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Mathematical modeling as an alternative for clinical trials in predicting effectiveness of preventive measures against influenza in healthcare settings

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Samenvatting van de aanvraag

Annually, influenza epidemics are responsible for thousands of hospitalizations and hundreds of deaths in The Netherlands. Outbreaks within nursing homes, hospitals and other health care institutions, with attack rates over 60% among residents, are especially threatening. Despite the availability of several preventive measures for influenza, most are not common medical practice yet. Preventive options include: (1) vaccination of patients and/or health care workers, (2) pre-emptive treatment or post-exposure prophylaxis by neuraminidase inhibitors and (3) non-specific interventions to reduce transmission (e.g. hand hygiene and isolation of patients). However, the effectiveness of individual or combined measures against influenza in health care institutions has not been determined yet. Although comparisons using a randomized trial design with clinically relevant endpoints are the paradigm to study intervention effectiveness, the large numbers of patients needed render such interventions costly and logistically a challenge. Alternatively, studies combining epidemiological data and mathematical modeling can provide evidence for the effectiveness of different preventive measures. We therefore propose to prospectively monitor occurrence of influenza and contact patterns in approximately 30 nursing homes and in several departments of a peripheral and academic hospital during three consecutive influenza seasons. We will develop mathematical models for influenza transmission in institutions that best describe the infection cycle of influenza, contact patterns and in- and efflux of persons, as well as the impact of prevention and therapy measures on transmission and disease burden. The modeling approach will provide information to develop evidence-based guidelines on the relative contribution of several (combinations of) influenza preventive measures and may be of use to describe transmission of several other airborne viruses (e.g. RSV, SARS).

Onderwerpen

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Projectnummer:
61200015
Looptijd: 100%
Looptijd: 100 %
2005
2008
Onderdeel van programma:
Projectleider en penvoerder:
Prof. dr. E. Hak
Verantwoordelijke organisatie:
Universitair Medisch Centrum Utrecht