Influenza pandemic preparedness in France: modelling the impact of interventions
Identifieur interne : 000319 ( France/Analysis ); précédent : 000318; suivant : 000320Influenza pandemic preparedness in France: modelling the impact of interventions
Auteurs : Aoife Doyle [France] ; Isabelle Bonmarin ; Daniel Lévy-Bruhl ; Yann Le Strat ; Jean-Claude DesenclosSource :
- Journal of Epidemiology and Community Health [ 0143-005X ] ; 2006-05.
English descriptors
- KwdEn :
- Teeft :
- Antiviral, Antiviral drugs, Antiviral strategies, Antiviral treatment, Appropriate interventions, Attack rate, Clinical attack rate, Clinical evidence, Contributor, Control strategies, Death rates, Direct cost, Dos, Economic impact, Epidemiol community health, Essential healthcare, Euro, France metropole, French pandemic preparedness plan, General population, Gross attack rate, Health event, Health events, Health outcomes, Healthcare professionals, High risk, High risk groups, Highest risk, Hospitalisation, Influenza, Influenza pandemic, Influenza pandemic preparedness, Influenza vaccination, Influenza vaccine, Input variables, Large number, Limited availability, Limited stocks, Lower limit, Modelled influenza pandemic, Monte carlo simulation model, Next pandemic, Oseltamivir, Pandemic, Pandemic influenza, Pandemic plan, Pandemic strain, Pandemic virus, Pandemie grippale, Peer reviewer, Peer reviewers, Preparedness, Previous pandemics, Previous studies, Priority groups, Priority population, Priority populations, Probability distributions, Prophylaxis, Relative benefits, Risk group, Risk groups, Seasonal prophylaxis, Target group, Therapeutic treatment, Total population, Treatment effectiveness, Vaccination, Vaccine, World health organisation, Year olds.
Abstract
Background: Influenza pandemics result in excess mortality and social disruption. To assist health authorities update the French pandemic plan, the authors estimated the number of health events (cases, hospitalisations, and deaths) in a pandemic and compared interventions in terms of impact and efficiency. Method: A Monte Carlo simulation model, incorporating probability distributions of key variables, provided estimates of health events (HE) by age and risk group. Input variables were set after literature and expert consultation. The impact of targeted influenza vaccination and antiviral prophylaxis/treatment (oseltamivir) in high risk groups (elderly, chronic diseases), priority (essential professionals), and total populations was compared. Outcome measures were HE avoided, number of doses needed, and direct cost per HE avoided. Results: Without intervention, an influenza pandemic could result in 14.9 million cases, 0.12 million deaths, and 0.6 million hospitalisations in France. Twenty four per cent of deaths and 40% of hospitalisations would be among high risk groups. With a 25% attack rate, 2000–86 000 deaths could be avoided, depending on population targeted and intervention. If available initially, vaccination of the total population is preferred. If not, for priority populations, seasonal prophylaxis seems the best strategy. For high risk groups, antiviral treatment, although less effective, seems more feasible and cost effective than prophylaxis (respectively 29% deaths avoided; 1800 doses/death avoided and 56% deaths avoided; 18 500 doses/death avoided) and should be chosen, especially if limited drug availability. Conclusion: The results suggest a strong role for antivirals in an influenza pandemic. While this model can compare the impact of different intervention strategies, there remains uncertainty surrounding key variables.
Url:
DOI: 10.1136/jech.2005.034082
Affiliations:
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<front><div type="abstract" xml:lang="en">Background: Influenza pandemics result in excess mortality and social disruption. To assist health authorities update the French pandemic plan, the authors estimated the number of health events (cases, hospitalisations, and deaths) in a pandemic and compared interventions in terms of impact and efficiency. Method: A Monte Carlo simulation model, incorporating probability distributions of key variables, provided estimates of health events (HE) by age and risk group. Input variables were set after literature and expert consultation. The impact of targeted influenza vaccination and antiviral prophylaxis/treatment (oseltamivir) in high risk groups (elderly, chronic diseases), priority (essential professionals), and total populations was compared. Outcome measures were HE avoided, number of doses needed, and direct cost per HE avoided. Results: Without intervention, an influenza pandemic could result in 14.9 million cases, 0.12 million deaths, and 0.6 million hospitalisations in France. Twenty four per cent of deaths and 40% of hospitalisations would be among high risk groups. With a 25% attack rate, 2000–86 000 deaths could be avoided, depending on population targeted and intervention. If available initially, vaccination of the total population is preferred. If not, for priority populations, seasonal prophylaxis seems the best strategy. For high risk groups, antiviral treatment, although less effective, seems more feasible and cost effective than prophylaxis (respectively 29% deaths avoided; 1800 doses/death avoided and 56% deaths avoided; 18 500 doses/death avoided) and should be chosen, especially if limited drug availability. Conclusion: The results suggest a strong role for antivirals in an influenza pandemic. While this model can compare the impact of different intervention strategies, there remains uncertainty surrounding key variables.</div>
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