tetano
Editor, Senior Moderator
Ann Intern Med. 2014 May 20;160(10):684-94. doi: 10.7326/M13-2071.
Health and Economic Benefits of Early Vaccination and Nonpharmaceutical Interventions for a Human Influenza A (H7N9) Pandemic: A Modeling Study.
Khazeni N, Hutton DW, Collins CI, Garber AM, Owens DK.
Abstract
BACKGROUND:
Vaccination for the 2009 pandemic did not occur until late in the outbreak, which limited its benefits. Influenza A (H7N9) is causing increasing morbidity and mortality in China, and researchers have modified the A (H5N1) virus to transmit via aerosol, which again heightens concerns about pandemic influenza preparedness.
OBJECTIVE:
To determine how quickly vaccination should be completed to reduce infections, deaths, and health care costs in a pandemic with characteristics similar to influenza A (H7N9) and A (H5N1).
DESIGN:
Dynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.
DATA SOURCES:
Literature and expert opinion.
TARGET POPULATION:
Residents of a U.S. metropolitan city with characteristics similar to New York City.
TIME HORIZON:
Lifetime.
PERSPECTIVE:
Societal.
INTERVENTION:
Vaccination of 30% of the population at 4 or 6 months.
OUTCOME MEASURES:
Infections and deaths averted and cost-effectiveness.
RESULTS OF BASE-CASE ANALYSIS:
In 12 months, 48 254 persons would die. Vaccinating at 9 months would avert 2365 of these deaths. Vaccinating at 6 months would save 5775 additional lives and $51 million at a city level. Accelerating delivery to 4 months would save an additional 5633 lives and $50 million.
RESULTS OF SENSITIVITY ANALYSIS:
If vaccination were delayed for 9 months, reducing contacts by 8% through nonpharmaceutical interventions would yield a similar reduction in infections and deaths as vaccination at 4 months.
LIMITATION:
The model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.
CONCLUSION:
Vaccination in an influenza A (H7N9) pandemic would need to be completed much faster than in 2009 to substantially reduce morbidity, mortality, and health care costs. Maximizing non-pharmaceutical interventions can substantially mitigate the pandemic until a matched vaccine becomes available.
PRIMARY FUNDING SOURCE:
Agency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.
PMID:
24842415
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/24842415
Health and Economic Benefits of Early Vaccination and Nonpharmaceutical Interventions for a Human Influenza A (H7N9) Pandemic: A Modeling Study.
Khazeni N, Hutton DW, Collins CI, Garber AM, Owens DK.
Abstract
BACKGROUND:
Vaccination for the 2009 pandemic did not occur until late in the outbreak, which limited its benefits. Influenza A (H7N9) is causing increasing morbidity and mortality in China, and researchers have modified the A (H5N1) virus to transmit via aerosol, which again heightens concerns about pandemic influenza preparedness.
OBJECTIVE:
To determine how quickly vaccination should be completed to reduce infections, deaths, and health care costs in a pandemic with characteristics similar to influenza A (H7N9) and A (H5N1).
DESIGN:
Dynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.
DATA SOURCES:
Literature and expert opinion.
TARGET POPULATION:
Residents of a U.S. metropolitan city with characteristics similar to New York City.
TIME HORIZON:
Lifetime.
PERSPECTIVE:
Societal.
INTERVENTION:
Vaccination of 30% of the population at 4 or 6 months.
OUTCOME MEASURES:
Infections and deaths averted and cost-effectiveness.
RESULTS OF BASE-CASE ANALYSIS:
In 12 months, 48 254 persons would die. Vaccinating at 9 months would avert 2365 of these deaths. Vaccinating at 6 months would save 5775 additional lives and $51 million at a city level. Accelerating delivery to 4 months would save an additional 5633 lives and $50 million.
RESULTS OF SENSITIVITY ANALYSIS:
If vaccination were delayed for 9 months, reducing contacts by 8% through nonpharmaceutical interventions would yield a similar reduction in infections and deaths as vaccination at 4 months.
LIMITATION:
The model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.
CONCLUSION:
Vaccination in an influenza A (H7N9) pandemic would need to be completed much faster than in 2009 to substantially reduce morbidity, mortality, and health care costs. Maximizing non-pharmaceutical interventions can substantially mitigate the pandemic until a matched vaccine becomes available.
PRIMARY FUNDING SOURCE:
Agency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.
PMID:
24842415
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/24842415