Waning of Influenza Vaccine Protection: Exploring the Trade-offs of Changes in Vaccination Timing Among Older Adults
Waning of Influenza Vaccine Protection: Exploring the Trade-offs of Changes in Vaccination Timing Among Older Adults
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DOI：
10.1093/cid/ciz452
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发表时间：
2020-04-15
影响因子：
11.8
通讯作者：
Fry, Alicia M.
中科院分区：
文献类型：
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作者：
Ferdinands, Jill M.;Alyanak, Elif;Fry, Alicia M.
背景在最近的流感疫苗有效性（VE）研究中，观察到随着接种时间的增加，有效性降低，这就提出了最佳接种时机的问题。我们试图评估由于疫苗接种时间的潜在变化而导致的老年人流感相关住院的估计数量。使用经验数据和健康状态转换模型，我们估计了如果疫苗接种延迟到10月1日，预计在美国年龄≥ 65岁的人群中发生的流感相关住院的变化。我们假设在2012-2013年观察到的疫苗接种时间、覆盖率和有效性是典型的流感季节，VE每月减少约7%，通常在10月之前接种疫苗的人中有0%到50%没有接种疫苗。我们还评估了流感相关住院治疗的变化，如果接种疫苗的吸收大幅转向8月和9月。在一个典型的季节，如果超过14%的老年人通常在8月和9月接种疫苗，那么将疫苗接种推迟到10月会增加流感住院率。延迟接种疫苗的后果在很大程度上取决于流感季节的时间、消退速度和总体VE。在8月和9月转向疫苗接种导致流感相关住院率平均增加，但这一结果对流感季节时间也很敏感。延迟接种疫苗的后果差异很大。关于疫苗接种的减少和延迟对疫苗覆盖率的影响的不确定性表明，改变目前的疫苗建议还为时过早，尽管防止向早期疫苗接种的重大转变可能是谨慎的。
Background. In recent studies of influenza vaccine effectiveness (VE), lower effectiveness with increasing time since vaccination was observed, raising the question of optimal vaccination timing. We sought to evaluate the estimated number of influenza-associated hospitalizations among older adults due to potential changes in vaccination timing.Methods. Using empirical data and a health state transition model, we estimated change in influenza-associated hospitalizations predicted to occur among the US population aged >= 65 years if vaccination were delayed until October 1. We assumed the vaccination timing, coverage, and effectiveness observed in 2012-2013 as a prototypical influenza season, approximately 7% monthly waning of VE, and that between 0% and 50% of individuals who usually get vaccinated earlier than October failed to get vaccinated. We also assessed change in influenza-associated hospitalizations if vaccination uptake shifted substantially toward August and September.Results. In a typical season, delaying vaccination until October increased influenza hospitalizations if more than 14% of older adults usually vaccinated in August and September failed to get vaccinated. The consequences of delayed vaccination depended heavily on influenza season timing, rate of waning, and overall VE. A shift toward vaccination in August and September led to, on average, an increase in influenza-associated hospitalizations, but this result was also sensitive to influenza season timing.Conclusions. Consequences of delayed vaccination varied widely. Uncertainties about vaccine waning and effects of a delay on vaccine coverage suggest it is premature to change current vaccine recommendations, although it may be prudent to prevent a substantial shift toward early vaccination.