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: 10045619
• 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/10045619
• 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; 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; 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 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.

摘要 CDC推荐23价肺炎球菌多糖疫苗（PPSV 23）和13价 肺炎球菌结合疫苗（PCV 13）用于年龄≥65岁的成人。然而，PCV 13在老年人中的使用，现在被认为是 基于共同决策，在免疫功能正常的情况下， (herd免疫力）保护儿童免受PCV 13使用的影响;最近的分析显示，使用这两种疫苗都需要花费- 没有什么额外的健康益处。服务不足的少数民族成年人，谁是在更大的风险，不太经常真空- 接种疫苗，更常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- 型疾病占肺炎球菌疾病的40-49%，并且疫苗摄取仍然不理想。解决 在这些问题上，更多的血清型被添加到结合疫苗中，而政策制定者则在争论是否需要 成人使用结合物，考虑到儿童接种的间接影响。一种成人配制的疫苗， 可以考虑保护。提高成人疫苗接种率的策略未得到充分利用，但可能是 这是改善肺炎球菌疾病保护的首选方式，特别是在服务不足的少数民族老年人中。 为了调查，我们将使用决策分析模型来检查推荐疫苗的变化， 干预计划，以解决次优疫苗接种策略和低疫苗摄取。这一努力将使- 制定战略，以：a）提高所有老年人对肺炎球菌疾病的保护，B）减少疫苗接种 和疾病的不平等。成人肺炎球菌疾病的潜在变化，由于广告- 将检查间接的儿童疫苗接种效果。我们将综合现有的数据，并根据- 通过对不确定性的严格建模形成预测，以协助决策并为研究资源提供信息 配置中将对儿童和成人疫苗形成的潜在变化进行建模。具体目标是：1） 估计高效价结合疫苗对儿童肺炎球菌疾病的影响， 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效果，检查更高的效价， 疫苗、成人配制疫苗和仅PPSV 23，有和没有增加疫苗摄取的计划。 将通过马尔可夫模型比较服务不足的少数群体和一般人群队列的疫苗接种策略 基于模型的成本效益分析，包括概率敏感性分析和信息价值分析， SIS以确定有利的策略并确定未来研究的有价值的领域。我们还将创新 考虑一种成人配制的结合疫苗，旨在减轻种族疾病差异。从疾控中心撤离后- 电影评价越来越多地考虑经济分析，分析结果可以像以前一样， 协助疫苗接种建议的决定，并可能改变政策，以更好地保护服务不足的人。