Age-prioritized use of antivirals during an influenza pandemic
Identifieur interne : 000C54 ( Pmc/Checkpoint ); précédent : 000C53; suivant : 000C55Age-prioritized use of antivirals during an influenza pandemic
Auteurs : Stefano Merler [Italie] ; Marco Ajelli [Italie] ; Caterina Rizzo [Italie]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2009.
Abstract
The WHO suggested that governments stockpile, as part of preparations for the next influenza pandemic, sufficient influenza antiviral drugs to treat approximately 25% of their populations. Our aim is two-fold: first, since in many countries the antiviral stockpile is well below this level, we search for suboptimal strategies based on treatment provided only to an age-dependent fraction of cases. Second, since in some countries the stockpile exceeds the suggested minimum level, we search for optimal strategies for post-exposure prophylactic treatment of close contacts of cases.
We used a stochastic, spatially structured individual-based model, considering explicit transmission in households, schools and workplaces, to simulate the spatiotemporal spread of an influenza pandemic in Italy and to evaluate the efficacy of interventions based on age-prioritized use of antivirals.
Our results show that the antiviral stockpile required for treatment of cases ranges from 10% to 35% of the population for
Our results strongly suggest that governments stockpile sufficient influenza antiviral drugs to treat approximately 25% of their populations, under the assumption that
Url:
DOI: 10.1186/1471-2334-9-117
PubMed: 19638194
PubMed Central: 2728723
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Age-prioritized use of antivirals during an influenza pandemic</title><author><name sortKey="Merler, Stefano" sort="Merler, Stefano" uniqKey="Merler S" first="Stefano" last="Merler">Stefano Merler</name><affiliation wicri:level="1"><nlm:aff id="I1">Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento</wicri:regionArea><wicri:noRegion>Trento</wicri:noRegion></affiliation></author><author><name sortKey="Ajelli, Marco" sort="Ajelli, Marco" uniqKey="Ajelli M" first="Marco" last="Ajelli">Marco Ajelli</name><affiliation wicri:level="1"><nlm:aff id="I1">Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento</wicri:regionArea><wicri:noRegion>Trento</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Information Engineering and Computer Science Department, University of Trento, Trento, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Information Engineering and Computer Science Department, University of Trento, Trento</wicri:regionArea><wicri:noRegion>Trento</wicri:noRegion></affiliation></author><author><name sortKey="Rizzo, Caterina" sort="Rizzo, Caterina" uniqKey="Rizzo C" first="Caterina" last="Rizzo">Caterina Rizzo</name><affiliation wicri:level="3"><nlm:aff id="I3">National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19638194</idno><idno type="pmc">2728723</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728723</idno><idno type="RBID">PMC:2728723</idno><idno type="doi">10.1186/1471-2334-9-117</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000923</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000923</idno><idno type="wicri:Area/Pmc/Curation">000923</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000923</idno><idno type="wicri:Area/Pmc/Checkpoint">000C54</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000C54</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Age-prioritized use of antivirals during an influenza pandemic</title><author><name sortKey="Merler, Stefano" sort="Merler, Stefano" uniqKey="Merler S" first="Stefano" last="Merler">Stefano Merler</name><affiliation wicri:level="1"><nlm:aff id="I1">Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento</wicri:regionArea><wicri:noRegion>Trento</wicri:noRegion></affiliation></author><author><name sortKey="Ajelli, Marco" sort="Ajelli, Marco" uniqKey="Ajelli M" first="Marco" last="Ajelli">Marco Ajelli</name><affiliation wicri:level="1"><nlm:aff id="I1">Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento</wicri:regionArea><wicri:noRegion>Trento</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Information Engineering and Computer Science Department, University of Trento, Trento, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Information Engineering and Computer Science Department, University of Trento, Trento</wicri:regionArea><wicri:noRegion>Trento</wicri:noRegion></affiliation></author><author><name sortKey="Rizzo, Caterina" sort="Rizzo, Caterina" uniqKey="Rizzo C" first="Caterina" last="Rizzo">Caterina Rizzo</name><affiliation wicri:level="3"><nlm:aff id="I3">National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The WHO suggested that governments stockpile, as part of preparations for the next influenza pandemic, sufficient influenza antiviral drugs to treat approximately 25% of their populations. Our aim is two-fold: first, since in many countries the antiviral stockpile is well below this level, we search for suboptimal strategies based on treatment provided only to an age-dependent fraction of cases. Second, since in some countries the stockpile exceeds the suggested minimum level, we search for optimal strategies for post-exposure prophylactic treatment of close contacts of cases.</p></sec><sec><title>Methods</title><p>We used a stochastic, spatially structured individual-based model, considering explicit transmission in households, schools and workplaces, to simulate the spatiotemporal spread of an influenza pandemic in Italy and to evaluate the efficacy of interventions based on age-prioritized use of antivirals.</p></sec><sec><title>Results</title><p>Our results show that the antiviral stockpile required for treatment of cases ranges from 10% to 35% of the population for <italic>R</italic><sub>0 </sub>in 1.4 – 3. No suboptimal strategies, based on treatment provided to an age-dependent fraction of cases, were found able to remarkably reduce both clinical attack rate and antiviral drugs needs, though they can contribute to largely reduce the excess mortality. Treatment of all cases coupled with prophylaxis provided to younger individuals is the only intervention resulting in a significant reduction of the clinical attack rate and requiring a relatively small stockpile of antivirals.