Can a Two-Dose Influenza Vaccine Regimen Better Protect Older Adults? An Agent-Based Modeling Study.
Can a Two-Dose Influenza Vaccine Regimen Better Protect Older Adults? An Agent-Based Modeling Study.
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老年人（年龄≥ 65岁）是流感发病率和死亡率的高风险人群。这项研究评估了假设的每个季节两剂流感疫苗方案的影响，通过提供季前（第一剂）和季中（第二剂）保护来抵消疫苗有效性（VE）的减弱，以减少有症状的流感病例。重建流行病学动力学框架（FRED）是一个基于代理的建模平台，用于比较典型的一剂疫苗接种和两剂疫苗接种策略。主要模型包括每月10%的VE下降和不同的流感季节时间（12月至3月），以估计老年人的病例和住院情况。其他场景模拟了第二剂的摄取和VE减少以及总体减弱。在高峰较晚的季节，两剂疫苗最有可能减少病例（2月高峰为14.4%，3月高峰为18.7%）和住院（2月高峰为13.1%，3月高峰为16.8%）。病例和住院治疗仍然减少，但当30%的人未能接受第二次剂量时，第二次剂量VE减少，或每月总体减少至7%时，病例和住院治疗减少。基于代理的建模表明，两剂流感疫苗可以减少老年人的病例和住院率。最大的影响发生在更经常观察到的晚高峰季节。尽管第二剂量的摄取减少、第二剂量的VE减少或总体VE减弱的模型情景，但两剂量方案的有益影响持续存在。
Older adults (age ≥ 65) are at high risk of influenza morbidity and mortality. This study evaluated the impact of a hypothetical two-dose influenza vaccine regimen per season to reduce symptomatic flu cases by providing preseason (first dose) and mid-season (second dose) protection to offset waning vaccine effectiveness (VE). The Framework for Reconstructing Epidemiological Dynamics (FRED), an agent-based modeling platform, was used to compare typical one-dose vaccination to a two-dose vaccination strategy. Primary models incorporated waning VE of 10% per month and varied influenza season timing (December through March) to estimate cases and hospitalizations in older adults. Additional scenarios modeled reductions in uptake and VE of the second dose, and overall waning. In seasons with later peaks, two vaccine doses had the largest potential to reduce cases (14.4% with February peak, 18.7% with March peak) and hospitalizations (13.1% with February peak, 16.8% with March peak). Reductions in cases and hospitalizations still resulted but decreased when 30% of individuals failed to receive a second dose, second dose VE was reduced, or overall waning was reduced to 7% per month. Agent-based modeling indicates that two influenza vaccine doses could decrease cases and hospitalizations in older individuals. The highest impact occurred in the more frequently observed late-peak seasons. The beneficial impact of the two-dose regimen persisted despite model scenarios of reduced uptake of the second dose, decreased VE of the second dose, or overall VE waning.
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