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  • Modelling scenarios of diffusion and control of pandemic influenza, Italy

    Modelling scenarios of diffusion and control of pandemic influenza, Italy
    http://www.eurosurveillance.org/ew/2007/070104.asp#2
    Epico working group* (iannelli@science.unitn.it)
    The updated Italian national plan for preparedness and response to an influenza pandemic was published in February 2006 [1], in response to recommendations and checklists on national influenza pandemic preparedness plans issued by the World Health Organization [2].
    The Italian plan includes the following preventive measures:
    <TABLE cellSpacing=2 cellPadding=2 width="75%" border=0><TBODY><TR vAlign=top align=left><TD></TD><TD colSpan=2>
    vaccination, prioritising the following categories:
    </TD></TR><TR><TD> </TD><TD vAlign=top align=left> </TD><TD vAlign=top align=left>1. personnel of health services and other essential services,
    </TD></TR><TR><TD> </TD><TD vAlign=top align=left> </TD><TD vAlign=top align=left>2. high risk groups including >=65 years old individuals and all-age individuals with underlying chronic diseases,
    </TD></TR><TR><TD> </TD><TD vAlign=top align=left> </TD><TD vAlign=top align=left>3. healthy children and adolescents from 2 to 18 years,
    </TD></TR><TR><TD> </TD><TD vAlign=top align=left> </TD><TD vAlign=top align=left>4. healthy adults;
    </TD></TR><TR><TD> </TD><TD vAlign=top align=left colSpan=2>antiviral prophylaxis, </TD></TR><TR><TD> </TD><TD vAlign=top align=left colSpan=2>social distancing measures.</TD></TR></TBODY></TABLE>To evaluate the impact of these preventive measures on the national population, a mathematical model was developed by a working group that included researchers from the Universities of Trento, Pisa and Rome, and the National Institute of Health (Istituto Superiore di sanit?, ISS) The results were published in an ISS report in December 2006 [3] and are summarised here.
    Modelling pandemic influenza transmission and control measures
    A SEIR (susceptible; infected but not infectious; infectious; resistent, that is, immune to re-infection) deterministic model, with a stochastic simulation component was used. An R<SUB>0</SUB> (the basic reproductive number) of 1.8 was assumed, with a cumulative attack rate (AR) of 35% [4].
    We modelled the impact of vaccination, antiviral prophylaxis and measures aimed to increase social distancing. For each measure, various scenarios were considered, assuming different target populations and duration of interventions [3].
    As standard parameters, we considered that the target population would receive the first dose of vaccine 12 weeks after the onset of the index case in Italy, and the second dose four weeks after that. This two dose cycle was assumed to be 70% effective, starting 15 days after the administration of the second dose. Vaccine coverage was fixed at 60%.
    Antiviral prophylaxis of uninfected individuals was assumed to reduce susceptibility to infection by 30% [5]. We supposed that only household contacts of influenza cases would be treated, limiting the use of antiviral prohlylaxis to a maximum of 8 weeks after the onset of illness in the index case.
    School closure lasting 3 weeks was assumed to start 2, 4, or 8 weeks after the onset of the index case. As the same time, it was assumed that public offices not providing essential services would be closed for 4 weeks, and recreational venues such as theatres and cinemas, for 8 weeks.
    Results
    In absence of control measures, the epidemic peak would be reached approximately 4 months after the first case onset, with a total of 3 million cases during the peak week. The epidemic would be over in 7 months, with a cumulative attack rate of 35% (approximately 20 million cases).
    The interventions considered, when implemented singly, would reduce the cumulative attack rate to, at best, approximately 32% (vaccination only). Using either prophylaxis with antiviral drugs or social distancing measures alone would have no effect in reducing the cumulative AR, but would delay the epidemic peak by approximately one and three weeks, respectively.
    Multiple interventions involving vaccination, antiviral prophylaxis and social distancing measures, would reduce the cumulative attack rate to 20% at a minimum [range: 20% - 24%], with 8 millions cases avoided.
    Conclusions
    Modelling results confirm the need to respond to a pandemic with multiple preventive measures [6-8]. None of the interventions looked at is highly effective when implemented independently.
    These results, which evaluated interventions included in the national prepardness plan, also show that preparedness is crucial, in order to organise all the control measures necessary to face an emergency. Timing is also essential, and measures which at first glance appear to be less important, such as increasing social distancing, could be extremely useful for delaying the epidemic peak, allowing time for greater availability of a vaccine, and thus optimising its impact.
    The implementation of multiple measures, including closure of schools and workplaces requires the involvment of various medical and non-medical structures. It is therefore essential to properly communicate them the importance of such actions. Mathematical modelling based on national data are a relevant tool to assist public health decisors in preparing for responding to a new influenza pandemic.


