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This pre-existing immunity is consistent with clinical surveillance reported in New Zealand where pandemic cases were concentrated in younger age groups [14], [21].
The optimal antiviral targeting strategy identified here is to use PCRtests to diagnose pandemic cases until the available lab capacity is exceeded, from which point syndromic diagnosis (the presence of ILI symptoms) should be used.
Agents recovered by postmortem cultures of lung samples from 96 fatal 1918 influenza pandemic cases included S. pneumoniae (23.2%), S. haemolyticus (18.0%), S. aureus (7.7%) and H. influenzae (4.7%) [3].
Nevertheless, it is surprising that the eFlu surveillance system was able to capture the majority of hospitalized pandemic cases younger than 50, but only captured 30-60% hospitalized pandemic cases for those older than 50 years.
We present our results using 300 (30 samples times 10 simulated pandemics) sampled time series of pandemic cases.
Six weeks of prophylaxis was marginally beneficial, if one assumes that prophylaxis was initiated after incident pandemic cases exceeded 10% of the baseline ILI rate.
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Considering the pandemic case definitions with reference to international guidelines [17], these last four cases were categorized as H1N1pdm-confirmed cases.
For long term stockpiling strategies with 1957 and 1968 pandemic case-fatality rates of 0.4 to 0.6%, stockpiling would be cost-beneficial only if the pandemic occurred within 10 years, the shelf-life was 5 years, and vaccine effectiveness was >80%.
But we have used a range of pandemic case reporting rates as discussed below).
Patient data were derived from two 2009 pandemic case-series of U.S. pH1N1 hospitalizations.
The detection specificity (Sp) and the pandemic case reporting rate were set for all methods at the following values: Sp = 99% and α = 5%.
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