Modelling the effectiveness of antiviral treatment strategies to prevent household transmission of acute respiratory viruses.

Abstract

Households are a major driver of transmission of acute respiratory viruses, such as SARS-CoV-2 or Influenza. Until now antiviral treatments have mostly been used as a curative treatment in symptomatic individuals. During an outbreak, more aggressive strategies involving pre- or post-exposure prophylaxis (PrEP or PEP) could be employed to further reduce the risk of severe disease but also prevent transmission to household contacts. In order to understand the effectiveness of such strategies and the factors that may modulate them, we developed a multi-scale model that follows the infection at both the individual-level (viral dynamics) and the population-level (transmission dynamics) in households. Using a simulation study we explored different antiviral treatment strategies, evaluating their effectiveness on reducing the transmission risk and the virological burden in households for a range of virus characteristics (e.g., secondary attack rate-SAR, or time to peak viral load). We found that when the index case can be identified and treated before symptom onset, both transmission and virological burden are reduced by > 75% for most SAR values and time to peak viral load, with minimal benefit to treat additionally household contacts. While treatment initiated after index symptom onset does not reduce the risk of transmission, it can still reduce the virological burden in the household, a proxy for severe disease and subsequent transmission risk outside the household. In that case optimal strategies involve treatment of both index case and household contacts as PEP, with efficacy > 50% when peak viral load occurs after symptom onset, and 30-50% otherwise. In all the considered cases, antiviral treatment strategies were optimal for SAR ranging 20-60%, and for larger household sizes. This study highlights the opportunity of antiviral drug-based interventions in households during an outbreak to minimize viral transmission and disease burden.