Simulation studies of influenza epidemics: assessment of parameter estimation and sensitivity.

The influenza simulation model of Elveback et al is used to evaluate the accuracy of the maximum likelihood procedure of Longini et al for estimating the secondary attack rate in households. The sample population from the Tecumseh Respiratory Illness Study is mapped into the simulation model and simulations are carried out over a range of parameter values and conditions, some of which were derived from influenza seasons in Tecumseh and from the Seattle Flu Study for the years 1975-1980. The estimation procedure is found to be quite robust for parameter values preset within appropriate limits for influenza. However, a significant difference is found between the preset and estimated household contact parameter for epidemics of medium and high intensity when the preset value is zero. Incremental increases in the household contact parameter are shown to produce marked increases in the overall infection attack rate demonstrating that household spread is an important link in maintaining infection in other mixing groups such as schools, preschool groups and neighbourhood clusters of households.