**Table 5:** **_A taxonomy of_** **_<u>policies for containment and mitigation of pandemic influenza</u>_**

|Type|y<br>Sub‐Categor|Individualp<br>ent)<br>olicies (M: mitigation;C: containm|
|---|---|---|
||International|•<br>International land border quarantines(C)<br>_Air travel restrictions & advisori_<br>•<br>res<br>ns(C)<br>•<br>_es_(C)<br>trictio<br>Quarantine of ships & other|
||National or<br>central|•<br>_s_ (C, M)<br>_Inter­city movement restriction_<br>Aspects of quarantine(C, M)<br>•|
|**Nonpharmaceutical**||•<br>Public communic<br>s (C,M<br>ation<br>)|
||C<br>l<br>ommunity or<br>ocal|•<br>_Case detection an_<br>_ion_(C, M)<br>_d_<br>•<br>_isolat_<br>•<br>_Social distancing_(C, M)<br>•<br>_Local quarantines_(C, M)<br>•<br>Public hygiene and disinfection(C, M)<br>Local public communication(<br>)<br>•<br>Personalprotective equipme<br>C, M<br>nt (C,M)|
|**Pharmaceutical**|Vaccination|•<br>_Targeted vaccination policies_(M)<br>•<br>_Broad­based vaccination policy _(C,M)|
|**(or drug­based)**|Antiviral<br>prophylaxis|•<br>_Prophylaxis based on contact tracing_(C,M)<br>•<br>_Mass prophylaxis inthe at­risk population _(M)<br>•<br>_Targeted (ring) prophylaxis around a_<br>_ak_(C)<br>_n outbre_|

Distinctions between C and M only indicate emphasis, as containment achieves mitigation (lowers the GAR).

Based on results from modeling studies reviewed further below, different configurations of policies from Table 5 are currently proposed for pandemic influenza. These configurations are an example of prospective modeling evidence on effectiveness being used in policymaking. The review of studies follows after an introduction to the field.

In the earliest instance, a group of researchers within the MIDAS (Models of Infectious Disease Agents Study) network in the US proposed a framework for mitigation policies in the US after the emergence of pandemic influenza. The guiding assumptions were of limited antiviral supply with no effective vaccine immediately available, and that interventions must begin rapidly at the _community level_ to prevent an uncontrollable spread that overwhelms response. The proposed strategy of ‘targeted layered containment’ (TLC) attempts to benefit from synergies across the combined policies<sup>43</sup> . The policies considered high priority are: targeted antiviral treatment and isolation of cases, targeted prophylaxis and quarantine of household contacts of index cases, closure of schools and keeping children at home for the duration of the policy, social distancing at the workplace (telecommuting) and in the community (cancelling public events). Since the assumptions on pharmaceutical availability are very relevant for developing countries, this selection of policies from the menu has been influential for modeling and agenda‐setting.

The WHO Interim Protocol for community/local control measures<sup>1</sup> sets forward guidelines for the rapid containment of an outbreak of pandemic influenza, differentiating it from the response to current outbreaks of avian influenza. The Interim Protocol samples policies that also appear in TLC above, articulated here for the containment objective. The current version (dated May 2007) takes a geographically based approach where the initial area of the outbreak becomes the main target – the _containment zone_ – in which actions are taken to stamp out the infection and prevent its spread. Within the containment zone and in an area around it called the _buffer zone_ , surveillance and community mobilization will check and maintain containment. In the buffer zone, any ‘break through’ cases are quickly detected and isolated. The boundaries of the two zones, the duration of the operation, and 16