Abstract
In a recent report, the Institute of Medicine has stressed the need for dynamic mitigation strategies for pandemic influenza. In response to the need, we have developed a simulation-based optimization methodology for generating dynamic predictive mitigation strategies for pandemic outbreaks affecting several regions. Our methodology can accommodate varying virus and population dynamics. It progressively allocates a limited budget to procure vaccines and antivirals, capacities for their administration, and resources required to enforce social distancing. The methodology uses measures of morbidity, mortality, and social distancing, which are translated into the costs of lost productivity and medical services. The simulation model was calibrated using historic pandemic data. We illustrate the use of our methodology on a mock outbreak involving over four million people residing in four major population centers in Florida, USA. A sensitivity analysis is presented to estimate the impact of changes in the budget availability and variability of some of the critical parameters of mitigation strategies. The methodology is intended to assist public health policy makers.
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Arino J, Brauer F, den Driessche P, Watmough J, Wu J (2006) Simple models for containment of a pandemic. J R Soc Interface 3: 453–457
Atkinson M, Wein L (2008) Quantifying the routes of transmission for pandemic influenza. Bull Math Biol 70(3): 820–867
Aunins J, Lee A, Volkin D (2000) Vaccine production, 2nd edn. CRC Press LLC, Boca Raton
Ball F, Lyne O (2002) Optimal vaccination policies for stochastic epidemics among a population of households. Math Biosci 177–178: 333–354
Blendon R, DesRoches C, Cetron M, Benson J, Meinhardt T, Pollard W (2006) Attitudes toward the use of quarantine in a public health emergency in four countries. Health Aff 25(2): 15–25
Blendon R, Koonin L, Benson J, Cetron M, Pollard W, Mitchell E, Weldon K, Herrmann M (2008) Public response to community mitigation measures for pandemic influenza. Emerg Infect Dis 14(5): 778
Bootsma M, Ferguson N (2007) The effect of public health measures on the 1918 influenza pandemic in the US cities. PNAS 104(18): 7588–7593
Brundage J, Shanks G (2008) Deaths from bacterial pneumonia during 1918–19 influenza pandemic. Emerg Infect Dis 14(8): 1193
Bureau of Transportation Statistics (2002) 2001 National household travel survey (NTHS). http://www.bts.gov/programs/national_household_travel_survey/. Last accessed on 12/09/2008
Carrat F, Lavenu A, Cauchemez S, Deleguer S (2005) Repeated influenza vaccination of healthy children and adults: borrow now, pay later?. Epidemiol Infect 134: 63–70
Cauchemez S, Carrat F, Viboud C, Valleron A, Boelle P (2004) A Bayesian (MCMC) approach to study transmission of influenza: application to household longitudinal data. Stat Med 23: 3469–3487
Centers for Disease Control and Prevention (CDC) (2006) CDC influenza operational plan. http://www.cdc.gov/flu/pandemic/cdcplan.htm. Last accessed on 03/27/2009
Centers for Disease Control and Prevention (CDC) (2007a) Preparing for pandemic influenza. http://www.cdc.gov/flu/pandemic/preparedness.htm. Last accessed on 04/27/2009
Centers for Disease Control and Prevention (CDC) (2007b) Interim pre-pandemic planning guidance: community strategy for pandemic influenza mitigation in the United States. http://www.pandemicflu.gov/plan/community/community_mitigation.pdf. Last accessed on 04/01/2009
Centers for Disease Control and Prevention (CDC) (2008) Avian influenza: current H5N1 situation. http://www.cdc.gov/flu/avian/outbreaks/current.htm#clusters. Last accessed on 02/09/2008
Centers for Disease Control and Prevention (2009) CDC vaccine price list. http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm#flu. Last accessed on 12/28/2009
Colorado Department of Human Services Division of Mental Health (2009) Pandemic influenza: quarantine, isolation and social distancing. http://www.flu.gov/news/colorado_toolbox.pdf. Last accessed on 10/28/2009
Colizza V, Barrat A, Barthelemy M, Vespignani A (2006) The role of the airline transportation network in the prediction and predictability of global epidemics. PNAS 103: 2015–2020
Colizza V, Barrat A, Barthelemy AVM, Vespignani A (2007) Modeling the worldwide spread of pandemic influenza: baseline case and containment interventions. PLOS Med 4: 95–110
Committee on Modeling Community Containment for Pandemic Influenza (2006) Modeling community containment for pandemic influenza: a letter report. http://www.nap.edu/catalog/11800.html. Last accessed on 12/09/2008
