Potential impact of vaccination on the hepatitis C virus epidemic in injection drug users
Potential impact of vaccination on the hepatitis C virus epidemic in injection drug users
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DOI：
10.1016/j.epidem.2008.10.002
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发表时间：
2009-03-01
期刊：
影响因子：
3.8
通讯作者：
Getz, Wayne M.
中科院分区：
文献类型：
--
作者：
Hahn, Judith A.;Wylie, Dennis;Getz, Wayne M.
背景：丙型肝炎病毒（HCV）在全世界注射毒品使用者（IDU）中引起显著的发病率和死亡率。HCV候选疫苗已显示出降低急性感染的传染性和避免慢性感染的前景，但尚未探讨不同水平的疫苗效力和疫苗递送策略对静脉吸毒者中HCV流行的影响。我们利用在弗朗西斯科年轻注射吸毒者的UFO研究中收集的大量注射行为数据来构建一个随机个体-基于模型，反映异质性注射风险行为，历史HCV趋势，以及病毒动力学和疫苗特性的现有信息。我们模拟的HCV感染率与旧金山弗朗西斯科的HCV感染率密切相关，估计感染率为59%/人年（ppy），在引入风险降低后，PPy为27%。慢性HCV感染是导致肝脏疾病和肝细胞癌的HCV感染的临床相关状态，在流行早期估计为22% ppy（+/- 3%），在引入风险降低后为14% ppy（+/- 2%）。我们考虑了几种情况下，并强调，50%至80%的效力针对高风险或血清阴性注射吸毒者在高疫苗接种率的疫苗，可以进一步降低慢性丙型肝炎病毒的发病率在注射吸毒者2- 7%ppy30年后，其introduction.Conclusions：我们的研究结果强调了进一步努力开发HCV疫苗和最佳系统的重要性，以提供给注射吸毒人群。(C)2008年爱思唯尔公司All rights reserved.
Background: Hepatitis C virus (HCV) causes significant morbidity and mortality in injecting drug users (IDU) worldwide. HCV vaccine candidates have shown promise for reducing the infectivity of acute infection and averting chronic infection, yet the impact of varying levels of vaccine efficacy and vaccine delivery strategies on the HCV epidemic in IDU has not been explored.Methods: We utilized extensive data on injecting behavior collected in the UFO study of young IDU in San Francisco to construct a stochastic individual-based model that reflects heterogeneous injecting risk behavior, historical HCV trends, and existing information on viral dynamics and vaccine characteristics.Results: Our modeled HCV rate closely paralleled observed HCV incidence in San Francisco, with estimated incidence of 59% per person year (ppy) early in the epidemic, and 27% ppy after risk reduction was introduced. Chronic HCV infection, the clinically relevant state of HCV infection that leads to liver disease and hepatocellular cancer, was estimated at 22% ppy (+/- 3%) early in the epidemic and 14% ppy (+/- 2%) after risk reduction was introduced. We considered several scenarios, and highlight that a vaccine with 50% to 80% efficacy targeted to high-risk or sero-negative IDU at a high vaccination rate could further reduce chronic HCV incidence in IDU to 2-7% ppy 30 years after its introduction.Conclusions: Our results underscore the importance of further efforts to develop both HCV vaccines and optimal systems of delivery to IDU populations. (C) 2008 Elsevier Inc. All rights reserved.