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Targeted treatment could contain flu pandemic

Infection Control Monitor, April 1, 2004

A new study found that in a future outbreak of pandemic influenza, authorities could prevent thousands of deaths by giving antiviral agents to the close contacts of those with suspected cases of flu until adequate vaccine supplies are available, Drug Week reports.

The American Journal of Epidemiology published on April 1 the results of the research by Emory University professors of biostatistics Ira Longini, Jr., PhD, and M. Elizabeth Halloran, MD, DSc, and their colleagues Azhar Nizam, MS, and Yang Yang, BSc.

The Emory scientists used a simulation model of an influenza pandemic or bioterrorist attack for an agent similar to influenza A, which caused the Asian flu pandemic of 1957-58 and resulted in about 70,000 deaths in the United States. They found that if no interventions were used in a similar pandemic, 33% of the population would become ill, resulting in a death rate of 0.58 per 1,000 people.

But if antiviral prophylaxis were given to close contacts of 80% of people with suspected influenza, the epidemic could be contained. If targeted antiviral prophylaxis (TAP) began within one day of identifying suspected flu cases and used for up to eight weeks, only 2% of the population would become ill, and the death rate would be only 0.04 per 1,000 people. The researchers found that eight weeks of TAP would be nearly as effective as vaccinating 80% of the population.

This approach would be valuable because pandemics occur when there is a dramatic shift in the current flu strain. Annual flu vaccines are designed to counter the strain of flu from the previous season, and often there is insufficient time to make enough vaccine to fight the first wave of a new outbreak. Manufacturing and distributing a vaccine to match a newly identified strain can take six to eight months.

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