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Scenarios on the impact of pandemic influenza: preparedness planningMarianne van Genugten, Marie-Louise Heijnen, Hans Jager
Pandemic influenza | Genugten, Heijnen en Jager
Pandemic influenza?
• Influenza viruses changes slightly and frequently over time (antigenic drift)
• In some years the virus changes dramatically (antigenic shift)
• Earlier pandemics
Pandemic influenza | Genugten, Heijnen en Jager
Pandemic plan
• Another influenza pandemic is inevitable• High morbidity and mortality
Influenza pandemic planThe Dutch Ministry on Health, Welfare and sports
has designed a national plan in order to minimise the effects of pandemic influenza
Pandemic influenza | Genugten, Heijnen en Jager
Question
What is the expected number of of hospitalisations and deaths during an influenza pandemic?
1) What are options for intervention? Building-up of stocks (national level)
2) Number of hospital beds needed versus available. Contingency planning (local level)
Pandemic influenza | Genugten, Heijnen en Jager
Method
Many uncertainties Scenario-analysis
• model and data• expert consultation
– assumptions– scenario’s
Pandemic influenza | Genugten, Heijnen en Jager
v a c c in e c ov e r ag e a nd e ffic a cy
a tta c k r a te
h o sp ita lisa tio n r a ted e a th r a te
N u m b er ofh osp ita lisations
N u m b er ofd eaths
n u m b er of p ersonsw ith
in flu en za lik e illn ess
p op u lationat risk
p op u lation byh igh risk and
low risk
Model
Pandemic influenza | Genugten, Heijnen en Jager
Data need
• Population by risk • Age-specific attack, hospitalisation and
death rates – including excess
• Efficacy
Pandemic influenza | Genugten, Heijnen en Jager
Main assumptions
pandemic influenza ‘usual’ epidemic influenza
• age-specific hospitalisation, death and attack rates as in earlier epidemics
• basic care
(sensitivity analysis on age-specific rates)
Pandemic influenza | Genugten, Heijnen en Jager
Scenarios
• Non intervention • No influenza vaccine available and
pneumococcal vaccination of risk groups • No influenza vaccine available and
therapeutic use of antivirals for each person with influenza like illness
• Influenza vaccine available
Pandemic influenza | Genugten, Heijnen en Jager
1.915819
3.395
1.347
4.040
10.186
0
3.000
6.000
9.000
12.000
number of hospitalisations number of deaths
epidemic
pandemic of 10%
pandemic of 30%
Number of hospitalisations and deaths
Pandemic influenza | Genugten, Heijnen en Jager
2,78
4,693,59
15,62
5.093 (50%)
6.218 (61%)
6.339 (62%)
2.618 (26%)
0
5
10
15
20
25
pneumococcal vaccinationmedical risk groups
therapeutic use of antivirals influenza vaccination medicalrisk groups and health care
workers
influenza vaccination totalpopulation
req
uir
ed d
oses
/pre
scri
pti
ons
(mill
ion
s)
-
1.000
2.000
3.000
4.000
5.000
6.000
7.000
avoi
ded
nu
mb
er o
f h
osp
ital
isat
ion
s
Required doses/prescriptions
Avoided hospitalisations
Result 1: Avoided number of hospitalisations / required doses
Pandemic influenza | Genugten, Heijnen en Jager
Result 2: Hospital beds needed/available
Non intervention scenario– duration 6 weeks– length of hospital stay 8-14 days
6.000-8.500 beds needed
Total number of beds 55.000
Beds available depends on occupancy rate and nursing staff available
Pandemic influenza | Genugten, Heijnen en Jager
Preparedness planning
RIVM policy makers
Message policy makers ‘flu’ can be seriousminister of Health (national level)contingency planners (local level)
Pandemic influenza | Genugten, Heijnen en Jager
Conclusions
Scenario-analysis supports decision makers and contingency planners on national and local level
Insight in• the number of hospitalisations and deaths• comparison of intervention options • the crucial model parameters