Assessing effects of cholera vaccination in the presence of interference.
Assessing effects of cholera vaccination in the presence of interference.
复制标题
DOI：
10.1111/biom.12184
复制
发表时间：
2014-09
期刊：
影响因子：
1.9
通讯作者：
Emch ME
中科院分区：
文献类型：
--
作者：
Perez-Heydrich C;Hudgens MG;Halloran ME;Clemens JD;Ali M;Emch ME
当一个人的治疗影响另一个人的结果时，就会发生干预。例如，在传染病方面，一个人是否接种疫苗可能会影响另一个人是否感染或发展为疾病。量化疫苗接种的这种间接(或溢出)影响可能具有重要的公共卫生或政策影响。在这篇文章中，我们使用最近开发的在干扰存在的情况下治疗效果的逆概率加权(IPW)估计器来分析一项针对孟加拉国MatLab的121,982人的霍乱疫苗接种的个人随机、安慰剂对照试验。由于这些IPW估计器以前没有使用过，因此还进行了一项模拟研究，以评估估计器在类似霍乱疫苗试验的环境中的经验行为。模拟研究结果表明，当存在干扰时，IPW估计器可以对接种的直接、间接、总和总体影响做出无偏估计，前提是不可测试的无不可测量的混杂因素假设成立，并且正确地指定了组级倾向得分模型。将IPW估计值应用于霍乱疫苗试验表明存在干扰。例如，IPW的估计表明，与疫苗覆盖率为32%的社区相比，疫苗覆盖率为60%的社区内未接种疫苗的个人每1000人年平均少发生5.29例霍乱病例(95%可信区间2.61，7.96)。我们的分析还表明，不考虑干扰可能会导致关于疫苗接种的公共卫生效用的误导性结论。
Interference occurs when the treatment of one person affects the outcome of another. For example, in infectious diseases, whether one individual is vaccinated may affect whether another individual becomes infected or develops disease. Quantifying such indirect (or spillover) effects of vaccination could have important public health or policy implications. In this paper we use recently developed inverse-probability weighted (IPW) estimators of treatment effects in the presence of interference to analyze an individually-randomized, placebo-controlled trial of cholera vaccination that targeted 121,982 individuals in Matlab, Bangladesh. Because these IPW estimators have not been employed previously, a simulation study was also conducted to assess the empirical behavior of the estimators in settings similar to the cholera vaccine trial. Simulation study results demonstrate the IPW estimators can yield unbiased estimates of the direct, indirect, total and overall effects of vaccination when there is interference provided the untestable no unmeasured confounders assumption holds and the group-level propensity score model is correctly specified. Application of the IPW estimators to the cholera vaccine trial indicates the presence of interference. For example, the IPW estimates suggest on average 5.29 fewer cases of cholera per 1000 person-years (95% confidence interval 2.61, 7.96) will occur among unvaccinated individuals within neighborhoods with 60% vaccine coverage compared to neighborhoods with 32% coverage. Our analysis also demonstrates how not accounting for interference can render misleading conclusions about the public health utility of vaccination.
登录
查看更多内容
影响因子：
5.5
作者：
Ali, Mohammad;Emch, Michael;Clemens, John
通讯作者：
Clemens, John
影响因子：
1.9
作者：
VanderWeele TJ;Shpitser I
通讯作者：
Shpitser I
影响因子：
3.7
作者：
Root ED;Giebultowicz S;Ali M;Yunus M;Emch M
通讯作者：
Emch M
影响因子：
1.8
作者：
Stefanski, LA;Boos, DD
通讯作者：
Boos, DD
DOI：
10.1198/016214506000000636
发表时间：
2006-12-01
影响因子：
3.7
作者：
Sobel, Michael E.
通讯作者：
Sobel, Michael E.