Containing Pandemic Influenza at the Source

TLDR

Highly pathogenic avian influenza A (H5N1) threatens a human pandemic of potentially devastating proportions. A stochastic influenza simulation model for rural Southeast Asia was used to assess the effectiveness of targeted antiviral prophylaxis, quarantine, and pre‑vaccination in containing an emerging strain at the source. Simulations show that with R₀ below 1.6, targeted antivirals alone can contain the outbreak with a stockpile of 100,000–1 million courses; pre‑vaccination extends effectiveness to R₀ ≈ 2.1, and combined antiviral prophylaxis, pre‑vaccination, and quarantine can contain strains with R₀ up to 2.4.

Abstract

Highly pathogenic avian influenza A (subtype H5N1) is threatening to cause a human pandemic of potentially devastating proportions. We used a stochastic influenza simulation model for rural Southeast Asia to investigate the effectiveness of targeted antiviral prophylaxis, quarantine, and pre-vaccination in containing an emerging influenza strain at the source. If the basic reproductive number ( R 0 ) was below 1.60, our simulations showed that a prepared response with targeted antivirals would have a high probability of containing the disease. In that case, an antiviral agent stockpile on the order of 100,000 to 1 million courses for treatment and prophylaxis would be sufficient. If pre-vaccination occurred, then targeted antiviral prophylaxis could be effective for containing strains with an R 0 as high as 2.1. Combinations of targeted antiviral prophylaxis, pre-vaccination, and quarantine could contain strains with an R 0 as high as 2.4.