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Modeling Community Containment for Pandemic Influenza

A Letter Report

Committee on Modeling Community Containment for Pandemic Influenza

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES

Washington, D.C.
www.nap.edu



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Modeling Community Containment for Pandemic Influenza: A Letter Report Modeling Community Containment for Pandemic Influenza A Letter Report Committee on Modeling Community Containment for Pandemic Influenza Board on Population Health and Public Health Practice INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES Washington, D.C. www.nap.edu

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Modeling Community Containment for Pandemic Influenza: A Letter Report THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Grant No. 6 IOMHP041000-02-01 between the National Academy of Sciences and the US Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Modeling Community Containment for Pandemic Influenza: A Letter Report “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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Modeling Community Containment for Pandemic Influenza: A Letter Report THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Modeling Community Containment for Pandemic Influenza: A Letter Report COMMITTEE ON MODELING COMMUNITY CONTAINMENT FOR PANDEMIC INFLUENZA ADEL A.F. MAHMOUD, M.D., Ph.D., (Chair), Former President, Merck Vaccines, Princeton, NJ BENJAMIN BERKMAN, M.P.H., J.D., Fellow, Center for Law and Public’s Health, Georgetown University Law Center, Washington, DC KATHLEEN M. CARLEY, Ph.D., Professor, Institute for Software Research International, Carnegie Mellon University, Pittsburgh, PA PATRICK CHAULK, M.D., M.P.H., Senior Associate for Health, Annie B. Casey Foundation, Baltimore, MD JOSEPH FLAHERTY, M.D., Dean of the College of Medicine, Professor of Psychiatry, University of Illinois at Chicago JAMES M. HUGHES, M.D., Director, Program in Global Infectious Disease, School of Medicine, Emory University, Atlanta, GA PEGI MCEVOY, M.N., C.S., A.R.N.P., Safety Administrator, Security Department, Seattle Public Schools, Shoreline, WA ARNOLD S. MONTO, M.D., Professor, Department of Epidemiology, University of Michigan, Ann Arbor MARCELLO PAGANO, Ph.D., Professor of Statistical Computing, Department of Biostatistics, Harvard School of Public Health, Boston, MA A. DAVID PALTIEL, Ph.D., Associate Professor, Department of Epidemiology and Public Health, Yale School of Medicine, Yale University, New Haven, CT M. PATRICIA QUINLISK, M.D., Medical Director and State Epidemiologist, Iowa Department of Health, Des Moines ISAAC WEISFUSE, M.D., M.P.H., Deputy Commissioner, Division of Disease Control, New York City Department of Health and Mental Hygiene, NY RICHARD J. ZECKHAUSER, Ph.D., Frank P. Ramsey Professor of Political Economy, John F. Kennedy School of Government, Harvard University, Cambridge, MA Staff KATHLEEN STRATTON, Ph.D., Study Director ALICIA GABLE, M.P.H., Senior Program Officer KRISTINA VAN DOREN-SHULKIN, Senior Program Assistant ROSE MARIE MARTINEZ, Sc.D., Director, Board on Population Health and Public Health Practice

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Modeling Community Containment for Pandemic Influenza: A Letter Report REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Doug Campos-Outcalt, Department of Family and Community Medicine, University of Arizona College of Medicine, Phoenix Victor DeGruttola, Department of Biostatistics, Harvard School of Public Health, Boston, MA Catherine Dibble, Assistant Professor, Department of Geography, University of Maryland Kathleen Gensheimer, Bureau of Health, Maine Department of Human Services David Heyman, Homeland Security Program, Center for Strategic and International Studies Peter Palese, Department of Microbiology, Department of Medicine, Mount Sinai School of Medicine Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by David R. Challoner, Vice President for Health Affairs, Emeritus, University of Florida. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Modeling Community Containment for Pandemic Influenza: A Letter Report CONTENTS      INFLUENZA EPIDEMIOLOGY   2      MODELS OF CONTAINMENT STRATEGIES FOR PANDEMIC INFLUENZA   3      Role of Models in Policy Decisions,   3      Simulation Models of Containment Strategies for Pandemic Influenza,   5      EVALUATION OF MODELS OF COMMUNITY CONTAINMENT   10      Methods for Improving Predictive Ability of Models,   13      HISTORICAL ANALYSES   14      Case Series Analysis of Interventions During the 1918 US Pandemic,   14      Analysis of Timing of Interventions and Epidemic Patterns During the 1918 US Pandemic,   15      Effectiveness of Interventions During the 1918 US Pandemic and Effectiveness of School Closures,   16      LESSONS FROM SIMULATION MODELS AND HISTORICAL ANALYSES   19      OTHER FORMS OF EVIDENCE REVIEWED   20      THE ROLE FOR AND COMMUNITY IMPACT OF CONTAINMENT STRATEGIES   20      Considering Community Impact,   22      Infection Control and Prevention,   23      Antiviral Prophylaxis and Treatment,   25      Patient Management,   25      Contact Management,   26      Community Restrictions,   27      Risk Communication,   29      CONCLUDING REMARKS   29      TABLE 1:  SUMMARY OF COMMITTEE CONCLUSIONS   31      TABLE 2:  LIST OF COMMITTEE RECOMMENDATIONS   33      REFERENCES   35

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