Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T08:20:13.071Z Has data issue: false hasContentIssue false

Responding to Simulated Pandemic Influenza in San Antonio, Texas

Published online by Cambridge University Press:  02 January 2015

George Miller*
Affiliation:
Altarum Institute, Ann Arbor, Michigan
Stephen Randolph
Affiliation:
Altarum Institute, San Antonio, Texas
Jan E. Patterson
Affiliation:
Departments of Medicine and Pathology, University of Texas Health Science Centerand South Texas Veterans Health Care System, San Antonio, Texas
*
Altarum Institute, P.O. Box 134001, Ann Arbor, MI 48113-4001 ([email protected])

Abstract

Objective.

To describe the results of a simulation study of the spread of pandemic influenza, the effects of public health measures on the simulated pandemic, and the resultant adequacy of the surge capacity of the hospital infrastructure and to investigate the adequacy of key elements of the national pandemic influenza plan to reduce the overall attack rate so that surge capacity would not be overwhelmed.

Design.

We used 2 discrete-event simulation models: the first model simulates the contact and disease transmission process, as affected by public health interventions, to produce a stream of arriving patients, and the second model simulates the diagnosis and treatment process and determines patient outcomes.

Setting.

Hypothetical scenarios were based on the response plans, infrastructure, and demographic data of the population of San Antonio, Texas.

Results.

Use of a mix of strategies, including social distancing, antiviral medications, and targeted vaccination, may limit the overall attack rate so that demand for care would not exceed the capacity of the infrastructure. Additional simulations to assess social distancing as a sole mitigation strategy suggest that a reduction of infectious community contacts to half of normal levels would have to occur within approximately 7 days.

Conclusions.

Under ideal conditions, the mix of strategies may limit demand, which can then be met by community surge capacity. Given inadequate supplies of vaccines and antiviral medications, aggressive social distancing alone might allow for the control of a local epidemic without reliance on outside support.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Leitenberg, M. Assessing the biological weapons and bioterrorism threat. Strategic Studies Institute, US Army War College, 2005. Available at: http://www.cissm.umd.edu/papers/files/assessing_bw_threat.pdf. Accessed December 28, 2006.Google Scholar
2.US General Accounting Office. Bioterrorism, Federal Research and Preparedness Activities. Washington, DC: US General Accounting Office; 2001:22. GAO01-915.Google Scholar
3.Miller, G, Randolph, S, Gower, D. Simulating the response of a rural acute health-care delivery system to a bioterrorist attack. Intl J Disaster Med 2004;2:2432.CrossRefGoogle Scholar
4.Miller, G, Randolph, S, Patterson, JE. Responding to bioterrorist smallpox in San Antonio. Interfaces 2006;36:580590.CrossRefGoogle Scholar
5.Elveback, LR, Fox, JP, Ackerman, E, Langworthy, A, Boyd, M, Gatewood, L. An influenza simulation model for immunization studies. Am J Epidemiol 1976;103:152165.CrossRefGoogle ScholarPubMed
6.Cunha, B. Influenza: historical aspects of epidemics and pandemics. Dis Clin North Am 2004;18:141155.CrossRefGoogle ScholarPubMed
7.Billings, M. The Influenza Pandemic of 1918. June 1997. Available at: http://virus.stanford.edu/uda/. Accessed December 15, 2006.Google Scholar
8.Homeland Security Council. National Strategy for Pandemic Influenza. Washington, DC: Homeland Security Council; November 2005.Google Scholar
9.US Department of Health and Human Services. HHS Pandemic Influenza Plan. Washington, DC: US Dept of Health and Human Services; November 2005.Google Scholar
10.Bootsma, CJ, Ferguson, NM. The effect of public health measures on the 1918 influenza pandemic in US cities. 2007. Available at: http:// www.pnas.org/cgi/doi/10.1073/pnas.0611071104. Accessed May 1, 2007.Google Scholar
11.Longini, IM Jr, Nizam, A, Xu, S, et al.Containing pandemic influenza at the source. Science 2005;309:10831087.CrossRefGoogle ScholarPubMed
12.Ferguson, NM, Cummings, DAT, Cauchemez, S, et al.Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature 2005;437:209214.Google Scholar
13.Germann, TC, Kadau, K, Longini, IM Jr, Macken, CA. Mitigation measures for pandemic influenza in the United States. Proc Natl Acad Sci USA 2006;103:59355940.Google Scholar
14.US Department of Health and Human Services, Centers for Disease Control and Prevention. Interim pre-pandemic planning guidance: community strategy for pandemic influenza mitigation in the United States. February 2007. Available at: http://www.pandemicflu.gov/plan/ community/mitigation.html. Accessed February 26, 2007.Google Scholar
15.2000 US Census. Available at: http://www.census.gov/population/www/ projections/st_yr01to05.html. Accessed July 14, 2006.Google Scholar
16.Randolph, S, Miller, G. Validation of the Casualty Prediction Model. Altarum Institute. July 2007. Available at: http://www.altarum.org/ FCKeditor/UserFiles/File/CPMValidation_ib.pdf. Accessed November 19, 2007.Google Scholar
17.Longini, IM, Koopman, JS, Monto, AS, Fox, JP. Estimating household and community transmission parameters for influenza. Am J Epidemiol 1982;115:736751.Google Scholar
18.Longini, IM, Koopman, JS, Haber, M, Cotsonis, GA. Statistical inference for infectious diseases, risk-specific household and community transmission parameters. Am J Epidemiol 1988;128:845859.CrossRefGoogle ScholarPubMed
19.Barnitz, L. The Health Care Response to Pandemic Influenza: A Position Paper. Washington, DC: American College of Physicians; 2006.Google Scholar
20.Gani, R, Hughes, H, Fleming, D, Griffin, T, Medlock, J, Leach, S. Potential impact of antiviral drug use during influenza pandemic. Emerg Infect Dis 2005;11:13551362.CrossRefGoogle ScholarPubMed
21.Longini, IM, Halloran, ME, Nizam, A, Yang, Y. Containing pandemic influenza with antiviral agents. Am J Epidemiol 2004;159:623633.Google Scholar
22.Patterson, JE. SARS in Toronto: what does it mean for us? [commentary] Contagion 2005;2:14.Google Scholar
23.Hayden, FG, Pavia, AT. Antiviral management of seasonal and pandemic influenza. J Infect Dis 2006;194:S119S126.Google Scholar
24.Treanor, JJ, Campbell, JD, Zangwill, KM, Rowe, T, Wolff, M. Safety and immunogenicity of an inactivated subvirion influenza A (H5N1) vaccine. N Engl J Med 2006;354:13431351.Google Scholar
25.Markei, H, Lipman, HB, Navarro, JA, et al.Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA 2007;298:644654.Google Scholar
26.Markei, H, Stern, AM, Navarro, JA, Michaisen, JR. A historical assessment of nonpharmaceutical disease containment strategies employed by selected US communities during the wave of the 1918-1920 influenza pandemic. Defense Threat Reduction Agency, January 31, 2006. Available at: http:// www.med.umich.edu/medschool/chm/influenza/. Accessed August 13, 2007.Google Scholar