Health and Economic Benefits of Early Vaccination and Nonpharmaceutical Interventions for a Human Influenza A (H7N9) Pandemic: A Modeling Study

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Abstract

Background:

Vaccination for the 2009 pandemic did not occur until late in the outbreak, which limited its benefits. Influenza A (H7N9) is causing increasing morbidity and mortality in China, and researchers have modified the A (H5N1) virus to transmit via aerosol, which again heightens concerns about pandemic influenza preparedness.

Objective:

To determine how quickly vaccination should be completed to reduce infections, deaths, and health care costs in a pandemic with characteristics similar to influenza A (H7N9) and A (H5N1).

Design:

Dynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.

Data Sources:

Literature and expert opinion.

Target Population:

Residents of a U.S. metropolitan city with characteristics similar to New York City.

Time Horizon:

Lifetime.

Perspective:

Societal.

Intervention:

Vaccination of 30% of the population at 4 or 6 months.

Outcome Measures:

Infections and deaths averted and cost-effectiveness.

Results of Base-Case Analysis:

In 12 months, 48 254 persons would die. Vaccinating at 9 months would avert 2365 of these deaths. Vaccinating at 6 months would save 5775 additional lives and $51 million at a city level. Accelerating delivery to 4 months would save an additional 5633 lives and $50 million.

Results of Sensitivity Analysis:

If vaccination were delayed for 9 months, reducing contacts by 8% through nonpharmaceutical interventions would yield a similar reduction in infections and deaths as vaccination at 4 months.

Limitation:

The model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.

Conclusion:

Vaccination in an influenza A (H7N9) pandemic would need to be completed much faster than in 2009 to substantially reduce morbidity, mortality, and health care costs. Maximizing non-pharmaceutical interventions can substantially mitigate the pandemic until a matched vaccine becomes available.

Primary Funding Source:

Agency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.

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