Cooley P, Ganapathi L, Ghneim G, Holmberg S, Wheaton W, Hollingsworth C (2008) Using influenza-like illness data to reconstruct an influenza outbreak. Math Comput Model 48: 929–939
Cummings K, Jette A, Brock B, Haefner D (1979) Psychosocial determinants of immunization behavior in a swine influenza campaign. Med Care 17(6): 639–649
Dargatz C, Georgescu V, Held L (2006) Stochastic modelling of the spatial spread of influenza in Germany. Austrian J Stat 35(1): 5–20
Das T, Savachkin A (2008) A large scale simulation model for assessment of societal risk and development of dynamic mitigation strategies. IIE Trans 40(9): 893–905
Diekmann O, Heesterbeek J (2000) Mathematical epidemiology of infectious diseases: model building, analysis and interpretation. Wiley, Chichester
Eclipse F (2009) The spatio-temporal epidemiological modeler. http://www.eclipse.org/stem/intro.php. Last accessed on 11/06/2009
Epstein J, Goedecke D, Yu F, Morris R, Wagener D, Bobashev G (2007) Controlling pandemic flu: the value of international air travel restrictions. PLoS One 2(5): 1–11
Epstein J, Parker J, Cummings D, Hammond R (2008) Coupled contagion dynamics of fear and disease: mathematical and computational explorations. PLoS One 3(12): e3955
Eubank S, Guclu H, Kumar V, Marathe M, Srinivasan A, Toroczkai Z, Wang N (2004) Modelling disease outbreaks in realistic urban social networks. Nature 429: 180–184
Fedson D, Hant S (2003) Pandemic influenza and the global vaccine supply. Clin Infect Dis 36: 1552–1561
Ferguson N, Mallett S, Jackson H, Roberts N, Ward P (2003) A population-dynamic model for evaluating the potential spread of drug-resistant influenza virus infections during community-based use of antivirals. J Antimicrob Chemother 51: 977–990
Ferguson NM, Cummings D, Cauchemez S, Fraser C, Riley S, Aronrag M, Lamsirithaworn S, Burke D (2005) Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature 437: 209–214
Ferguson N, Cummings DA, Fraser C, Cajka J, Cooley PCC, Burke DS (2006) Strategies for mitigating an influenza pandemic. Nature 442(27): 448–452
Fraser C, Riley S, Anderson R, Ferguson N, May R (2004) Factors that make an infectious disease outbreak controllable. PNAS 101(16): 6146–6151
Germann T, Kadau K, Longini IM, Macken C (2006) Mitigation strategies for pandemic influenza in the United States. PNAS 103: 5935–5940
Glass R, Beyeler W, Min H (2006) Targeted social distancing design for pandemic influenza. Emerg Infect Dis 12(11): 1671–1681
Halder N, Kelso J, Milne G (2010) Analysis of the effectiveness of interventions used during the 2009 A/H1N1 influenza pandemic. BioMed Central 10(168): 1–14
Halfhill T (2009) Inflation calculator. http://www.halfhill.com/inflatation.html. Last accessed on 12/04/2009
Halloran M (2006) Invited commentary: challenges of using contact data to understand acute respiratory disease transmission. Am J Epidemiol 164(10): 945
Halloran ME, Longini IM, Nizam A, Yang Y (2002) Containing bioterrorist smallpox. Science 298: 1428–1432
Halloran ME, Ferguson NM, Eubank S, Longini I (2008) Modeling targeted layered containment of an influenza pandemic in the United States. PNAS 105(12): 4639–4644
Handel A, Longini I, Antia R (2009) Towards a quantitative understanding of the within-host dynamics of influenza A infections. Epidemics 1(3): 185–195
HHS (2007) Pandemic planning update iv. http://www.pandemicflu.gov/plan/panflureport4.html
Institute of Medicine (IOM) (2008) Antivirals for pandemic influenza: guidance on developing a distribution and dispensing program. The National Academies Press, Washington, DC
Jacksonville Aviation Authority: daily traffic volume data (2010) http://www.jaa.aero/General/Default.aspx. Last accessed on 04/07/2010
Keane M, Walter M, Patel B, Moorthy S, Stevens R, Bradley K, Buford J, Anderson E, Anderson L, Tibbals K (2005) Confidence in vaccination: a parent model. Vaccine 23(19): 2486–2493
Kelso J, Milne G, Kelly H (2009) Simulation suggests that rapid activation of social distancing can arrest epidemic development due to a novel strain of influenza. BMC Public Health 9(1): 1–10
Larson R (2007) Simple models of influenza progression within a heterogeneous population. Oper Res 55(399–412): 165–195
Lawless J, Lawless J (1982) Statistical models and methods for lifetime data. Wiley, New York
Lipsitch M, Cohen T, Murray M, Levin B (2007) Antiviral resistance and the control of pandemic influenza. PLoS Med 4(1): 111–115
