Antiviral Strategies for Emerging Influenza Viruses in Remote Communities

Abstract

BackgroundDue to the lack of timely access to resources for critical care, strategic use of antiviral drugs is crucial for mitigating the impact of novel influenza viruses with pandemic potential in remote and isolated communities. We sought to evaluate the effect of antiviral treatment and prophylaxis of close contacts in a Canadian remote northern community.MethodsWe used an agent-based, discrete-time simulation model for disease spread in a remote community, which was developed as an in-silico population using population census data. Relative and cumulative age-specific attack rates, and the total number of infections in simulated model scenarios were obtained.ResultsWe found that early initiation of antiviral treatment is more critical for lowering attack rates in a remote setting with a low population-average age compared to an urban population. Our results show that a significant reduction in the relative, age-specific attack rates due to increasing treatment coverage does not necessarily translate to a significant reduction in the overall arrack rate. When treatment coverage varies from low to moderate, targeted prophylaxis has a very limited impact in reducing attack rates and should be offered at a low level (below 10%) to avoid excessive waste of drugs.ConclusionsIn contrast to previous work, for conservative treatment coverages, our results do not provide any convincing evidence for the implementation of targeted prophylaxis. The findings suggest that public health strategies in remote communities should focus on the wider availability (higher coverage) and timely distribution of antiviral drugs for treatment of clinically ill individuals.

Predictors of Viral Pneumonia in Patients with Community-Acquired Pneumonia

“…Although viral pneumonia is increasingly recognized as a major cause of CAP and early antiviral therapy can reduce mortality, few studies have investigated the clinical predictors of viral pneumonia, and the results have been inconsistent [23] – [26] . Moreover, evaluations of the diagnostic value of any clinical parameters, including sensitivity, specificity, and positive and negative predictive values, have not been performed.…”

Strategies for Early Vaccination During Novel Influenza Outbreaks

“…The latent period was drawn from a uniform distribution with a minimum of 1 day and a maximum of 2 days 33 40 . The pre-symptomatic period for each infected individual was drawn from a log-normal distribution with the scale parameter μ = −0.775 days, and shape parameter days, giving an average of 0.5 days 28 41 . The duration of infection following the start of clinical symptoms was sampled from a log-normal distribution ( Fig.…”

“…The effect of antiviral treatment in reducing infectiousness was included as a reduction factor for disease transmissibility following the initiation of treatment for symptomatic infections. We assumed that treatment reduces the transmissibility by 60% 33 34 35 41 42 . The protection level of vaccination for each individual was sampled from the estimated ranges for vaccine effectiveness associated with each age group.…”

The Effect of Individual Movements and Interventions on the Spread of Influenza in Long-Term Care Facilities

“…21 Earlier models using this framework in the larger community presumed the activities of participants based on assumptions about behavioural patterns in an environment that includes homes, workplaces, schools, and other social contexts. [21][22][23] We adapted this framework to represent resident rooms, common areas, and staff areas within the LTCF.…”