Research Article: Adaptive Vaccination Strategies to Mitigate Pandemic Influenza: Mexico as a Case Study

Date Published: December 3, 2009

Publisher: Public Library of Science

Author(s): Gerardo Chowell, Cécile Viboud, Xiaohong Wang, Stefano M. Bertozzi, Mark A. Miller, Howard E. Gendelman.

Abstract: We explore vaccination strategies against pandemic influenza in Mexico using an age-structured transmission model calibrated against local epidemiological data from the Spring 2009 A(H1N1) pandemic.

Partial Text: Although countries have developed influenza pandemic preparedness plans, uncertainties remain in terms of the virulence and transmissibility of pandemic strains as well as population immunity profiles. In particular, there has been heterogeneity in the past three influenza pandemics of the 20th Century [1], [2] with regard to transmissibility, ranging from an average of 1.5 to 5.4 secondary cases per primary case in the community; [3], [4], [5], [6], [7]; case fatality rate, range, 0.1%–4% [3], [8] ; and age-specific mortality rates [3], [9]. While differences in transmissibility and case fatality rate remain poorly understood, mortality age patterns could be explained in part by the history of previously circulating influenza viruses, with early-life exposure to related viruses reducing risk for severe pandemic outcomes [10], [11]. Moreover, recent studies have evidenced important geographical variations in pandemic morbidity and mortality burden [2], [7], [12], [13], [14], [15], as well as variations in severity of successive pandemic waves. Pandemic preparedness plans have not adequately incorporated such uncertainties, which are difficult to resolve prior to pandemic onset but can be deduced once a novel pandemic virus is identified.

To compare the effectiveness of various vaccination strategies against pandemic influenza in Mexico, we used an age-structured influenza transmission model that accounts for age-specific risk of illness, hospitalization, and death and simulated a variety of epidemiological and vaccination scenarios encompassing the diversity of observed disease patterns from previous pandemics. Incidence rates of clinical cases, hospitalizations and deaths in the absence of vaccination were estimated based on the outbreak of S-OIV in Mexico. In this simulation approach, we assume limited vaccine supplies and age variation in vaccine efficacy. Below we describe the structure of the transmission model, discuss the pandemic scenarios considered, and detail the different vaccination strategies evaluated.

With today’s technologies, little to no vaccines would be immediately available for most of the world at the time of emergence of a novel pandemic virus to contain a potential “herald” wave, as was observed during the summer of 1918 in the US and Europe [4], [7], [39]. A similar situation occurred with the first wave of the S-OIV pandemic in Mexico and elsewhere in spring 2009. Previous models [16], [17], [18] predicted that containment of pandemic influenza could not succeed unless multiple medical and non-medical interventions were layered and applied early, a low to zero probability scenario given the rapidity of events in influenza transmission and global spread. Given the time line of vaccine production and delivery for pandemic viruses, a realistic use of vaccination would be its concurrent delivery during an ongoing pandemic, in particular during a second or third wave.



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