Potential role of human challenge studies for investigation of influenza transmission - 27/10/11

Doi : 10.1016/S1473-3099(11)70142-6

Ben Killingley, DrMD ^a,^⁎ , Joanne Enstone, MPhil ^a, Robert Booy, ProfMD ^b, Andrew Hayward, MD ^c, John Oxford, ProfDSc ^d, Neil Ferguson, ProfPhD ^e, Jonathan Nguyen Van-Tam, ProfDM ^a

on behalf of the influenza transmission strategy development group^{^‡}
For members and further details see end of report

^a Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK

^b National Centre for Immunisation Research and Surveillance, and Sydney Institute of Emerging Infectious Diseases and Biosecurity, Sydney, NSW, Australia

^c Centre for Infectious Disease Epidemiology, University College London, London, UK

^d Centre for Infectious Diseases, Bart’s and the London, Queen Mary’s School of Medicine and Dentistry, London, UK

^e MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK

^* Correspondence to: Dr Ben Killingley, Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK

Summary

The importance of different routes of influenza transmission (including the role of bioaerosols) and the ability of masks and hand hygiene to prevent transmission remain poorly understood. Interest in transmission of influenza has grown as the effectiveness of prevention measures implemented during the 2009 H1N1 pandemic are questioned and as plans to better prepare for the next pandemic are debated. Recent studies of naturally infected patients have encountered difficulties and have fallen short of providing definitive answers. Human challenge studies with influenza virus date back to the 1918 pandemic. In more recent decades they have been undertaken to investigate the efficacy of antiviral agents and vaccines. Could experimental challenge studies, in which volunteers are deliberately infected with influenza virus, provide an alternative approach to the study of transmission? Here, we review the latest intervention studies and discuss the potential of challenge studies to address the remaining gaps in our knowledge.

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