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Comparative Study
Health and economic benefits of early vaccination and nonpharmaceutical interventions for a human influenza A (H7N9) pandemic: a modeling study.
- Nayer Khazeni, David W Hutton, Cassandra I F Collins, Alan M Garber, and Douglas K Owens.
- Ann. Intern. Med. 2014 May 20; 160 (10): 684-94.
BackgroundVaccination 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.ObjectiveTo 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).DesignDynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.Data SourcesLiterature and expert opinion.Target PopulationResidents of a U.S. metropolitan city with characteristics similar to New York City.Time HorizonLifetime.PerspectiveSocietal.InterventionVaccination of 30% of the population at 4 or 6 months.Outcome MeasuresInfections and deaths averted and cost-effectiveness.Results Of Base Case AnalysisIn 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 AnalysisIf 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.LimitationThe model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.ConclusionVaccination 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 SourceAgency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.
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