Longini IM (1986) The generalized discrete-time epidemic model with immunity: a synthesis. Math Biosci 82: 19–41
Longini IM, Koopman JS (1982) Household and community transmission parameters from final distributions of infections in households. Biometrics 38: 115–126
Longini IM, Halloran ME, Nizam A, Yang Y (2004) Containing pandemic influenza with antiviral agents. Am J Epidemiol 159(7): 623–633
Longini IM, Nizam A, Shufu X, Ungchusak K, Hanshaoworakul W, Cummings D, Halloran ME (2005) Containing pandemic influenza at the source. Science 309: 1083–1087
Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, Sadavoy J, Verhaeghe L, Steinberg R, Mazzulli T (2003) The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Can Med Assoc J 168(10): 1245–1251
Meltzer M, Cox N, Fukuda K (1999) The economic impact of pandemic influenza in the United States: priorities for intervention. Emerg Infect Dis 5(5): 659–671
Miami International Airport: daily traffic volume data (2010) http://www.miami-airport.com. Last accessed on 04/07/2010
Mills C, Robins J, Lipsitch M (2004) Transmissibility of 1918 pandemic influenza. Nature 432: 904–906
Milne G, Kelso J, Kelly H, Huband S, McVernon J (2008) A small community model for the transmission of infectious diseases: comparison of school closure as an intervention in individual-based models of an influenza pandemic. PLoS One 3(12): 1–7
Niederhauser V, Baruffi G, Heck R (2001) Parental decision-making for the varicella vaccine. J Pediatr Health Care 15(5): 236–243
Nigmatulina KR, Larson RC (2009) Living with influenza: impacts of government imposed and voluntarily selected interventions. Eur J Oper Res 195(6/1): 613–627
Ortutay B (2010) How thermal-imaging cameras spot flu fevers. http://www.msnbc.msn.com/id/30523865/. Last accessed on 03/19/2010
Pasteur S (2009) Influenza A(H1N1) 2009 monovalent vaccine. http://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm182404.pfd. Last accessed on 11/18/2009
Patel R, Longini I, Halloran M (2005) Finding optimal vaccination strategies for pandemic influenza using genetic algorithms. J Theor Biol 234: 201–212
PayScale (2009) Job: registered nurse (rn). http://www.payscale.com/rcsearch.aspx?country=US&str=Registered+Nurse+. Last accessed on 12/28/2009
Pearson M, Bridges C, Harper S (2006) Influenza vaccination of health-care personnel. Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) [Internet]. Last accessed on 10/28/2009
PharmacyChecker.com (2009) Pricing & ordering comparisons. http://www.pharmacychecker.com/Pricing.asp?DrugId=36260&DrugStrengthId=61300&sortby=Price. Last accessed on 12/28/2009
Pitzer V, Olsen S, Bergstrom C, Dowell S, Lipsitch M (2007a) Little evidence for genetic susceptibility to influenza A (H5N1) from family clustering data. Emerg Infect Dis 13(7): 1074–1076
Pitzer V, Leung G, Lipsitch M (2007b) Estimating variability in the transmission of severe acute respiratory syndrome to household contacts in Hong Kong, China. Am J Epidemiol 166(3): 355–359
Pourbohloul B, Ahued A, Davoudi B, Meza R, Meyers L, Skowronski D, Villaseñor I, Galván F, Cravioto P, Earn D et al (2009) Initial human transmission dynamics of the pandemic (H1N1) 2009 virus in North America. Influenza Other Respir Viruses 3(5): 215–222
Rhodes S, Hergenrather K (2002) Exploring hepatitis B vaccination acceptance among young men who have sex with men: facilitators and barriers. Prevent Med 35(2): 128–134
Robertson E, Hershenfield K, Grace S, Stewart D (2004) The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatry 49: 403–407
Rosenthal S, Kottenhahn R, Biro F, Succop P (1995) Hepatitis B vaccine acceptance among adolescents and their parents. J Adolesc Health 17(4): 248–255
Sadique M, Edmunds W, Smith R, Meerding W, de Zwart O, Brug J, Beutels P (2007) Precautionary behavior in response to perceived threat of pandemic influenza. Emerg Infect Dis 13(9): 1307
Safranek T, Lawrence D, Kuriand L, Culver D, Wiederholt W, Hayner N, Osterholm M, O’Brien P, Hughes J (1991) Reassessment of the association between Guillain-Barré syndrome and receipt of swine influenza vaccine in 1976–1977: results of a two-state study. Am J Epidemiol 133(9): 940
Savachkin A, Uribe-Sánchez A, Das T, Prieto D, Santana A, Martinez D (2010a) Supplemental data and model parameter values for cross-regional simulation-based optimization testbed. http://imse.eng.usf.edu/pandemic/supplement.pdf. Last accessed on 04/15/2010
Savachkin A, Uribe A, Das T, Prieto D (2010b) Developing dynamic predictive strategies for mitigation of cross-regional pandemic outbreaks. IIE Trans (in review)
