The potential impact of vaccination on the prevalence of gonorrhea.
The potential impact of vaccination on the prevalence of gonorrhea.
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DOI：
10.1016/j.vaccine.2015.07.015
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发表时间：
2015-08-26
期刊：
影响因子：
5.5
通讯作者：
Seib KL
中科院分区：
文献类型：
--
作者：
Craig AP;Gray RT;Edwards JL;Apicella MA;Jennings MP;Wilson DP;Seib KL
淋病是世界上最常见的性传播感染之一，可导致严重的后遗症，包括不孕不育和艾滋病毒传播增加。最近，报告了无法治疗的耐多药淋病奈瑟菌菌株。在缺乏新抗生素的情况下，考虑到对所有以前使用的抗生素产生耐药性的速度，开发疫苗将是解决这一突发公共卫生事件的理想办法。了解抗淋球菌疫苗的预期特征、目标人群和预期影响对促进疫苗设计、评估和实施至关重要。本文提出的模型旨在填补这些概念空白，并为未来的淋球菌疫苗开发提供信息。使用基于个体的流行病学模拟模型，在引入不同效力（10-100%）和保护期（2.5-20年）的疫苗后，在10万名异性恋人群中模拟淋球菌流行情况。模型模拟预测，如果所有13岁儿童接种效力为50%的非减弱疫苗，或效力为100%的疫苗，但效力在7.5年后减弱，20年后淋球菌流行率至少可降低90%。使用效力仅为20%的非减弱疫苗，患病率可降低40%。我们的结论是，如果覆盖率高且保护在年轻人中最高风险期（即大多数性伴侣更换期）持续，那么中等效力和持续时间的疫苗可能对淋球菌患病率和疾病后遗症产生实质性影响。
Gonorrhea, one of the most common sexually transmitted infections worldwide, can lead to serious sequelae, including infertility and increased HIV transmission. Recently, untreatable, multidrug-resistant Neisseria gonorrhoeae strains have been reported. In the absence of new antibiotics, and given the speed with which resistance has emerged to all previously used antibiotics, development of a vaccine would be the ideal solution to this public health emergency. Understanding the desired characteristics, target population, and expected impact of an anti-gonococcal vaccine is essential to facilitate vaccine design, assessment and implementation. The modeling presented herein aims to fill these conceptual gaps, and inform future gonococcal vaccine development. Using an individual-based, epidemiological simulation model, gonococcal prevalence was simulated in a heterosexual population of 100,000 individuals after the introduction of vaccines with varied efficacy (10–100%) and duration of protection (2.5–20 years). Model simulations predict that gonococcal prevalence could be reduced by at least 90% after 20 years, if all 13-year-olds were given a non-waning vaccine with 50% efficacy, or a vaccine with 100% efficacy that wanes after 7.5 years. A 40% reduction in prevalence is achievable with a non-waning vaccine of only 20% efficacy. We conclude that a vaccine of moderate efficacy and duration could have a substantive impact on gonococcal prevalence, and disease sequelae, if coverage is high and protection lasts over the highest risk period (i.e., most sexual partner change) among young people.