RT Journal Article
SR Electronic
T1 Modelling mitigation strategies for pandemic (H1N1) 2009
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 673
OP 680
DO 10.1503/cmaj.091641
VO 181
IS 10
A1 Gojovic, Marija Zivkovic
A1 Sander, Beate
A1 Fisman, David
A1 Krahn, Murray D.
A1 Bauch, Chris T.
YR 2009
UL http://www.cmaj.ca/content/181/10/673.abstract
AB Background: The 2009 influenza A (H1N1) pandemic has required decision-makers to act in the face of substantial uncertainties. Simulation models can be used to project the effectiveness of mitigation strategies, but the choice of the best scenario may change depending on model assumptions and uncertainties. Methods: We developed a simulation model of a pandemic (H1N1) 2009 outbreak in a structured population using demographic data from a medium-sized city in Ontario and epidemiologic influenza pandemic data. We projected the attack rate under different combinations of vaccination, school closure and antiviral drug strategies (with corresponding “trigger” conditions). To assess the impact of epidemiologic and program uncertainty, we used “combinatorial uncertainty analysis.” This permitted us to identify the general features of public health response programs that resulted in the lowest attack rates. Results: Delays in vaccination of 30 days or more reduced the effectiveness of vaccination in lowering the attack rate. However, pre-existing immunity in 15% or more of the population kept the attack rates low, even if the whole population was not vaccinated or vaccination was delayed. School closure was effective in reducing the attack rate, especially if applied early in the outbreak, but this is not necessary if vaccine is available early or if pre-existing immunity is strong. Interpretation: Early action, especially rapid vaccine deployment, is disproportionately effective in reducing the attack rate. This finding is particularly important given the early appearance of pandemic (H1N1) 2009 in many schools in September 2009.