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PLoS One. 2011;6(9):e25149. doi: 10.1371/journal.pone.0025149. Epub 2011 Sep 22.

Comparing effectiveness of top-down and bottom-up strategies in containing influenza.

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Network Dynamics and Simulation Science Lab, Virginia Bioinformatics Institute at Virginia Tech, Blacksburg, Virginia, United States of America.


This research compares the performance of bottom-up, self-motivated behavioral interventions with top-down interventions targeted at controlling an "Influenza-like-illness". Both types of interventions use a variant of the ring strategy. In the first case, when the fraction of a person's direct contacts who are diagnosed exceeds a threshold, that person decides to seek prophylaxis, e.g. vaccine or antivirals; in the second case, we consider two intervention protocols, denoted Block and School: when a fraction of people who are diagnosed in a Census Block (resp., School) exceeds the threshold, prophylax the entire Block (resp., School). Results show that the bottom-up strategy outperforms the top-down strategies under our parameter settings. Even in situations where the Block strategy reduces the overall attack rate well, it incurs a much higher cost. These findings lend credence to the notion that if people used antivirals effectively, making them available quickly on demand to private citizens could be a very effective way to control an outbreak.

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