Analyzing Adult Pneumococcal Vaccination Implementation in the Underserved

分析服务欠缺地区成人肺炎球菌疫苗的实施情况

• 批准号: 10176377
• 负责人: KENNETH J SMITH
• 金额: $ 39.13万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176377
• 关键词: Accounting; Address; Adult; Area; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Clinical Trials; Conjugate Vaccines; Cost Effectiveness Analysis; Data; Decision Analysis; Decision Modeling; Disease; Effectiveness; Elderly; Epidemiology; Evaluation; Future; General Population; Health Benefit; Herd Immunity; Immunocompetent; Incidence; Manufacturer Name; Minority Groups; Modeling; Pneumococcal Infections; Pneumococcal conjugate vaccine; Pneumococcal vaccine; Policies; Polyvalent pneumococcal vaccine; Population; Public Health; Recommendation; Resource Allocation; Resources; Risk; Serotyping; Streptococcus pneumoniae; Techniques; Testing; Uncertainty; Update; Vaccinated; Vaccination; Vaccine Design; Vaccines; Work; base; cohort; cost; cost effectiveness; disease disparity; disorder risk; economic evaluation; human old age (65+); implementation strategy; improved; innovation; intervention cost; intervention program; markov model; novel; novel vaccines; programs; public health relevance; shared decision making; underserved minority; uptake; vaccination strategy; vaccine acceptance; vaccine development

Abstract CDC recommends both the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged ≥65 years. However, PCV13 use in seniors, now rec- ommended in the immunocompetent based on shared decision making, may not substantially add to indirect (herd immunity) protection from childhood PCV13 use; recent analyses show use of both vaccines to be expen- sive with little added health benefit. Underserved minority adults, who are at greater risk, are less often vac- cinated and more often infected with non-vaccine pneumococcal serotypes. In all US adults, non-vaccine sero- type disease accounts for 40-49% of pneumococcal disease and vaccine uptake remains suboptimal. To address these issues, more serotypes are being added to conjugate vaccines while policymakers debate the need for adult conjugate use, given childhood vaccination indirect effects. An adult-formulated vaccine to improve pro- tection could be considered. Strategies to improve adult vaccination uptake are underused but could be the preferred way to improve pneumococcal disease protection, particularly in underserved minority seniors. To investigate, we will use decision analysis modeling to examine changes in recommended vaccines and in- tervention programs to address suboptimal vaccination strategies and low vaccine uptake. This effort will elu- cidate strategies to: a) improve pneumococcal disease protection in all older adults and b) decrease vaccination and disease disparities in underserved minorities. Potential changes in adult pneumococcal disease due to ad- ditional indirect childhood vaccination effects will be examined. We will synthesize available data and per- form projections with rigorous modeling of uncertainty to assist policymaking and inform research resource allocation. Potential changes to pediatric and adult vaccine formations will be modeled. Specific aims are to: 1) estimate the impact of higher valency conjugate vaccines on pneumococcal disease in children and resulting indirect effects on disease incidence and serotype distribution in US seniors; and 2) compare pneumococcal vaccination strategies in seniors, while accounting for childhood vaccination effects, examining higher valency vaccines, adult-formulated vaccine, and PPSV23 only, with and without programs to increase vaccine uptake. Vaccination strategies in underserved minority and general population cohorts will be compared via Markov model-based cost-effectiveness analysis, with probabilistic sensitivity analysis and value of information analy- sis to determine favored strategies and identify valuable areas for future research. We will also innovatively consider an adult-formulated conjugate vaccine designed to mitigate racial disease disparities. Since CDC vac- cination evaluations increasingly consider economic analyses, analysis results can be used, as previously, to assist vaccination recommendation decisions and potentially change policy to better protect the underserved.

抽象的 CDC推荐23价肺炎球菌多糖疫苗（PPSV23）和13价肺炎球菌多糖疫苗（PPSV23） 肺炎球菌结合疫苗（PCV13）适用于 65 岁以上的成年人。然而，PCV13 在老年人中的使用，现在建议 基于共同决策的免疫能力中推荐的，可能不会实质上增加间接 （群体免疫）防止儿童使用 PCV13；最近的分析表明，使用这两种疫苗都是昂贵的 几乎没有什么额外的健康益处。服务不足的少数族裔成年人面临更大的风险，因此很少有机会获得疫苗接种。 引起的，更常见的是感染非疫苗肺炎球菌血清型。在所有美国成年人中，非疫苗血清 类型疾病占肺炎球菌疾病的 40-49%，而疫苗接种率仍然不理想。致地址 这些问题，更多的血清型被添加到结合​​疫苗中，而政策制定者正在争论是否需要 成人结合物使用，给儿童接种疫苗带来间接影响。一种成人配方疫苗，可改善亲 可以考虑保护。提高成人疫苗接种率的策略尚未得到充分利用，但可能是 改善肺炎球菌疾病保护的首选方法，尤其是服务不足的少数族裔老年人。 为了进行调查，我们将使用决策分析模型来检查推荐疫苗和信息的变化 旨在解决疫苗接种策略欠佳和疫苗接种率低问题的干预计划。这项努力将elu- 制定战略：a) 改善所有老年人的肺炎球菌疾病保护；b) 减少疫苗接种 以及服务不足的少数群体的疾病差异。由于成人肺炎球菌疾病的潜在变化 将检查其他间接儿童疫苗接种的效果。我们将综合可用数据并根据 通过严格的不确定性建模形成预测，以协助政策制定并为研究资源提供信息 分配。将对儿科和成人疫苗结构的潜在变化进行建模。具体目标是：1) 估计高价结合疫苗对儿童肺炎球菌疾病的影响以及由此产生的影响 对美国老年人疾病发病率和血清型分布的间接影响； 2) 比较肺炎球菌 老年人的疫苗接种策略，同时考虑儿童疫苗接种的影响，检查更高的效价 疫苗、成人配方疫苗和仅限 PPSV23，有或没有增加疫苗接种的计划。 将通过马尔可夫比较服务不足的少数群体和一般人群的疫苗接种策略 基于模型的成本效益分析，具有概率敏感性分析和信息分析的价值 sis 以确定有利的策略并确定未来研究的有价值的领域。我们也将创新地 考虑采用成人配制的结合疫苗来减轻种族疾病差异。自从 CDC 真空 随着经济评估越来越多地考虑经济分析，分析结果可以像以前一样用于 协助疫苗接种建议决策并可能改变政策以更好地保护服务不足的人群。