Nayer Khazeni, MD, MS; David W. Hutton, MS, PhD; Cassandra I.F. Collins, MPH; Alan M. Garber, MD, PhD; Douglas K. Owens, MD, MS
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Acknowledgment: The authors thank Charlotte Chae for her assistance with the graphics.
Grant Support: In part by Agency for Healthcare Research and Quality (grant 5 K08 HS 019816; Dr. Khazeni), National Institutes of Health (grant 5 R01 DA015612-12; Dr. Owens), and Veterans Affairs Palo Alto Health Care System (Dr. Owens).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2071.
Reproducible Research Statement: Study protocol, statistical code, and data set: An annotated version of the model is available in Supplement 1.
Requests for Single Reprints: Nayer Khazeni, MD, MS, Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, Room H3143, Stanford, CA 94305; e-mail, email@example.com.
Current Author Addresses: Dr. Khazeni: Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, Room H3143, Stanford, CA 94305.
Drs. Hutton and Collins: Department of Health Management & Policy, 1415 Washington Heights, University of Michigan, Ann Arbor, MI 48109.
Dr. Garber: Office of the Provost, Harvard University, Cambridge, MA 02138.
Dr. Owens: Center for Health Policy/Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305.
Author Contributions: Conception and design: N. Khazeni, D.W. Hutton, D.K. Owens.
Analysis and interpretation of the data: N. Khazeni, D.W. Hutton, A.M. Garber, D.K. Owens.
Drafting of the article: N. Khazeni, D.W. Hutton, C.I.F. Collins.
Critical revision of the article for important intellectual content: N. Khazeni, D.W. Hutton.
Final approval of the article: N. Khazeni, D.W. Hutton, C.I.F. Collins, A.M. Garber, D.K. Owens.
Provision of study materials or patients: N. Khazeni.
Statistical expertise: N. Khazeni, D.W. Hutton, A.M. Garber, D.K. Owens.
Obtaining of funding: N. Khazeni, D.K. Owens.
Administrative, technical, or logistic support: N. Khazeni, A.M. Garber, C.I.F. Collins.
Collection and assembly of data: N. Khazeni, C.I.F. Collins.
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.
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).
Dynamic transmission model to estimate health and economic consequences of a severe influenza pandemic in a large metropolitan city.
Literature and expert opinion.
Residents of a U.S. metropolitan city with characteristics similar to New York City.
Vaccination of 30% of the population at 4 or 6 months.
Infections and deaths averted and cost-effectiveness.
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.
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.
The model is not designed to evaluate programs targeting specific populations, such as children or persons with comorbid conditions.
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.
Agency for Healthcare Research and Quality, National Institutes of Health, and Department of Veterans Affairs.
Nayer Khazeni, David W. Hutton, Cassandra I.F. Collins, Alan M. Garber, Douglas K. Owens. Health and Economic Benefits of Early Vaccination and Nonpharmaceutical Interventions for a Human Influenza A (H7N9) Pandemic: A Modeling Study. Ann Intern Med. 2014;160:684–694. doi: 10.7326/M13-2071
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Published: Ann Intern Med. 2014;160(10):684-694.
High Value Care, Infectious Disease, Influenza, Prevention/Screening, Vaccines/Immunization.
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