Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States.
Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States.
复制标题
确定甲型肝炎病毒传播的群体免疫阈值，为美国 16 个州注射毒品者的疫苗接种策略提供信息。
DOI：
10.1093/cid/ciad552
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Martin,NatashaK
中科院分区：
文献类型：
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作者：
Yang,Judy;Lo,NathanC;Dankwa,EmmanuelleA;Donnelly,ChristlA;Gupta,Ribhav;Montgomery,MarthaP;Weng,MarkK;Martin,NatashaK
背景甲型肝炎病毒(HAV)在人与人之间广泛传播，特别是在注射毒品(PWID)的人群中，在美国和全球范围内继续蔓延。然而，预防暴发所需的群体免疫阈值和疫苗接种覆盖率尚不清楚。我们利用监测数据和动态模型估计了美国16个 州甲型肝炎病毒传播的群体免疫阈值。使用国家级校准模型，我们估计了每个州的PWID的基本繁殖数(R0)和群体免疫阈值。我们对人群免疫阈值进行了荟萃分析，以确定在PWID中预防大多数甲型肝炎暴发所需的关键疫苗接种率。结果北卡罗来纳州甲型肝炎感染的R0估计值从2.2(95%可信区间[CI]，1.9-2.5)到西弗吉尼亚州(5.0)(95%可信区间，4.5-5.6)。相应的群体免疫阈值从北卡罗来纳州的55%(95%可信区间，47%-61%)到西弗吉尼亚州的80%(95%可信区间，78%-82%)。在Meta分析的基础上，我们估计了PWID的混合群体免疫阈值为%(95%可信区间，61%-68%；90%预测区间，52%-76%)。使用预测区间上限(76%)，假设疫苗有效率为95%，我们估计疫苗接种率为80%可以预防大多数甲型肝炎疫情。结论美国甲型肝炎疫苗接种计划可能需要达到至少80%的疫苗接种率在PWID中，以防止该人群中大多数甲型肝炎疫情的爆发。
BackgroundWidespread outbreaks of person-to-person transmitted hepatitis A virus (HAV), particularly among people who inject drugs (PWID), continue across the United States and globally. However, the herd immunity threshold and vaccination coverage required to prevent outbreaks are unknown. We used surveillance data and dynamic modeling to estimate herd immunity thresholds among PWID in 16 US states.MethodsWe used a previously published dynamic model of HAV transmission calibrated to surveillance data from outbreaks involving PWID in 16 states. Using state-level calibrated models, we estimated the basic reproduction number (R0) and herd immunity threshold for PWID in each state. We performed a meta-analysis of herd immunity thresholds to determine the critical vaccination coverage required to prevent most HAV outbreaks among PWID.ResultsEstimates ofR0for HAV infection ranged from 2.2 (95% confidence interval [CI], 1.9–2.5) for North Carolina to 5.0 (95% CI, 4.5–5.6) for West Virginia. Corresponding herd immunity thresholds ranged from 55% (95% CI, 47%–61%) for North Carolina to 80% (95% CI, 78%–82%) for West Virginia. Based on the meta-analysis, we estimated a pooled herd immunity threshold of 64% (95% CI, 61%–68%; 90% prediction interval, 52%–76%) among PWID. Using the prediction interval upper bound (76%) and assuming 95% vaccine efficacy, we estimated that vaccination coverage of 80% could prevent most HAV outbreaks.ConclusionsHepatitis A vaccination programs in the United States may need to achieve vaccination coverage of at least 80% among PWID in order to prevent most HAV outbreaks among this population.