Engineering Effective Response to Outbreaks of Influenza AAAS National Meeting, San Jose, California Richard C. Larson Massachusetts Institute of Technology.

Engineering Effective Response to Outbreaks of Influenza

AAAS National Meeting, San Jose, California

Richard C. LarsonMassachusetts Institute of Technology

Cambridge, Massachusetts 02139

February 13, 2015

Status: MERS

Flu H5N1

Flu H9N7

Each a Major Threat to the World

And now, Ebola

We Often Plan Based on Past “Anchored Events”

• 1918 ‘Spanish’ Flu

And, about 60 months ago, we found ourselves living with

Novel H1N1 “Swine Flu”

Supported by the CDC, the Sloan Foundation & IBM• “Decision-Oriented Analysis of Pandemic

Flu Preparedness & Response.” • Our focus: Social distancing, hygienic

responses and other NPI’s, Non- Pharmaceutical Interventions.

• Vaccine allocation.• Educational outreach.

Our Team• Dr. Stan Finkelstein, Co-PI, ESD and Harvard Medical School

faculty member.

• Richard C. Larson, PI, ESD.

• John M. Barry, Historian

• James McDevitt, Ph.D., Faculty, Harvard School of Public Health

• Karima Nigmatulina, OR Ph.D. Student

• Anna Teytelman, OR Ph.D. student

• Dr. Sahar Hashmi, MD and ESD Ph.D. student

• Shiva Prakash, Sloan Masters student

• Kallie Hedberg, MIT CEE Undergraduate student

• Julia A. Hopkins, MIT CEE Undergraduate student (now MIT PhD student in environmental science)

SARS, 2003NPI’s: We Learned from SARS

A simple law----

Flu Fundamentals:

R0=pfrequency of daily contacts (“lambda”)

p=probability of transmitting infection, given contact

•Let’s talk about

Let’s talk about p

Let’s talk about The probability

distribution whose mean is R0

Karima Nigmatulina’s Ph.D. Thesis:Modeling and Responding to Pandemic Influenza:

Importance of Population Distributional Attributes and Non-Pharmaceutical Interventions

Vaccine distribution ---

Large

Vaccine Distribution in the US

> 4 weeks after peak

between 2 and 4 weeks after peak

> 4 weeks before peak

1 week before peak

1 week after peak

between 2 and 4 weeks before peak

at peak

First vaccines delivered with respect to peak of

infection

• The CDC started shipping vaccines in early October 2009

Measure: Number of WeeksBefore Peak that Vaccines

are Shipped

H1N1 Vaccine Administration

# Of States Peaking…Week 39 or

earlierWeek 40 or

earlierWeek 41 or

earlierWeek 42 or

earlierWeek 43 or earlier Week 44 or

earlier

10 14 24 34 40 44

Week Ending October 10

Paper published: Vaccine availability in the United States during the 2009 H1N1 outbreak. American Journal of Disaster Medicine.

Typical Example: Indiana

• Administration of vaccine lags shipment• Vaccine effectiveness lags administration Few are protected in time to affect epidemic

Vaccine Distribution Model

Goal: To estimate numbers of flu cases averted by delivery of the vaccine according to reported data.

Goal: To estimate the beneficial effects of delivering the vaccine earlier than actual.

Key metrics: Numbers of infections averted; number of deaths averted.

Example: Oklahoma

Example: Oklahoma

Vaccine Model: Results• Effect of single vaccine depends on timing

• Vaccinating early avoids infection for more than the vaccinated person

• Needs to be taken into account

Best Paper of the Year Award, Value in Health

Think of Fire Fighting

• Is it better to pour lots of water on a fire already blazing and out of control? OR

• To focus the limited water on at-risk structures that are not yet burning, and save them entirely?

Finally, Two More Items:

Article designated for AMA PRA Category 1 Credit™. Physicians and other health professionals earn credit by reading the article in the online issue of DMPHP and taking a quiz online.

The CDC is now undertaking a trial implementation of requiring this article and its approach for all CDC employees.

Discussion…

HealthMap tracks Ebola’s footprints online

• ESD Ph.D. Student -- Maia Majumder• http://healthmap.org/site/diseasedaily/article/estimating-fatality-2014-west-af

rican-ebola-outbreak-91014