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, firstname.lastname@example.org.
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.
Khazeni N, Hutton DW, Collins CI, Garber AM, Owens DK. 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.
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.
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Infectious Disease, Vaccines/Immunization, Influenza, Prevention/Screening.
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