1. Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
2. The Institute of Mathematical Sciences, Imperial College London, 53 Princes Gate, London, SW7 2PG, UK
3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, Maryland 21205, USA
4. INSERM U707, 27 rue Chaligny, Paris 75571, cedex 12, France
5. Department of Community Medicine, 5/F William M. W. Mong Block, Faculty of Medicine Building, The University of Hong Kong, 21 Sassoon Road, Hong Kong
6. Bureau of Epidemiology, Department of Diseases Control, Ministry of Public Health, Tivanonda Road, Nonthaburi 11000, Thailand

Correspondence to: Neil M. Ferguson^1,2 Correspondence and requests for materials should be addressed to N.M.F. (Email: neil.ferguson@imperial.ac.uk).

Abstract

Highly pathogenic H5N1 influenza A viruses are now endemic in avian populations in Southeast Asia, and human cases continue to accumulate. Although currently incapable of sustained human-to-human transmission, H5N1 represents a serious pandemic threat owing to the risk of a mutation or reassortment generating a virus with increased transmissibility. Identifying public health interventions that might be able to halt a pandemic in its earliest stages is therefore a priority. Here we use a simulation model of influenza transmission in Southeast Asia to evaluate the potential effectiveness of targeted mass prophylactic use of antiviral drugs as a containment strategy. Other interventions aimed at reducing population contact rates are also examined as reinforcements to an antiviral-based containment policy. We show that elimination of a nascent pandemic may be feasible using a combination of geographically targeted prophylaxis and social distancing measures, if the basic reproduction number of the new virus is below 1.8. We predict that a stockpile of 3 million courses of antiviral drugs should be sufficient for elimination. Policy effectiveness depends critically on how quickly clinical cases are diagnosed and the speed with which antiviral drugs can be distributed.

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