Health and Economic Benefits of Early Vaccination and Nonpharmaceutical Interventions for a Human Influenza A (H7N9) Pandemic

Abstract

Background 2009 pandemic vaccination occurred late, limiting its benefits. Influenza A (H7N9) is causing high morbidity and mortality in China, and researchers have modified A (H5N1) to transmit via aerosol, again heightening concerns about pandemic influenza preparedness. Objective We sought to determine how much more quickly a vaccination program should be implemented to reduce infections, deaths, and healthcare costs in a pandemic with characteristics similar to influenza A (H7N9) and A (H5N1). Design We used a 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. Perspective Societal. Time Horizon Lifetime. Interventions Vaccination of 30% of the population at 4 or 6 months. Outcome Measures Infections and deaths averted, cost-effectiveness. Results of Base Case Analysis 48,254 would die in 12 months; vaccinating at 9 months would avert 2,365 of these deaths. Vaccinating at 6 months would save 5,775 additional lives and $51 million at a city level. Further accelerating delivery to 4 months would save an additional 5,633 lives and $50 million. Results of Sensitivity Analysis In the event of a vaccine delay to 9 months, increasing reductions in contacts via non-pharmaceutical interventions by 8% would yield a similar reduction in infections and deaths as vaccination at 4 months. Limitations The model is not designed to evaluate programs targeting specific populations such as children or individuals with comorbidities. Conclusions Vaccination in an influenza A (H7N9) pandemic would need to be performed far more rapidly than in 2009 to substantially reduce morbidity, mortality, and healthcare costs. Maximizing non-pharmacological interventions can substantially mitigate the pandemic until matched vaccine becomes available.

Discovery of Pentacyclic Triterpenoids as Potential Entry Inhibitors of Influenza Viruses

“…11 Currently, two classes of anti-influenza drugs have been developed for interruption of specific processes in influenza infection. Amantadine and rimantadine target the M2 protein which is an ion channel allowing protons to move through the viral envelope to uncoat viral RNA, and thus block the release of viral RNA into the cytoplasm.…”

Avian influenza surveillance in Central and West Africa, 2010–2014

“…Since subtype H5N1 has already caused losses of $20 billion to the global poultry industry [20], it could have a substantial impact on food production in Central and West Africa. Furthermore, subtype H7N9, which has high virulence in humans and circulates in songbirds in China, could result in treatment costs of $5.3 billion if it spreads to a major city [28]. Improving our understanding of the occurrence of AIV in African birds can provide insights useful for the formulation agricultural and biosecurity policies.…”

Seasonality dynamics of avian influenza occurrences in Central and West Africa

“…Since subtype H5N1 has already caused losses of $20 billion to the global poultry industry [39], it could have a substantial impact on food production in Central and West Africa. Furthermore, subtype H7N9, which has high virulence in humans and circulates in songbirds in China, could result in treatment costs of $5.3 billion if it spreads to a major city [40]. Improving our understanding of the occurrence and seasonality of AIV in African birds can provide insights useful for the formulation agricultural and biosecurity policies.…”