Pre‐dispensing of antivirals to high‐risk individuals in an influenza pandemic

Goldstein, Édward; Miller, Joel C.; O’Hagan, Justin; Lipsitch, Marc

doi:10.1111/j.1750-2659.2009.00128.x

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…For example, the implementation of nurse triage telephone lines to facilitate antiviral prescribing could help reduce treatment delays [48, 49] and pre-dispensing of antivirals to individuals at high-risk of complications from influenza has also been suggested as a means of ensuring timely treatment of those most at risk of severe outcomes [50]. Temporary vaccination clinics were used to increase coverage during the 2009 H1N1 pandemic vaccination campaign and such dispensing points could also be considered for antiviral distribution [51].…”

Section: Discussionmentioning

confidence: 99%

Estimating the United States Demand for Influenza Antivirals and the Effect on Severe Influenza Disease During a Potential Pandemic

O’Hagan

Wong

Campbell

et al. 2015

Clinical Infectious Diseases

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Following the detection of a novel influenza strain, A(H7N9), we modeled the use of antiviral treatment in the United States to mitigate severe disease across a range of hypothetical pandemic scenarios. Our outcomes were total demand for antiviral (neuraminidase inhibitor) treatment and the number of hospitalizations and deaths averted. The model included estimates of attack rate, healthcare-seeking behavior, prescription rates, adherence, disease severity, and the potential effect of antivirals on the risks of hospitalization and death. Based on these inputs, the total antiviral regimens estimated to be available in the United States (as of April 2013) were sufficient to meet treatment needs for the scenarios considered. However, distribution logistics were not examined and should be addressed in future work. Treatment was estimated to avert many severe outcomes (5,200–248,000 deaths; 4,800–504,000 hospitalizations); however, large numbers remained (25,000–425,000 deaths; 583,000–3,700,000 hospitalizations), suggesting that the impact of combinations of interventions should be examined.

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Section: Discussionmentioning

confidence: 99%

Estimating the United States Demand for Influenza Antivirals and the Effect on Severe Influenza Disease During a Potential Pandemic

O’Hagan

Wong

Campbell

et al. 2015

Clinical Infectious Diseases

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“…For H1N1pdm infections, two recent studies suggest that early oseltamivir treatment for hospitalized H1N1 patients was beneficial in reducing the risk of death [ 4 ] and ICU admission [ 5 ]. In [ 6 ] a subset of the present authors consider the net benefits of pre-dispensing antivirals to high-risk individuals during an influenza pandemic, where the measure of the benefit is the number of lives saved by antivirals in the whole population. One factor which makes pre-dispensing beneficial is that individuals to whom antivirals have been pre-dispensed may be able to initiate treatment early, reducing their risk of progression to severe disease.…”

Section: Introductionmentioning

confidence: 99%

Oseltamivir for treatment and prevention of pandemic influenza A/H1N1 virus infection in households, Milwaukee, 2009

et al. 2010

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BackgroundDuring an influenza pandemic, a substantial proportion of transmission is thought to occur in households. We used data on influenza progression in individuals and their contacts collected by the City of Milwaukee Health Department (MHD) to study the transmission of pandemic influenza A/H1N1 virus in 362 households in Milwaukee, WI, and the effects of oseltamivir treatment and chemoprophylaxis.Methods135 households had chronological information on symptoms and oseltamivir usage for all household members. The effect of oseltamivir treatment and other factors on the household secondary attack rate was estimated using univariate and multivariate logistic regression with households as the unit of analysis. The effect of oseltamivir treatment and other factors on the individual secondary attack rate was estimated using univariate and multivariate logistic regression with individual household contacts as the unit of analysis, and a generalized estimating equations approach was used to fit the model to allow for clustering within households.ResultsOseltamivir index treatment on onset day or the following day (early treatment) was associated with a 42% reduction (OR: 0.58, 95% CI: 0.19, 1.73) in the odds of one or more secondary infections in a household and a 50% reduction (OR: 0.5, 95% CI: 0.17, 1.46) in the odds of a secondary infection in individual contacts. The confidence bounds are wide due to a small sample of households with early oseltamivir index usage - in 29 such households, 5 had a secondary attack. Younger household contacts were at higher risk of infection (OR: 2.79, 95% CI: 1.50-5.20).ConclusionsEarly oseltamivir treatment may be beneficial in preventing H1N1pdm influenza transmission; this may have relevance to future control measures for influenza pandemics. Larger randomized trials are needed to confirm this finding statistically.

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“…For other community measures, we only considered self-isolation with the probability of 90% for symptomatic cases only 37 . We assumed that antiviral treatment is offered to only 10% of symptomatic patients 38 with the effect of reducing infectiousness by 10% and the duration of infectious period by 1 day on average 3 . We assumed a 0.5-day delay in start of antiviral treatment after the onset of symptoms for those who sought care.…”

Section: Methodsmentioning

confidence: 99%

Assessing the benefits of early pandemic influenza vaccine availability: a case study for Ontario, Canada

Champredon

Laskowski

Charland

et al. 2018

Sci Rep

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New vaccine production technologies can significantly shorten the timelines for availability of a strain-specific vaccine in the event of an influenza pandemic. We sought to evaluate the potential benefits of early vaccination in reducing the clinical attack rate (CAR), taking into account the timing and speed of vaccination roll-out. Various scenarios corresponding to the transmissibility of a pandemic strain and vaccine prioritization strategies were simulated using an agent-based model of disease spread in Ontario, the largest Canadian province. We found that the relative reduction of the CAR reached 60% (90%CI: 44–100%) in a best-case scenario, in which the pandemic strain was moderately transmissible, vaccination started 4 weeks before the first imported case, the vaccine administration rate was 4 times higher than its average for seasonal influenza, and the vaccine efficacy was up to 90%. But the relative reductions in the CAR decreased significantly when the vaccination campaign was delayed or the administration rate reduced. In urban settings with similar characteristics to our population study, early availability and high rates of vaccine administration has the potential to substantially reduce the number of influenza cases. Low rates of vaccine administration or uptake can potentially offset the benefits of early vaccination.

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Pre‐dispensing of antivirals to high‐risk individuals in an influenza pandemic

Cited by 6 publications

References 19 publications

Estimating the United States Demand for Influenza Antivirals and the Effect on Severe Influenza Disease During a Potential Pandemic

Estimating the United States Demand for Influenza Antivirals and the Effect on Severe Influenza Disease During a Potential Pandemic

Oseltamivir for treatment and prevention of pandemic influenza A/H1N1 virus infection in households, Milwaukee, 2009

Assessing the benefits of early pandemic influenza vaccine availability: a case study for Ontario, Canada

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