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Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community

BACKGROUND: The 2009 influenza A (H1N1) pandemic was mild by historical standards, but was more severe in isolated Canadian Indigenous communities. Oseltamivir was used aggressively for outbreak control in an isolated northern Ontario First Nations community. We used mathematical modeling to quantif...

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Autores principales: Xiao, Yanyu, Patel, Zeenat, Fiddler, Adam, Yuan, Lilian, Delvin, Marie‐Elaine, Fisman, David N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634281/
https://www.ncbi.nlm.nih.gov/pubmed/23879801
http://dx.doi.org/10.1111/irv.12141
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author Xiao, Yanyu
Patel, Zeenat
Fiddler, Adam
Yuan, Lilian
Delvin, Marie‐Elaine
Fisman, David N.
author_facet Xiao, Yanyu
Patel, Zeenat
Fiddler, Adam
Yuan, Lilian
Delvin, Marie‐Elaine
Fisman, David N.
author_sort Xiao, Yanyu
collection PubMed
description BACKGROUND: The 2009 influenza A (H1N1) pandemic was mild by historical standards, but was more severe in isolated Canadian Indigenous communities. Oseltamivir was used aggressively for outbreak control in an isolated northern Ontario First Nations community. We used mathematical modeling to quantify the impact of antiviral therapy on the course of this outbreak. METHODS: We used both a Richards growth model and a compartmental model to evaluate the characteristics of the outbreak based on both respiratory visits and influenza‐like illness counts. Estimates of best‐fit model parameters, including basic reproductive number (R (0)) and antiviral efficacy, and simulations, were used to estimate the impact of antiviral drugs compared to social distancing interventions alone. RESULTS: Using both approaches, we found that a rapidly growing outbreak slowed markedly with aggressive antiviral therapy. Richards model turning points occurred within 24 hours of antiviral implementation. Compartmental models estimated antiviral efficacy at 70–95%. Plausible estimates of R from both modeling approaches ranged from 4·0 to 15·8, higher than published estimates for southern Canada; utilization of aggressive antiviral therapy in this community prevented 962–1757 cases of symptomatic influenza and as many as 114 medical evacuations in this community. CONCLUSION: Although not advocated in other settings in Canada, aggressive antiviral therapy markedly reduced the impact of a pandemic‐related influenza A (H1N1) outbreak in an isolated Canadian First Nations community in northern Ontario, Canada. The differential risk experienced by such communities makes tailored interventions that consider risk and lack of access to medical services, appropriate.
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spelling pubmed-46342812015-12-01 Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community Xiao, Yanyu Patel, Zeenat Fiddler, Adam Yuan, Lilian Delvin, Marie‐Elaine Fisman, David N. Influenza Other Respir Viruses Part 5 BACKGROUND: The 2009 influenza A (H1N1) pandemic was mild by historical standards, but was more severe in isolated Canadian Indigenous communities. Oseltamivir was used aggressively for outbreak control in an isolated northern Ontario First Nations community. We used mathematical modeling to quantify the impact of antiviral therapy on the course of this outbreak. METHODS: We used both a Richards growth model and a compartmental model to evaluate the characteristics of the outbreak based on both respiratory visits and influenza‐like illness counts. Estimates of best‐fit model parameters, including basic reproductive number (R (0)) and antiviral efficacy, and simulations, were used to estimate the impact of antiviral drugs compared to social distancing interventions alone. RESULTS: Using both approaches, we found that a rapidly growing outbreak slowed markedly with aggressive antiviral therapy. Richards model turning points occurred within 24 hours of antiviral implementation. Compartmental models estimated antiviral efficacy at 70–95%. Plausible estimates of R from both modeling approaches ranged from 4·0 to 15·8, higher than published estimates for southern Canada; utilization of aggressive antiviral therapy in this community prevented 962–1757 cases of symptomatic influenza and as many as 114 medical evacuations in this community. CONCLUSION: Although not advocated in other settings in Canada, aggressive antiviral therapy markedly reduced the impact of a pandemic‐related influenza A (H1N1) outbreak in an isolated Canadian First Nations community in northern Ontario, Canada. The differential risk experienced by such communities makes tailored interventions that consider risk and lack of access to medical services, appropriate. John Wiley and Sons Inc. 2013-07-23 2013-11 /pmc/articles/PMC4634281/ /pubmed/23879801 http://dx.doi.org/10.1111/irv.12141 Text en © 2013 John Wiley & Sons Ltd
spellingShingle Part 5
Xiao, Yanyu
Patel, Zeenat
Fiddler, Adam
Yuan, Lilian
Delvin, Marie‐Elaine
Fisman, David N.
Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community
title Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community
title_full Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community
title_fullStr Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community
title_full_unstemmed Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community
title_short Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community
title_sort estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza h1n1 in an isolated first nations community
topic Part 5
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634281/
https://www.ncbi.nlm.nih.gov/pubmed/23879801
http://dx.doi.org/10.1111/irv.12141
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