    *EPICO working group:
    M L Ciofi degli Atti<SUP>1</SUP>, C Rizzo<SUP>1</SUP>, A Bella<SUP>1</SUP>, M Massari<SUP>1</SUP>, M Iannelli<SUP>2</SUP>, A Lunelli<SUP>2</SUP>, A Pugliese<SUP>2</SUP>, J Ripoll<SUP>2</SUP>, P Manfredi<SUP>3</SUP>, G Scalia Tomba<SUP>4</SUP>, S Merler<SUP>5</SUP>, G Jurman<SUP>5</SUP>, C Furlanello<SUP>5</SUP>
    <SUP>1</SUP>Istituto Superiore di Sanit?, Centro nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Reparto Epidemiologia delle Malattie infettive, Rome, Italy
    <SUP>2</SUP>Universit? degli Studi di Trento; Dipartimento di matematica, Trento, Italy
    <SUP>3</SUP>Universit? degli Studi di Pisa, Dipartimento di Statistica e Matematica Applicata all'Economia, Pisa, Italy
    <SUP>4</SUP>Universit? degli Studi di Roma Tor Vergata; Dipartimento di matematica, Rome, Italy
    <SUP>5</SUP>Istituto Trentino di Cultura, Istituto per la ricerca scientifica e tecnologica (ITC-IRST), Trento, Italy

    References:
    1. Ministero della Salute. Piano Nazionale di preparazione e risposta ad una pandemia influenzale 2006. Available at: (http://www.ministerosalute.it/imgs/C_17_pubblicazioni_511_allegato.pdf)
    2. WHO global influenza preparedness plan: the role of WHO and recommendations for national measures before and during pandemics. WHO/CDS/CSR/GIP/2005.5. Geneva: World Health Organization; March 2005. (http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5/en/)
    3. Epico working Group. Scenarios of diffusion and control of influenza pandemic in Italy In Italian, English abstract available. Rapporto Istisan 2006; 33/06. (http://www.iss.it/publ/rapp/cont.php?id=2010&lang=1&tipo=5&anno=2006)
    4. Glezen WP. Emerging infections: pandemic influenza. Epidemiol Rev 1996;18(1):64-76.
    5. Monto AS. Vaccines and antiviral drugs in pandemic preparedness. Emerg Infect Dis 2006 Jan;12(1):55-60. (http://www.cdc.gov/ncidod/EID/vol12no01/05-1068.htm)
    6. Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature 2006 Jul 27;442(7101):448-52
    7. Longini IM Jr, Nizam A, Xu S, Ungchusak K, Hanshaoworakul W, Cummings DA, et al. Containing pandemic influenza at the source. Science 2005 Aug 12;309(5737):1083-7.
    8. Germann TC, Kadau K, Longini IM, Jr., Macken CA. Mitigation strategies for pandemic influenza in the United States. Proc Natl Acad Sci U S A 2006 Apr 11;103(15):5935-40
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    <HR>New research funding opportunities from DG Research
    Editorial team (eurosurveillance.weekly@hpa.org.uk) , Eurosurveillance editorial office
    New research funding opportunities that may interest Eurosurveillance readers are now available from the European Commission?s DG Research [1].
    The total budget available for the theme ?FP7-HEALTH-2007-A ? is ? 628 000 000. There is a range of documents for applicants to read through, all of which can be downloaded from website (Click on the FP7-HEALTH-2007-A link at http://cordis.europa.eu/fp7/dc/index.cfm). The topics for proposals are listed in detail the provisional work programme, and are listed in a shorter table in the call fiche, along with some of the eligibility criteria. Some examples of topics are given in the table below.
    <TABLE cellSpacing=0 cellPadding=0 width="75%" border=1><TBODY><TR bgColor=#ccffff><TD>
    Section
    </TD><TD colSpan=2>
    Subsections
    </TD><TD>
    Example of topics in this section
    </TD><TD>
    Identifier
    </TD><TD>
    Funding scheme
    </TD><TD>
    Page number in work programme
    </TD><TD>
    Deadline
    </TD></TR><TR><TD>2. Translating research for human health</TD><TD>2.1. Integrating biological data and processes: large-scale data gathering,systems biology</TD><TD> </TD><TD>Characterisation and variability of the microbial communities in the Human Body.</TD><TD>HEALTH-2007-2.1.1-4</TD><TD>Collaborative project (Large-scale integrating project)</TD><TD>
    20
    </TD><TD>19 April 2007</TD></TR><TR><TD> </TD><TD>2.3 translational research in major infectious diseases: to confront major threats to public health</TD><TD>2.3.1. Anti-microbial drug resistance including fungal pathogens</TD><TD>Novel targets for drugs against Gram negative bacteria.</TD><TD>HEALTH-2007-2.3.1-1</TD><TD>Collaborative projects (Small or medium-scale focused research projects with maximum EC contribution of ? 6,000,000/project)

    </TD><TD>
    26
    </TD><TD>18 September 2007</TD></TR><TR><TD> </TD><TD> </TD><TD>2.3.2. HIV/AIDS, malaria and tuberculosis</TD><TD>HIV/AIDS Drug Discovery and Preclinical Development.</TD><TD>HEALTH-2007-2.3.2-1</TD><TD>Collaborative projects (Small or medium-scale focused research projects)

