_|Journ Inf Dis: PRIORITIZATIONS FOR PANDEMIC IV TO MINIMIZE Ys OF LIFE LOST|_

[Giuseppe]

Prioritization of Influenza Pandemic Vaccination to Minimize Years of Life Lost

Mark A. Miller,1 - Cecile Viboud,1 - Donald R. Olson,2 - Rebecca F. Grais,1 - Maia A. Rabaa,1 and - Lone Simonsen3

1Fogarty International Center, National Institutes of Health, Bethesda, Maryland; 2New York City Department of Health and Mental Hygiene, New York, New York; 3Department of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC

Background.
How to allocate limited vaccine supplies in the event of an influenza pandemic is currently under debate.

Conventional vaccination strategies focus on those at highest risk for severe outcomes, including seniors, but do not consider

-- (1) the signature pandemic pattern in which mortality risk is shifted to younger ages,
-- (2) likely reduced vaccine response in seniors, and
-- (3) differences in remaining years of life with age.

Methods.
We integrated these factors to project the age-specific years of life lost (YLL) and saved in a future pandemic, on the basis of mortality patterns from 3 historical pandemics, age-specific vaccine efficacy, and the 2000 US population structure.

Results.
For a 1918-like scenario, the absolute mortality risk is highest in people <45 years old; in contrast, seniors (those 65 years old) have the highest mortality risk in the 1957 and 1968 scenarios.

The greatest YLL savings would be achieved by targeting different age groups in each scenario; people <45 years old in the 1918 scenario, people 45-64 years old in the 1968 scenario, and people >45 years old in the 1957 scenario.

Conclusions.
Our findings shift the focus of pandemic vaccination strategies onto younger populations and illustrate the need for real-time surveillance of mortality patterns in a future pandemic.

Flexible setting of vaccination priority is essential to minimize mortality.
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Received 1 November 2007; accepted 14 February 2008; electronically published 17 June 2008.

Potential conflicts of interest: none reported.

Presented in part: Options for the Control of Influenza VI, Toronto, 16-23 June 2007 (abstract O104); Ninth Annual Conference on Vaccine Research, Baltimore, 8-10 May 2006 (presentation S6).

Financial support: National Institutes of Health; Fogarty International Center; National Institute of Allergy and Infectious Disease.

This article reflects the opinions of the authors and in no way reflects current policies of the Department of Health and Human Services of the United States government.

Reprints or correspondence: Dr. Mark Miller, Div. of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, 16 Center Dr., Bethesda, MD 20892 (millemar@mail.nih.gov).
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http://www.journals.uchicago.edu/doi/abs/10.1086/589716

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[mixin]

Re: _|Journ Inf Dis: PRIORITIZATIONS FOR PANDEMIC IV TO MINIMIZE Ys OF LIFE LOST|_

For the newer people who have not seen the proposed Vax plan, here is the link: http://www.webdialogues.net/cs/panfl.../view/dcat/185. It's the last one on the list.. Quick Reference: target group and tiers...

I think it will be really interesting to compare the groups in the antiviral plan, the vax plan and the ventilator plan.

In the vax plan, healthy adults aged 19-64 are in tier 5 for a severe pandemic; but since that is the working age, many of them are likely to be covered in the all the tier 1 categories.

If they use antivirals basically for treatment, then a lot of those people may not need the vax if they show immunity.

That would leave the vents for those who didn't get either of the above.

Next, we'll need a plan for who gets a hospital room with a bed and who gets a cot on the curb.