandemic. Hence, for early mitigation and possible containment, non-pharmaceutical interventions (NPIs) offer a viable alternative. Also, NPIs may be the only available interventions for most underdeveloped countries. In this paper we present a comprehensive methodology for design of effective NPI strategies.MethodsWe develop a statistical ANOVA-based design approach that uses a detailed agent-based simulation as an underlying model. The design approach obtains the marginal effect of the characteristic parameters of NPIs, social behavior, and their interactions on various pandemic outcome measures including total number of contacts, infections, and deaths. We use the marginal effects to establish regression equations for the outcome measures, which are optimized to obtain NPI strategies. Efficacy of the NPI strategies designed using our methodology is demonstrated using simulated pandemic influenza outbreaks with different levels of virus transmissibility.ResultsOur methodology was able to design effective NPI strategies, which were able to contain outbreaks by reducing infection attack rates (IAR) to below 10% in low and medium virus transmissibility scenarios with 33% and 50% IAR, respectively. The level of reduction in the high transmissibility scenario (with 65% IAR) was also significant. As noted in the published literature, we also found school closure to be the single most effective intervention among all NPIs.ConclusionsIf harnessed effectively, NPIs offer a significant potential for mitigation of pandemic influenza outbreaks. The methodology presented here fills a gap in the literature, which, though replete with models on NPI strategy evaluation, lacks a treatise on optimal strategy design.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1328) contains supplementary material, which is available to authorized users.
Highlights
As seen during past pandemic influenza outbreaks, pharmaceutical interventions (PHIs) with vaccines and antivirals are the most effective methods of mitigation
We demonstrate the efficacy of the design approach on simulated outbreaks of pandemic influenza with different levels of virus transmissibility
Using a statistical experimental design approach, we examined the influence of some of the characteristic parameters of virus epidemiology, social behavior, and non-pharmaceutical interventions on various measures of pandemic impact, such as total number of infected and total number of deaths in various age groups
Summary
As seen during past pandemic influenza outbreaks, pharmaceutical interventions (PHIs) with vaccines and antivirals are the most effective methods of mitigation. Availability of PHIs is unlikely to be adequate during the early stages of a pandemic. For early mitigation and possible containment, non-pharmaceutical interventions (NPIs) offer a viable alternative. NPIs may be the only available interventions for most underdeveloped countries. In the absence of any control measures, it was estimated that it could cause around 200,000 deaths, 700,000 hospitalizations, 42 million outpatient visits, and an economic impact ranging between $71.3 and $166.5 billion in the. A potent influenza pandemic emergency crisis would likely last much longer than most other emergency events, and the resources needed to address the crisis such as supplies of vaccines, antiviral drugs, healthcare providers, hospital beds and medical supplies would be limited. The most notorious ones being the avian influenza or bird flu, H5N1 and H7N9
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