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Stockpiling neuraminidase inhibitors (NAIs) such as oseltamivir and zanamivir is part of a global effort to be prepared for an influenza pandemic. However, the contribution of NAIs for treatment and prevention of influenza and its complications is largely debatable. Here, we developed a transparent mathematical modelling setting to analyse the impact of NAIs on influenza disease at within-host and population level. Analytical and simulation results indicate that even assuming unrealistically high efficacies for NAIs, drug intake starting on the onset of symptoms has a negligible effect on an individual's viral load and symptoms score. Increasing NAIs doses does not provide a better outcome as is generally believed. Considering Tamiflu's pandemic regimen for prophylaxis, different multiscale simulation scenarios reveal modest reductions in epidemic size despite high investments in stockpiling. Our results question the use of NAIs in general to treat influenza as well as the respective stockpiling by regulatory authorities.
The successful elimination of bacteria such as Streptococcus pneumoniae from a host involves the coordination between different parts of the immune system. Previous studies have explored the effects of the initial pneumococcal load (bacterial dose) on different representations of innate immunity, finding that pathogenic outcomes can vary with the size of the bacterial dose. However, others yield support to the notion of dose-independent factors contributing to bacterial clearance. In this paper, we seek to provide a deeper understanding of the immune responses associated to the pneumococcus. To this end, we formulate a model that realizes an abstraction of the innate-regulatory immune host response. Stability and bifurcation analyses of the model reveal the following trichotomy of pneumococcal outcomes determined by the bifurcation parameters: (i) dose-independent clearance; (ii) dose-independent persistence; and (iii) dose-limited clearance. Bistability, where the bacteria-free equilibrium co-stabilizes with the most substantial steady-state bacterial load is the specific result behind dose-limited clearance. The trichotomy of pneumococcal outcomes here described integrates all previously observed bacterial fates into a unified framework.