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Epidemiology: The best way to tackle a flu pandemic (AOP)
DOI: 10.1038/nature04795
Rapid treatment and isolation of not just infected cases but also their household contacts will be the key elements of an effective strategy to beat a future influenza pandemic, report researchers who have simulated the spread of such an outbreak in both Great Britain and the United States. Vaccine stockpiles should also be gathered in readiness for a pandemic, the research suggests, even if the vaccine has low efficacy. But border controls and travel restrictions will only significantly slow the outbreak if they are enforced with virtually no exceptions, the simulations show.
Neil Ferguson and colleagues used state-of-the-art computer models to evaluate the influence of a range of anti-pandemic measures, such as treatment and prophylaxis with antiviral drugs, household quarantine, vaccination and restrictions on travel. They show that with a policy of giving antiviral drugs both as treatment to infected cases and prophylactically to their families coupled with early closure of schools hit by the outbreak, rates of disease could be cut by nearly half. However, for this policy to be feasible, antiviral stockpiles would need to be sufficient to treat 50% of the population — twice what many countries are planning. Combining such a policy with targeted immunization of children with a stockpiled trial vaccine might reduce illness rates by two-thirds, even if the vaccine was not particularly effective in its protection. Even greater drug coverage would have a correspondingly larger protective impact, the researchers report in their study published online by Nature.
The calculations apply to a 'typical' strain of human influenza. But a virus that causes a more prolonged and severe disease — as the H5N1 avian influenza virus might if it mutates into a human form — might be easier to control, the authors say. This is because the generation time for a pandemic would possibly be longer, giving more time to react.
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