Vaccination and non-pharmaceutical interventions for COVID-19: a mathematical modelling study.
Vaccination and non-pharmaceutical interventions for COVID-19: a mathematical modelling study.
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DOI：
10.1016/s1473-3099(21)00143-2
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Keeling MJ
中科院分区：
文献类型：
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作者：
Moore S;Hill EM;Tildesley MJ;Dyson L;Keeling MJ
由于年龄依赖性因素、感染水平的变化以及随着感知风险下降而放松非药物干预措施 (NPI)，SARS-CoV-2 疫苗接种的动态变得复杂，因此需要使用数学模型。我们的目标是利用英国的流行病学数据以及疫苗功效的估计来预测计划的疫苗推出中 SARS-CoV-2 可能的长期动态。在这项研究中，我们使用了按年龄和英国地区构建的数学模型，该模型适合英国的一系列流行病学数据，其中纳入了计划推出的两剂疫苗接种计划（剂量间隔 12 周，疫苗接种后 14 天起保护作用）。我们假设 80 岁及以上人群的默认疫苗接种率为 95%，50-79 岁人群为 85%，18-49 岁人群为 75%，然后乐观和悲观地改变接种率。根据英国使用的辉瑞-BioNTech 和牛津-阿斯利康疫苗，假设针对症状性疾病的疫苗功效为 88%，针对感染的保护率从 0% 到 85% 不等。我们考虑了英国疫苗接种计划与未来多个潜在的 NPI 放宽（或取消）的相互作用，以预测 2021 年 1 月至 2024 年 1 月期间因 COVID-19 导致的再生数 (R) 以及每日死亡和入院模式。我们估计，仅靠疫苗接种不足以遏制疫情。在没有 NPI 的情况下，即使我们最乐观地假设疫苗将预防 85% 的感染，一旦所有符合条件的成年人都接种了两剂疫苗，我们估计 R 为 1·58（95% 可信区间 [CI] 1·36–1·84）。在默认情况下，疫苗接种计划完成后取消所有 NPI 预计将导致 21 400 人因 COVID-19 死亡 (95% CI 1400–55 100)，因为疫苗可预防 85% 的感染，但如果疫苗只能预防 60% 的感染，这一数字会增加到 96 700 人死亡 (51 800–173 200)。感染。尽管疫苗接种大大减少了总死亡人数，但它只能为个人提供部分保护；我们估计，在默认接种情况和 60% 的感染保护率下，接种一剂或两剂疫苗的个体将分别有 48·3% (95% CI 48·1–48·5) 和 16·0% (15·7–16·3) 的死亡。对于我们调查的所有疫苗接种场景，我们的预测强调了与早期或快速放松 NPI 相关的风险。尽管针对 SARS-CoV-2 的新型疫苗为大流行提供了一种潜在的退出策略，但成功很大程度上取决于疫苗的精确特性和人群的吸收情况，两者都需要仔细监测。国家健康研究所、医学研究委员会和英国研究与创新。
The dynamics of vaccination against SARS-CoV-2 are complicated by age-dependent factors, changing levels of infection, and the relaxation of non-pharmaceutical interventions (NPIs) as the perceived risk declines, necessitating the use of mathematical models. Our aims were to use epidemiological data from the UK together with estimates of vaccine efficacy to predict the possible long-term dynamics of SARS-CoV-2 under the planned vaccine rollout. In this study, we used a mathematical model structured by age and UK region, fitted to a range of epidemiological data in the UK, which incorporated the planned rollout of a two-dose vaccination programme (doses 12 weeks apart, protection onset 14 days after vaccination). We assumed default vaccine uptake of 95% in those aged 80 years and older, 85% in those aged 50–79 years, and 75% in those aged 18–49 years, and then varied uptake optimistically and pessimistically. Vaccine efficacy against symptomatic disease was assumed to be 88% on the basis of Pfizer-BioNTech and Oxford-AstraZeneca vaccines being administered in the UK, and protection against infection was varied from 0% to 85%. We considered the combined interaction of the UK vaccination programme with multiple potential future relaxations (or removals) of NPIs, to predict the reproduction number (R) and pattern of daily deaths and hospital admissions due to COVID-19 from January, 2021, to January, 2024. We estimate that vaccination alone is insufficient to contain the outbreak. In the absence of NPIs, even with our most optimistic assumption that the vaccine will prevent 85% of infections, we estimate R to be 1·58 (95% credible intervals [CI] 1·36–1·84) once all eligible adults have been offered both doses of the vaccine. Under the default uptake scenario, removal of all NPIs once the vaccination programme is complete is predicted to lead to 21 400 deaths (95% CI 1400–55 100) due to COVID-19 for a vaccine that prevents 85% of infections, although this number increases to 96 700 deaths (51 800–173 200) if the vaccine only prevents 60% of infections. Although vaccination substantially reduces total deaths, it only provides partial protection for the individual; we estimate that, for the default uptake scenario and 60% protection against infection, 48·3% (95% CI 48·1–48·5) and 16·0% (15·7–16·3) of deaths will be in individuals who have received one or two doses of the vaccine, respectively. For all vaccination scenarios we investigated, our predictions highlight the risks associated with early or rapid relaxation of NPIs. Although novel vaccines against SARS-CoV-2 offer a potential exit strategy for the pandemic, success is highly contingent on the precise vaccine properties and population uptake, both of which need to be carefully monitored. National Institute for Health Research, Medical Research Council, and UK Research and Innovation.