Prioritising COVID-19 vaccination in changing social and epidemiological landscapes: a mathematical modelling study.
Prioritising COVID-19 vaccination in changing social and epidemiological landscapes: a mathematical modelling study.
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在不断变化的社会和流行病学格局中优先考虑 COVID-19 疫苗接种：数学模型研究。
DOI：
10.1016/s1473-3099(21)00057-8
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
Bauch CT
中科院分区：
文献类型：
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作者：
Jentsch PC;Anand M;Bauch CT
在2019冠状病毒病大流行期间，当局必须决定在不断变化的社会流行病学格局中优先接种哪些群体，其中大规模非药物干预措施的成功需要广泛的社会接受。我们旨在比较四种不同策略下的预计COVID-19死亡率，以确定SARS-CoV-2疫苗的优先顺序。我们开发了一个SARS-CoV-2传播的社会-流行病学耦合模型，其中社会和流行病学动态相互作用。我们模拟了人群对非药物干预的依从性如何对病例发生率做出反应。在该模式中，学校和工作场所也根据报告的案件关闭和重新开放。该模型采用加拿大安大略（人口1450万）的COVID-19病例和死亡率、SARS-CoV-2血清阳性率、人口流动性和人口统计学数据进行参数化。疾病进展参数来自SARS-CoV-2流行病学文献。我们假设一种疫苗对疾病和传染性的有效性为75%。我们比较了先接种60岁及以上人群（最年长者优先策略）、先接种20岁以下人群（最年长者优先策略）、按年龄统一接种（统一策略）和一种新的基于接触的策略。后三项战略阻断传播，而第一项战略针对弱势群体以减少疾病。从2021年1月1日或9月1日开始，每周的疫苗接种率为0.5%至5%。病例通知、非药物干预依从性和封锁经历了连续的波动，这些波动与疫苗计划的时间相互作用，以确定四种策略的相对有效性。随着群体免疫力的建立，传播阻断策略会随着时间的推移变得相对更有效。该模型预测，在没有接种疫苗的情况下，（95%可信区间40 000-122 000）将于2021年1月1日至2025年3月14日在安大略发生，疫苗接种率为每周1.5%的人口，最年长者优先的策略将使COVID-19死亡率平均降低90.8%（其次是89.5%的制服，88.9%的基于接触的策略和88.2%的最年长者优先策略）。60 000人死亡在没有接种疫苗的情况下，2021年9月1日至2025年3月14日将发生31，000-108，000人，基于接触的策略将使COVID-19死亡率平均降低92.6%（其次是92.1%的制服，91.0%的最年长的第一，88.3%的最年长的第一战略），每周接种率为1.5%的人口。降低COVID-19死亡率的最有效疫苗接种策略取决于人群中大流行的时间进程。对于较晚的疫苗接种开始日期，使用SARS-CoV-2疫苗阻断传播可能比优先考虑脆弱年龄组预防更多死亡。安大略大学部。
During the COVID-19 pandemic, authorities must decide which groups to prioritise for vaccination in a shifting social–epidemiological landscape in which the success of large-scale non-pharmaceutical interventions requires broad social acceptance. We aimed to compare projected COVID-19 mortality under four different strategies for the prioritisation of SARS-CoV-2 vaccines. We developed a coupled social–epidemiological model of SARS-CoV-2 transmission in which social and epidemiological dynamics interact with one another. We modelled how population adherence to non-pharmaceutical interventions responds to case incidence. In the model, schools and workplaces are also closed and reopened on the basis of reported cases. The model was parameterised with data on COVID-19 cases and mortality, SARS-CoV-2 seroprevalence, population mobility, and demography from Ontario, Canada (population 14·5 million). Disease progression parameters came from the SARS-CoV-2 epidemiological literature. We assumed a vaccine with 75% efficacy against disease and transmissibility. We compared vaccinating those aged 60 years and older first (oldest-first strategy), vaccinating those younger than 20 years first (youngest-first strategy), vaccinating uniformly by age (uniform strategy), and a novel contact-based strategy. The latter three strategies interrupt transmission, whereas the first targets a vulnerable group to reduce disease. Vaccination rates ranged from 0·5% to 5% of the population per week, beginning on either Jan 1 or Sept 1, 2021. Case notifications, non-pharmaceutical intervention adherence, and lockdown undergo successive waves that interact with the timing of the vaccine programme to determine the relative effectiveness of the four strategies. Transmission-interrupting strategies become relatively more effective with time as herd immunity builds. The model predicts that, in the absence of vaccination, 72 000 deaths (95% credible interval 40 000–122 000) would occur in Ontario from Jan 1, 2021, to March 14, 2025, and at a vaccination rate of 1·5% of the population per week, the oldest-first strategy would reduce COVID-19 mortality by 90·8% on average (followed by 89·5% in the uniform, 88·9% in the contact-based, and 88·2% in the youngest-first strategies). 60 000 deaths (31 000–108 000) would occur from Sept 1, 2021, to March 14, 2025, in the absence of vaccination, and the contact-based strategy would reduce COVID-19 mortality by 92·6% on average (followed by 92·1% in the uniform, 91·0% in the oldest-first, and 88·3% in the youngest-first strategies) at a vaccination rate of 1·5% of the population per week. The most effective vaccination strategy for reducing mortality due to COVID-19 depends on the time course of the pandemic in the population. For later vaccination start dates, use of SARS-CoV-2 vaccines to interrupt transmission might prevent more deaths than prioritising vulnerable age groups. Ontario Ministry of Colleges and Universities.