Scharfstein D, Halloran M, Chu H, Daniels M (2006) On estimation of vaccine efficacy using validation samples with selection bias. Biostatistics 7(4): 615
Schoenstadt A (2009) Spanish flu. http://flu.emedtv.com/spanish-flu/spanish-flu.html. Last accessed on 12/15/2009
Smailbegovic M, Laing G, Bedford H (2003) Why do parents decide against immunization? The effect of health beliefs and health professionals. Child Care Health Dev 29(4): 303
Svensson A (2007) A note on generation times in epidemic models. Math Biosci 208(1): 300–311
Treanor J, Campbell J, Zangwill K, Rowe T, Wolff M (2006) Safety and immunogenicity of an inactivated subvirion influenza A(H5N1) vaccine. N Engl J Med 3554(13): 1343
Tallahassee Regional Airport: daily traffic volume data (2010) http://www.talgov.com/airport/index.cfm. Last accessed on 04/07/2010
Tampa International Airport: daily traffic volume data (2010) http://www.tampaairport.com. Last accessed on 04/07/2010
Tang Y, Longini I, Halloran M (2006) Design and evaluation of prophylactic interventions using disease incidence data from close contact groups. Appl Stat 55(3): 317–330
The New Yorker (2009) The fear factor. http://www.newyorker.com/talk/comment/2009/10/12/091012taco_talk_specter. Last accessed on 10/28/2009
The New York Times (2009) Doctors swamped by swine flu vaccine fears. http://www.msnbc.msn.com/id/33179695/ns/health-swine_flu/. Last accessed on 10/28/2009
Uribe A, Prieto D, Savachkin A, Das T, Zhu Y (2008) A cross-regional pandemic outbreak simulation model: an aid to national resource allocation policy making. In: Proceedings of the 3rd INFORMS workshop on data mining and health informatics (DM-DI 2008)
US Census Bureau (2000) 2001 American community survey. http://www.census.gov/prod/2001pubs/statab/sec01.pdf. Last accessed on 03/27/2009
US Department of Health & Human Services (2007) HHS pandemic influenza plan. http://www.hhs.gov/pandemicflu/plan/. Last accessed on 03/27/2009
WHO Global Influenza Programme (2009) Pandemic influenza preparedness and response. Tech. Rep. World Health Organization
World Health Organization (WHO) (2004) WHO guidelines on the use of vaccine and antivirals during influenza pandemics. http://www.who.int/csr/resources/publications/influenza/11_29_01_A.pdf. Retrieved 03/27/2009
World Health Organization (2009) Pandemic (h1n1) 2009 vaccine deployment update, 17 December 2009. http://www.who.int/csr/disease/swineflu/vaccines/h1n1_vaccination_deployment_update_20091217.pdf
World Health Organization (WHO) (2010a) Cumulative number of confirmed human cases of Avian Influenza A(H5N1) reported to WHO. http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_07_05/en/index.html
World Health Organization (2010b) Pandemic (H1N1) 2009—update 107. http://www.who.int/csr/don/2010_07_02/en/index.html. Last accessed on 07/08/2010
Writing Committee of the World Health Organization (WHO): (2005) Consultation on human influenza A/H5. Avian influenza A(H5N1) infection in humans. N Engl J Med 353(13): 1374–1385
Wu JT, Riley S, Fraser C, Leung G (2006a) Spatial considerations for the allocation of pre-pandemic influenza vaccination in the United States. Proc R Soc Biol Sci 274(1627): 2811–2817
Wu JT, Riley S, Fraser C, Leung G (2006b) Reducing the impact of the next influenza pandemic using household-based public health interventions. PLoS Med 3(9): 1532–1540
Yang Y, Sugimoto J, Halloran M, Basta N, Chao D, Matrajt L, Potter G, Kenah E, Longini I Jr (2009a) The transmissibility and control of pandemic influenza A (H1N1) virus. Science 326(5953): 729–733
Yang Y, Halloran M, Longini I Jr (2009b) A Bayesian model for evaluating influenza antiviral efficacy in household studies with asymptomatic infections. Biostatistics 10(2): 390
Yang Y, Halloran M, Sugimoto J, Longini I Jr (2007) Detecting human-to-human transmission of avian influenza A (H5N1). Emerg Infect Dis 13(9): 1348–1353
Yasuda H, Suzuki K (2009) Measures against transmission of pandemic H1N1 influenza in Japan in 2009: simulation model. Eur Commun Dis Bull [Euro surveillance: bulletin européen sur les maladies transmissibles] 14(44): 1–7
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Uribe-Sánchez, A., Savachkin, A., Santana, A. et al. A predictive decision-aid methodology for dynamic mitigation of influenza pandemics. OR Spectrum 33, 751–786 (2011). https://doi.org/10.1007/s00291-011-0249-0
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DOI: https://doi.org/10.1007/s00291-011-0249-0