Pandemic influenza in Papua New Guinea: a modelling study comparison with pandemic spread in a developed country

Milne, George J; Baskaran, Pravin; Halder, Nilimesh; Karl, Stephan; Kelso, Joel

We have rephrased the captions in Table 2 . The numbers in Table 2 are the absolute number of infected people per location. 'Pharmaceutical-based interventions were not considered in this study due to cost and delivery issues found with low-income countries. However, consideration may need to be given to some form of antiviral agent use, possibly for case treatment, given the poor performance of purely social distancing interventions in developing countries as suggested by this study. The advantage of antiviral use is that it may be targetted at reducing within-household transmission, a location of transmission otherwise not impacted by social distancing interventions. The present study shows that larger numbers of transmissions occur within households due to the larger household sizes in developing countries. Furthermore, low-income countries generally have population health profiles not seen in developed countries, including the prevalence of diseases such as malaria, tuberculosis and HIV. [18] Antiviral treatment of influenza cases who are co-infected with such diseases may be an appropriate intervention strategy given the poorer health outcomes which co-morbidity may impose. [7] The provision and use of antiviral agents will have challenges not faced by industrialised countries, due to the cost of providing an antiviral stockpile and subsequent distribution of antivirals in countries which have health systems already stretched to capacity. [19] '