Predicting the public health impact of bivalent vaccines and nirmatrelvir-ritonavir against COVID-19.
Predicting the public health impact of bivalent vaccines and nirmatrelvir-ritonavir against COVID-19.
复制标题
预测二价疫苗和 nirmatrelvir-ritonavir 针对 COVID-19 的公共卫生影响。
DOI：
10.1101/2023.05.18.23289533
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Lo,NathanC
中科院分区：
文献类型：
--
作者：
Park,HaileyJ;Tan,SophiaT;León,TomásM;Jain,Seema;Schechter,Robert;Lo,NathanC
在美国，COVID-19二价疫苗和口服药物nirmatrelvir-ritonavir （Paxlovid）的吸收量仍然很低。评估在主要风险群体中越来越多地采用这些干预措施对公共卫生的影响，可以指导进一步的公共卫生资源和政策。该模型研究使用了加州公共卫生部2022年7月23日至2023年1月23日期间COVID-19病例、住院、死亡和疫苗接种的个人数据。我们对不同危险人群(按年龄（50岁以上、65岁以上、75岁以上）和疫苗接种状况（每个人，仅一次接种，以前接种过）定义的急性疾病期间额外接种双价COVID-19疫苗和尼马特韦-利托那韦的影响进行了建模。我们预测了避免的COVID-19病例数、住院人数、死亡人数和需要治疗的人数（NNT）。结果对于二价疫苗和nirmatrelvir-ritonavir，预防严重COVID-19的最有效策略（基于NNT）是针对75岁以上人群。我们预测，在75岁以上年龄组中，二价增强剂的完全覆盖将避免3,920例住院（95%UI: 2,491-4,882；总避免率7.8%;NNT 387）和1,074例死亡（95%UI: 774-1,355；总避免率16.2%;NNT 1,410）。75岁以上患者完全接受尼马特韦-利托那韦可避免5,644例住院（95%UI: 3,947-6,826； 11.2%总避免；NNT 11）和1,669例死亡（95%UI: 1,053-2,038； 25.2%总避免；NNT 35）。这些发现表明，在老年人群中优先使用双价增强剂和尼马特韦-利托那韦对减轻重症COVID-19负担是有效的，并对公共卫生产生重大影响，但不能解决重症COVID-19的全部负担。
BackgroundUptake of COVID-19 bivalent vaccines and oral medication nirmatrelvir-ritonavir (Paxlovid) has remained low across the United States. Assessing the public health impact of increasing uptake of these interventions in key risk groups can guide further public health resources and policy.MethodsThis modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from July 23, 2022 to January 23, 2023. We modeled the impact of additional uptake of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups defined by age (50+, 65+, 75+ years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 cases, hospitalizations, and deaths and number needed to treat (NNT).ResultsFor both bivalent vaccines and nirmatrelvir-ritonavir, the most efficient strategy (based on NNT) for averting severe COVID-19 was targeting the 75+ years group. We predicted that perfect coverage of bivalent boosters in the 75+ years group would avert 3,920 hospitalizations (95%UI: 2,491-4,882; 7.8% total averted; NNT 387) and 1,074 deaths (95%UI: 774-1,355; 16.2% total averted; NNT 1,410). Perfect uptake of nirmatrelvir-ritonavir in the 75+ years group would avert 5,644 hospitalizations (95%UI: 3,947-6,826; 11.2% total averted; NNT 11) and 1,669 deaths (95%UI: 1,053-2,038; 25.2% total averted; NNT 35).ConclusionsThese findings suggest prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among the oldest age groups would be efficient and have substantial public health impact in reducing the burden of severe COVID-19, but would not address the entire burden of severe COVID-19.