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dc.contributor.authorLipsitch, Marc
dc.contributor.authorCohen, Ted
dc.contributor.authorMurray, Megan Blanche
dc.contributor.authorLevin, Bruce R
dc.date.accessioned2011-05-19T00:28:31Z
dc.date.issued2007
dc.identifier.citationLipsitch, Marc, Ted Cohen, Megan Murray, and Bruce R. Levin. 2007. Antiviral Resistance and the Control of Pandemic Influenza. PLoS Medicine 4(1): e15.en_US
dc.identifier.issn1549-1277en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4891658
dc.description.abstractBackground: The response to the next influenza pandemic will likely include extensive use of antiviral drugs (mainly oseltamivir), combined with other transmission-reducing measures. Animal and in vitro studies suggest that some strains of influenza may become resistant to oseltamivir while maintaining infectiousness (fitness). Use of antiviral agents on the scale anticipated for the control of pandemic influenza will create an unprecedented selective pressure for the emergence and spread of these strains. Nonetheless, antiviral resistance has received little attention when evaluating these plans. Methods and Findings: We designed and analyzed a deterministic compartmental model of the transmission of oseltamivir-sensitive and -resistant influenza infections during a pandemic. The model predicts that even if antiviral treatment or prophylaxis leads to the emergence of a transmissible resistant strain in as few as 1 in 50,000 treated persons and 1 in 500,000 prophylaxed persons, widespread use of antivirals may strongly promote the spread of resistant strains at the population level, leading to a prevalence of tens of percent by the end of a pandemic. On the other hand, even in circumstances in which a resistant strain spreads widely, the use of antivirals may significantly delay and/or reduce the total size of the pandemic. If resistant strains carry some fitness cost, then, despite widespread emergence of resistance, antivirals could slow pandemic spread by months or more, and buy time for vaccine development; this delay would be prolonged by nondrug control measures (e.g., social distancing) that reduce transmission, or use of a stockpiled suboptimal vaccine. Surprisingly, the model suggests that such nondrug control measures would increase the proportion of the epidemic caused by resistant strains. Conclusions: The benefits of antiviral drug use to control an influenza pandemic may be reduced, although not completely offset, by drug resistance in the virus. Therefore, the risk of resistance should be considered in pandemic planning and monitored closely during a pandemic.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pmed.0040015en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779817/pdf/en_US
dash.licenseLAA
dc.subjectinfectious diseasesen_US
dc.subjectnon-clinical medicineen_US
dc.subjectpublic health and epidemiologyen_US
dc.subjectvirologyen_US
dc.subjectepidemiologyen_US
dc.subjectpublic healthen_US
dc.subjectdrugs and adverse drug reactionsen_US
dc.subjecthealth policyen_US
dc.titleAntiviral Resistance and the Control of Pandemic Influenzaen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS Medicineen_US
dash.depositing.authorLipsitch, Marc
dc.date.available2011-05-19T00:28:31Z
dash.affiliation.otherSPH^Epidemiologyen_US
dash.affiliation.otherSPH^Epidemiologyen_US
dash.affiliation.otherHMS^Medicine-Brigham and Women's Hospitalen_US
dc.identifier.doi10.1371/journal.pmed.0040015*
dash.contributor.affiliatedMurray, Megan
dash.contributor.affiliatedLipsitch, Marc


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