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Modeling the Worldwide Spread of Pandemic Influenza: Baseline Case and Containment Interventions
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Vittoria Colizza<SUP>1,</SUP><SUP>2</SUP>, Alain Barrat<SUP>2,</SUP><SUP>3</SUP>, Marc Barthelemy<SUP>1,</SUP><SUP>4</SUP>, Alain-Jacques Valleron<SUP>5,</SUP><SUP>6</SUP>, Alessandro Vespignani<SUP>1,</SUP><SUP>2</SUP><SUP>*</SUP>
<!-- end authors --><!-- start affiliations -->1 School of Informatics and Center for Biocomplexity, Indiana University, Bloomington, Indiana, United States of America, 2 Complex Networks Lagrange Laboratory, Institute for Scientific Interchange Foundation, Turin, Italy, 3 Unit? Mixte de Recherche 8627, Centre National de la Recherche Scientifique, Universit? Paris-Sud, Orsay, France, 4 Commissariat ? l'Energie Atomique, Direction Ile-de-France, Centre d'Etudes de Bruy?res Le Ch?tel, Bruy?res Le Ch?tel, France, 5 Unit? de Recherche en Epid?miologie, Syst?mes d'Information et Mod?lisation, Institut National de la Sant? et de la Recherche M?dicale, Unit? Mixte de Recherche 707, Universit? Pierre et Marie Curie, Paris, France, 6 H?pital Saint-Antoine, Assistance Publique-H?pitaux de Paris, Paris, France
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Background The highly pathogenic H5N1 avian influenza virus, which is now widespread in Southeast Asia and which diffused recently in some areas of the Balkans region and Western Europe, has raised a public alert toward the potential occurrence of a new severe influenza pandemic. Here we study the worldwide spread of a pandemic and its possible containment at a global level taking into account all available information on air travel.
Methods and Findings We studied a metapopulation stochastic epidemic model on a global scale that considers airline travel flow data among urban areas. We provided a temporal and spatial evolution of the pandemic with a sensitivity analysis of different levels of infectiousness of the virus and initial outbreak conditions (both geographical and seasonal). For each spreading scenario we provided the timeline and the geographical impact of the pandemic in 3,100 urban areas, located in 220 different countries. We compared the baseline cases with different containment strategies, including travel restrictions and the therapeutic use of antiviral (AV) drugs. We investigated the effect of the use of AV drugs in the event that therapeutic protocols can be carried out with maximal coverage for the populations in all countries. In view of the wide diversity of AV stockpiles in different regions of the world, we also studied scenarios in which only a limited number of countries are prepared (i.e., have considerable AV supplies). In particular, we compared different plans in which, on the one hand, only prepared and wealthy countries benefit from large AV resources, with, on the other hand, cooperative containment scenarios in which countries with large AV stockpiles make a small portion of their supplies available worldwide.
Conclusions We show that the inclusion of air transportation is crucial in the assessment of the occurrence probability of global outbreaks. The large-scale therapeutic usage of AV drugs in all hit countries would be able to mitigate a pandemic effect with a reproductive rate as high as 1.9 during the first year; with AV supply use sufficient to treat approximately 2% to 6% of the population, in conjunction with efficient case detection and timely drug distribution. For highly contagious viruses (i.e., a reproductive rate as high as 2.3), even the unrealistic use of supplies corresponding to the treatment of approximately 20% of the population leaves 30%?50% of the population infected. In the case of limited AV supplies and pandemics with a reproductive rate as high as 1.9, we demonstrate that the more cooperative the strategy, the more effective are the containment results in all regions of the world, including those countries that made part of their resources available for global use.
