Abstract
BackgroundMany nations maintain stockpiles of neuraminidase inhibitor (NAI) antiviral agents for use in influenza pandemics to reduce transmission and mitigate the course of clinical infection. Pandemic preparedness plans include the use of these stockpiles to deliver proportionate responses, informed by emerging evidence of clinical impact. Recent uncertainty about the effectiveness of NAIs has prompted these nations to reconsider the role of NAIs in pandemic response, with implications for pandemic planning and for NAI stockpile size.MethodsWe combined a dynamic model of influenza epidemiology with a model of the clinical care pathways in the Australian health care system to identify effective NAI strategies for reducing morbidity and mortality in pandemic events, and the stockpile requirements for these strategies. The models were informed by a 2015 assessment of NAI effectiveness against susceptibility, pathogenicity, and transmission of influenza.ResultsLiberal distribution of NAIs for early treatment in outpatient settings yielded the greatest benefits in all of the considered scenarios. Restriction of community-based treatment to risk groups was effective in those groups, but failed to prevent the large proportion of cases arising from lower risk individuals who comprise the majority of the population.ConclusionsThese targeted strategies are only effective if they can be deployed within the constraints of existing health care infrastructure. This finding highlights the critical importance of identifying optimal models of care delivery for effective emergency health care response.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1866-7) contains supplementary material, which is available to authorized users.
Highlights
Many nations maintain stockpiles of neuraminidase inhibitor (NAI) antiviral agents for use in influenza pandemics to reduce transmission and mitigate the course of clinical infection
This design allows us to account for uncertainty in the precise nature of the epidemic itself, in the early estimates of transmissibility and severity obtained during initial action, in the effectiveness of NAIs to reduce susceptibility, pathogenicity, and transmission, in logistic capacities that limit NAI distribution, and in population compliance
NAI treatment strategies can substantially reduce the number of deaths in even the most severe pandemic scenarios where hospital bed capacities are substantially overwhelmed for many weeks, assuming that antivirals can continue to be delivered in a timely and effective manner
Summary
Many nations maintain stockpiles of neuraminidase inhibitor (NAI) antiviral agents for use in influenza pandemics to reduce transmission and mitigate the course of clinical infection. Many developed nations maintain stockpiles of neuraminidase inhibitor (NAI) antiviral agents for use in the event of an influenza pandemic, and have developed management plans for using these stockpiles to deliver a proportionate response, informed by emerging evidence of likely clinical impact. The focus has shifted from using NAIs for containment (e.g., limiting transmission until vaccines become available) to using them to mitigate complications and population impact In these scenarios, where pharmaceutical interventions are likely unable to reduce transmission, evidence supports some degree of clinical effectiveness against complications and death [9] and indicates that early administration of NAIs to reduce hospitalisations, severe outcomes and death is an appropriate strategy [10]. The benefits of such treatment appear greatest in individuals with underlying risk conditions [10]
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