Estimating effect of antiviral drug use during pandemic (H1N1) 2009 outbreak, United States.

From April 2009 through March 2010, during the pandemic (H1N1) 2009 outbreak, ≈8.2 million prescriptions for influenza neuraminidase-inhibiting antiviral drugs were filled in the United States. We estimated the number of hospitalizations likely averted due to use of these antiviral medications. After adjusting for prescriptions that were used for prophylaxis and personal stockpiles, as well as for patients who did not complete their drug regimen, we estimated the filled prescriptions prevented ≈8,400-12,600 hospitalizations (on the basis of median values). Approximately 60% of these prevented hospitalizations were among adults 18-64 years of age, with the remainder almost equally divided between children 0-17 years of age and adults >65 years of age. Public health officials should consider these estimates an indication of success of treating patients during the 2009 pandemic and a warning of the need for renewed planning to cope with the next pandemic.

Developing national standards for public health emergency preparedness with a limited evidence base.

OBJECTIVE: The paucity of evidence and wide variation among communities creates challenges for developing congressionally mandated national performance standards for public health preparedness. Using countermeasure dispensing as an example, we present an approach for developing standards that balances national uniformity and local flexibility, consistent with the quality of evidence available. METHODS: We used multiple methods, including a survey of community practices, mathematical modeling, and expert panel discussion. RESULTS: The article presents recommended dispensing standards, along with a general framework that can be used to analyze tradeoffs involved in developing other preparedness standards. CONCLUSIONS: Standards can be developed using existing evidence, but would be helped immensely by a stronger evidence base.