<!-- end abstract --><!-- start footnote section -->Funding: AB and AV are partially funded by the European Commission contract 001907 Dynamically Evolving Large-scale Information Systems (DELIS). AV is partially funded by the National Science Foundation award IIS-0513650. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Academic Editor: Alison P. Galvani, Yale University, United States of America
Citation: Colizza V, Barrat A, Barthelemy M, Valleron AJ, Vespignani A (2007) Modeling the Worldwide Spread of Pandemic Influenza: Baseline Case and Containment Interventions. PLoS Med 4(1): e13 doi:10.1371/journal.pmed.0040013
Received: April 27, 2006; Accepted: November 27, 2006; Published: January 23, 2007
Copyright: ? 2007 Colizza et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abbreviations: AV, antiviral
full article at: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040013
hat-tip to andy
<!-- end title area --><!-- start authors -->
Vittoria Colizza<SUP>1,</SUP><SUP>2</SUP>, Alain Barrat<SUP>2,</SUP><SUP>3</SUP>, Marc Barthelemy<SUP>1,</SUP><SUP>4</SUP>, Alain-Jacques Valleron<SUP>5,</SUP><SUP>6</SUP>, Alessandro Vespignani<SUP>1,</SUP><SUP>2</SUP><SUP>*</SUP>
<!-- end authors --><!-- start affiliations -->1 School of Informatics and Center for Biocomplexity, Indiana University, Bloomington, Indiana, United States of America, 2 Complex Networks Lagrange Laboratory, Institute for Scientific Interchange Foundation, Turin, Italy, 3 Unit? Mixte de Recherche 8627, Centre National de la Recherche Scientifique, Universit? Paris-Sud, Orsay, France, 4 Commissariat ? l'Energie Atomique, Direction Ile-de-France, Centre d'Etudes de Bruy?res Le Ch?tel, Bruy?res Le Ch?tel, France, 5 Unit? de Recherche en Epid?miologie, Syst?mes d'Information et Mod?lisation, Institut National de la Sant? et de la Recherche M?dicale, Unit? Mixte de Recherche 707, Universit? Pierre et Marie Curie, Paris, France, 6 H?pital Saint-Antoine, Assistance Publique-H?pitaux de Paris, Paris, France
<!-- end affiliations --><!-- start: abstract -->
Background The highly pathogenic H5N1 avian influenza virus, which is now widespread in Southeast Asia and which diffused recently in some areas of the Balkans region and Western Europe, has raised a public alert toward the potential occurrence of a new severe influenza pandemic. Here we study the worldwide spread of a pandemic and its possible containment at a global level taking into account all available information on air travel.
Methods and Findings We studied a metapopulation stochastic epidemic model on a global scale that considers airline travel flow data among urban areas. We provided a temporal and spatial evolution of the pandemic with a sensitivity analysis of different levels of infectiousness of the virus and initial outbreak conditions (both geographical and seasonal). For each spreading scenario we provided the timeline and the geographical impact of the pandemic in 3,100 urban areas, located in 220 different countries. We compared the baseline cases with different containment strategies, including travel restrictions and the therapeutic use of antiviral (AV) drugs. We investigated the effect of the use of AV drugs in the event that therapeutic protocols can be carried out with maximal coverage for the populations in all countries. In view of the wide diversity of AV stockpiles in different regions of the world, we also studied scenarios in which only a limited number of countries are prepared (i.e., have considerable AV supplies). In particular, we compared different plans in which, on the one hand, only prepared and wealthy countries benefit from large AV resources, with, on the other hand, cooperative containment scenarios in which countries with large AV stockpiles make a small portion of their supplies available worldwide.
Conclusions We show that the inclusion of air transportation is crucial in the assessment of the occurrence probability of global outbreaks. The large-scale therapeutic usage of AV drugs in all hit countries would be able to mitigate a pandemic effect with a reproductive rate as high as 1.9 during the first year; with AV supply use sufficient to treat approximately 2% to 6% of the population, in conjunction with efficient case detection and timely drug distribution. For highly contagious viruses (i.e., a reproductive rate as high as 2.3), even the unrealistic use of supplies corresponding to the treatment of approximately 20% of the population leaves 30%?50% of the population infected. In the case of limited AV supplies and pandemics with a reproductive rate as high as 1.9, we demonstrate that the more cooperative the strategy, the more effective are the containment results in all regions of the world, including those countries that made part of their resources available for global use.
<!-- end abstract --><!-- start footnote section -->Funding: AB and AV are partially funded by the European Commission contract 001907 Dynamically Evolving Large-scale Information Systems (DELIS). AV is partially funded by the National Science Foundation award IIS-0513650. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Academic Editor: Alison P. Galvani, Yale University, United States of America
Citation: Colizza V, Barrat A, Barthelemy M, Valleron AJ, Vespignani A (2007) Modeling the Worldwide Spread of Pandemic Influenza: Baseline Case and Containment Interventions. PLoS Med 4(1): e13 doi:10.1371/journal.pmed.0040013
Received: April 27, 2006; Accepted: November 27, 2006; Published: January 23, 2007
Copyright: ? 2007 Colizza et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abbreviations: AV, antiviral
full article at: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040013
hat-tip to andy
