Effective, Robust Design of Community Mitigation for Pandemic Influenza: A Systematic Examination of Proposed US Guidance

摘要: Background: The US government proposes pandemic influenza mitigation guidance that includes isolation and antiviral treatment of ill persons, voluntary household member quarantine prophylaxis, social distancing individuals, school closure, reduction contacts at work, prioritized vaccination. Is this the best strategy combination? choice robust to uncertainties? What are critical enablers community resilience? Methods Findings: We systematically simulate a broad range scenarios strategies using networked, agent-based model explicit, multiply-overlapping contact networks. evaluate illness societal burden for alterations in networks, parameters, or intervention implementation. For 1918like pandemic, minimizes ,1% population combines network-based (e.g. all with adults’ work reduced), case-based measures prophylaxis members). find removal enhanced transmission by young, additional complexity altered natural history including extended viral shedding. Administration age-group randomly targeted 50% effective pre-pandemic vaccine 7% coverage (current H5N1 stockpile) had minimal effect on outcomes. In order, success depends rapid implementation, high compliance, regional mitigation, rigorous rescinding criteria; these resilience. Conclusions: Systematic evaluation feasible, recommended interventions generally confirms yields choices planning wide uncertainty. network- interventions; paramount. Because must be applied rapidly, regionally, stringently greatest benefit, preparation public education is required long-lasting, compliance during pandemic.