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Highly pathogenic H5N1 influenza A viruses are now endemic in avian populations in Southeast Asia, and human cases continue to accumulate. Although currently incapable of sustained human-to-human transmission, H5N1 represents a serious pandemic threat owing to the risk of a mutation or reassortment generating a virus with increased transmissibility. Identifying public health interventions that might be able to halt a pandemic in its earliest stages is therefore a priority. Here we use a simulation model of influenza transmission in Southeast Asia to evaluate the potential effectiveness of targeted mass prophylactic use of antiviral drugs as a containment strategy. Other interventions aimed at reducing population contact rates are also examined as reinforcements to an antiviral-based containment policy. We show that elimination of a nascent pandemic may be feasible using a combination of geographically targeted prophylaxis and social distancing measures, if the basic reproduction number of the new virus is below 1.8. We predict that a stockpile of 3 million courses of antiviral drugs should be sufficient for elimination. Policy effectiveness depends critically on how quickly clinical cases are diagnosed and the speed with which antiviral drugs can be distributed.

Original publication

DOI

10.1038/nature04017

Type

Journal article

Journal

Nature

Publication Date

09/2005

Volume

437

Pages

209 - 214

Addresses

Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK. neil.ferguson@imperial.ac.uk

Keywords

Animals, Humans, Reassortant Viruses, Influenza A virus, Antiviral Agents, Contact Tracing, Probability, Sensitivity and Specificity, Age Distribution, Population Density, Communicable Disease Control, Quarantine, Virus Replication, Virus Shedding, Mutation, Models, Biological, Time Factors, Travel, Computer Simulation, Asia, Southeastern, Thailand, Influenza, Human