</p></sec><sec><title>Conclusion</title><p>Our results strongly suggest that governments stockpile sufficient influenza antiviral drugs to treat approximately 25% of their populations, under the assumption that <italic>R</italic><sub>0 </sub>is not much larger than 2. In countries where the number of antiviral stockpiled exceeds the suggested minimum level, providing prophylaxis to younger individuals is an option that could be taken into account in preparedness plans. In countries where the number of antivirals stockpiled is well below 25% of the population, priority should be decided based on age-specific case fatality rates. However, late detection of cases (administration of antivirals 48 hours after the clinical onset of symptoms) dramatically affects the efficacy of both treatment and prophylaxis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ferguson, Nm" uniqKey="Ferguson N">NM Ferguson</name></author><author><name sortKey="Cummings, Da" uniqKey="Cummings D">DA Cummings</name></author><author><name sortKey="Cauchemez, S" uniqKey="Cauchemez S">S Cauchemez</name></author><author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name></author><author><name sortKey="Riley, S" uniqKey="Riley S">S Riley</name></author><author><name sortKey="Meeyai, A" uniqKey="Meeyai A">A Meeyai</name></author><author><name sortKey="Iamsirithaworn, S" uniqKey="Iamsirithaworn S">S Iamsirithaworn</name></author><author><name sortKey="Burke, Ds" uniqKey="Burke D">DS 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id><journal-title-group><journal-title>BMC Infectious Diseases</journal-title></journal-title-group><issn pub-type="epub">1471-2334</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19638194</article-id><article-id pub-id-type="pmc">2728723</article-id><article-id pub-id-type="publisher-id">1471-2334-9-117</article-id><article-id pub-id-type="doi">10.1186/1471-2334-9-117</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Age-prioritized use of antivirals during an influenza pandemic</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Merler</surname><given-names>Stefano</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>merler@fbk.eu</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Ajelli</surname><given-names>Marco</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I2">2</xref><email>ajelli@fbk.eu</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Rizzo</surname><given-names>Caterina</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>caterina.rizzo@iss.it</email></contrib></contrib-group><aff id="I1"><label>1</label>Predictive Models for Biomedicine and Environment, Fondazione Bruno Kessler, Trento, Italy</aff><aff id="I2"><label>2</label>Information Engineering and Computer Science Department, University of Trento, Trento, Italy</aff><aff id="I3"><label>3</label>National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy</aff><pub-date pub-type="collection"><year>2009</year></pub-date><pub-date pub-type="epub"><day>28</day><month>7</month><year>2009</year></pub-date><volume>9</volume><fpage>117</fpage><lpage>117</lpage><history><date date-type="received"><day>25</day><month>3</month><year>2009</year></date><date date-type="accepted"><day>28</day><month>7</month><year>2009</year></date></history><permissions><copyright-statement>Copyright ©2009 Merler et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2009</copyright-year><copyright-holder>Merler et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.biomedcentral.com/1471-2334/9/117"></self-uri><abstract><sec><title>Background</title><p>The WHO suggested that governments stockpile, as part of preparations for the next influenza pandemic, sufficient influenza antiviral drugs to treat approximately 25% of their populations. Our aim is two-fold: first, since in many countries the antiviral stockpile is well below this level, we search for suboptimal strategies based on treatment provided only to an age-dependent fraction of cases. Second, since in some countries the stockpile exceeds the suggested minimum level, we search for optimal strategies for post-exposure prophylactic treatment of close contacts of cases.</p></sec><sec><title>Methods</title><p>We used a stochastic, spatially structured individual-based model, considering explicit transmission in households, schools and workplaces, to simulate the spatiotemporal spread of an influenza pandemic in Italy and to evaluate the efficacy of interventions based on age-prioritized use of antivirals.</p></sec><sec><title>Results</title><p>Our results show that the antiviral stockpile required for treatment of cases ranges from 10% to 35% of the population for <italic>R</italic><sub>0 </sub>in 1.4 – 3. No suboptimal strategies, based on treatment provided to an age-dependent fraction of cases, were found able to remarkably reduce both clinical attack rate and antiviral drugs needs, though they can contribute to largely reduce the excess mortality. Treatment of all cases coupled with prophylaxis provided to younger individuals is the only intervention resulting in a significant reduction of the clinical attack rate and requiring a relatively small stockpile of antivirals.</p></sec><sec><title>Conclusion</title><p>Our results strongly suggest that governments stockpile sufficient influenza antiviral drugs to treat approximately 25% of their populations, under the assumption that <italic>R</italic><sub>0 </sub>is not much larger than 2. In countries where the number of antiviral stockpiled exceeds the suggested minimum level, providing prophylaxis to younger individuals is an option that could be taken into account in preparedness plans. In countries where the number of antivirals stockpiled is well below 25% of the population, priority should be decided based on age-specific case fatality rates. However, late detection of cases (administration of antivirals 48 hours after the clinical onset of symptoms) dramatically affects the efficacy of both treatment and prophylaxis.</p></sec></abstract></article-meta></front></pmc><affiliations><list><country><li>Italie</li></country><region><li>Latium</li></region><settlement><li>Rome</li></settlement></list><tree><country name="Italie"><noRegion><name sortKey="Merler, Stefano" sort="Merler, Stefano" uniqKey="Merler S" first="Stefano" last="Merler">Stefano Merler</name></noRegion><name sortKey="Ajelli, Marco" sort="Ajelli, Marco" uniqKey="Ajelli M" first="Marco" last="Ajelli">Marco Ajelli</name><name sortKey="Ajelli, Marco" sort="Ajelli, Marco" uniqKey="Ajelli M" first="Marco" last="Ajelli">Marco Ajelli</name><name sortKey="Rizzo, Caterina" sort="Rizzo, Caterina" uniqKey="Rizzo C" first="Caterina" last="Rizzo">Caterina Rizzo</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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