Influenza control in Australian prison settings: Cost-benefit analysis of major strategies

Repeated influenza outbreaks are surprisingly rare in prison settings worldwide, a factor that has made it superfluous, to date, to develop contingency plans for responding to prison-based influenza epidemics. However, the influenza outbreak that occurred in an Australian prison in 2000 has highlighted the appropriateness of developing an outbreak plan, not least because of the security implications of a widespread prison influenza epidemic. Using reported attack rates and morbidity profiles of the 2000 Australian prison influenza outbreak to develop scenarios, the authors estimated the cost–benefit of mass vaccination and antiviral chemotherapy approaches for the control of hypothetical widespread influenza outbreaks in New South Wales prisons, occurring at an average frequency of once every 10 years. It was concluded that, from the perspectives of maintaining prison security as well as health care services’ provision to prisoners, early antiviral chemotherapy fo r symptomatic individuals will have more favourable cost–benefit ratios than a mass vaccination approach for controlling prison-based influenza outbreaks that occur in line with this model.