    </TD><TD>
    27
    </TD><TD>19 April 2007</TD></TR><TR><TD> </TD><TD> </TD><TD> </TD><TD>HIV and Hepatitis co-infection.</TD><TD>HEALTH-2007-2.3.2-8</TD><TD>Coordination and Support Action (Coordination or Support action)

    </TD><TD>
    29
    </TD><TD>18 September 2007</TD></TR><TR><TD> </TD><TD> </TD><TD>2.3.3. Potentially new and re-emerging epidemics</TD><TD>Development of broadly protective influenza vaccine candidates.</TD><TD>HEALTH-2007-2.3.3-1</TD><TD>Collaborative projects (Small or medium-scale focused research projects with maximum EC contribution of ? 6,000,000/project)

    </TD><TD>
    30
    </TD><TD>19 April 2007</TD></TR><TR><TD> </TD><TD> </TD><TD>2.3.4. Neglected infectious diseases</TD><TD>Development of new tools to control infections due to parasites of the Trypanosomatidae family.</TD><TD>HEALTH-2007-2.3.4-1</TD><TD>Collaborative projects (Small or medium-scale focused research projects)</TD><TD>
    33
    </TD><TD>18 September 2007</TD></TR><TR><TD>3. Optimising the delivery of health care to European citizens</TD><TD>3.3. Enhanced health promotion and disease prevention</TD><TD> </TD><TD>Improve vaccination coverage.</TD><TD>HEALTH-2007-3.3-5</TD><TD>Collaborative projects (Small or medium-scale focused research projects)</TD><TD>
    46
    </TD><TD>18 September 2007</TD></TR><TR><TD> </TD><TD>3.4. Horizontal coordination and support actions across "optimising the delivery of health care to european citizens"</TD><TD> </TD><TD>Disease networks of centres of reference.</TD><TD>HEALTH-2007-3.4-1</TD><TD>Coordination and Support Action (Support action)</TD><TD>
    46
    </TD><TD>18 September 2007</TD></TR></TBODY></TABLE>This table is meant as a basic guide only, so please check the work programme carefully for details of deadlines, etc.
    Research funding in the European Union from 2007 to 2013 is organised within the Seventh Framework Programme for research and technological development (FP7). In recent years, ?framework programmes? have been the main financial tools through which the European Union supports scientific research and development activities. Frequently asked questions on FP7 in 21 languages can be found at http://ec.europa.eu/research/fp7/understanding/index.html.
    Currently, the FP7 service on CORDIS is available in English, but the official documents that can be downloaded from the website are meant to be available in all EU official languages. If you have trouble obtaining documents in your preferred language, there are contact points available in all EU member and associated states (http://cordis.europa.eu/fp7/ncp_en.html)
    There are four specific programmes within FP7, which have been named
    <TABLE cellSpacing=2 cellPadding=2 width="75%" border=0><TBODY><TR><TD> </TD><TD>Cooperation - collaborative research;</TD></TR><TR><TD> </TD><TD>Ideas - the establishment of a European Research Council (ERC) to support frontier research;</TD></TR><TR><TD> </TD><TD>People - human resources; </TD></TR><TR><TD> </TD><TD>Capacities - research infrastructure and potential research capacity.</TD></TR></TBODY></TABLE>The current call for proposals in the Health theme comes under the Cooperation programme.
    Eligibility
    A detailed document about rules for participation, including information about who is eligible to apply for funding, can be downloaded from the FP7-HEALTH-2007-A page, and is also available on the public register of European council documents [2].
    Deadlines
    There are two main deadlines for proposals, depending on the topic: 19 April and 18 September 2007, so interested parties should check carefully before preparing their applications.



    References:
    1. Calls for proposals under the provisional work programmes of the 7th EC Framework Programme for Research, Technological Development and Demonstration Activities and the 7th EURATOM Framework Programme for Nuclear Research and Training Activities (2006/C 316/10). Official Journal of the European Union 2006; C316/26. 22 December. (http://eur-lex.europa.eu/LexUriServ/site/en/oj/2006/c_316/c_31620061222en00230025.pdf)
    2. Regulation Of The European Parliament And Of The Council Laying Down The Rules For The Participation Of Undertakings, Research Centres And Universities In Actions Under The Seventh Framework Programme And For The Dissemination Of Research Results (2007-2013). PE-CONS 3668/2/06 REV 2. Brussels: European Union and Council; 18 December 2006. (http://register.consilium.europa.eu/pdf/en/06/st03/st03668-re02.en06.pdf)
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    Citation style for articles

    - Article 1 : Mazick A, Participants of a workshop on mortality monitoring in Europe. Monitoring excess mortality for public health action: potential for a future European network. Euro Surveill 2007;12(1):E070104.1. Available from: http://www.eurosurveillance.org/ew/2007/070104.asp#1

    - Article 2 : Epico working group. Modelling scenarios of diffusion and control of pandemic influenza, Italy. Euro Surveill 2007;12(1):E070104.2. Available from: http://www.eurosurveillance.org/ew/2007/070104.asp#2

    - Article 3 : Editorial team. New research funding opportunities from DG Research. Euro Surveill 2007;12(1):E070104.3. Available from: http://www.eurosurveillance.org/ew/2007/070104.asp#3




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