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Published at www.nejm.org May 27, 2009 (10.1056/NEJMp0904380)

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The early phases of an epidemic present decision makers with predictable challenges¹ that have been evident as the current novel influenza A (H1N1) virus has spread. The scale of the problem is uncertain when a disease first appears but may increase rapidly. Early action is required, but decisions about action must be made when the threat is only modest — and consequently, they involve a trade-off between the comparatively small, but nearly certain, harm that an intervention may cause (such as rare adverse events from large-scale vaccination or economic and social costs from school dismissals) and the uncertain probability of . . . [Full Text of this Article]

Source Information

Dr. Lipsitch is a professor of epidemiology at the Harvard School of Public Health, Boston. Dr. Riley is an assistant professor in the Department of Community Medicine, Li Ka Shing Faculty of Medicine, and the School of Public Health, University of Hong Kong — both in Hong Kong. Dr. Cauchemez is a research fellow, and Drs. Ghani and Ferguson professors, at the Medical Research Council Centre for Outbreak Analysis and Modeling, Department of Infectious Disease Epidemiology, Imperial College London, London.

This article (10.1056/NEJMp0904380) was published on May 27, 2009, and updated May 28, 2009, at NEJM.org.

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