Spatial considerations for the allocation of pre-pandemic influenza vaccination in the United States
Spatial considerations for the allocation of pre-pandemic influenza vaccination in the United States
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DOI：
10.1098/rspb.2007.0893
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发表时间：
2007-11-22
影响因子：
4.7
通讯作者：
Leung, Gabriel M.
中科院分区：
文献类型：
--
作者：
Wu, Joseph T.;Riley, Steven;Leung, Gabriel M.
在国家流行病开始之前，使用针对当前禽流感菌株的流行前疫苗在国家流行病开始之前，可以通过诱导个体的免疫力来减轻下一个流感流行的影响。美国卫生与公共服务部（HHS）打算根据预定义优先组的人口大小，即大约亲比塔，将流行前疫苗分配给各州。我们表明，这样的公平政策在避免感染的数量方面可能有效最低。我们证明，如果允许完全酌情决定政策，即某些区域是分配足够的疫苗以实现牛群免疫力，而其他地区则没有分配其他疫苗，那么潜在的收益可能会很大。由于这样的不平等政策可能是不切实际的，因此我们考虑中间政策的敏感性（其中50％的库存是基于比例分配的）来关键传输不确定性。 50％的酌处政策的好处对参数值敏感，而参数值是无法提前知道的。因此，尽管非PRO-RATA政策具有巨大的潜在益处，但我们的结果表明，当前按国家划分的RATA分配的HHS政策在简单性，鲁棒性，公平性和效率方面是良好的妥协。
The impact of the next influenza pandemic may be mitigated by inducing immunity in individuals prior to the start of national epidemics using a pre-pandemic vaccine targeted against current avian influenza strains. The US Department of Health and Human Services (HHS) intends that pre-pandemic vaccines will be allocated to states in proportion to the size of their population in predefined priority groups, i.e. approximately pro-rata. We show that such an equitable policy is likely to be the least efficient in terms of the number of infections averted. We demonstrate that the potential benefits could be substantial if a fully discretionary policy is allowed, i.e. if some regions are allocated sufficient vaccines to achieve herd immunity while other regions are allocated no vaccine. Since such an inequitable policy may be impractical, we consider the sensitivity of an intermediate policy (in which 50% of the stockpile is allocated on a pro-rata basis) to key transmission uncertainties. The benefits of the 50% discretionary policy are sensitive to parameter values which cannot be known in advance. Therefore, despite substantial potential benefits of non-pro-rata policies, our results suggest that the current HHS policy of pro-rata allocation by state is a good compromise in terms of simplicity, robustness, equity and efficiency.