Adult vaccination strategies for the control of pertussis in the United States: an economic evaluation including the dynamic population effects.
Adult vaccination strategies for the control of pertussis in the United States: an economic evaluation including the dynamic population effects.
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DOI：
10.1371/journal.pone.0006284
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发表时间：
2009-07-16
期刊：
影响因子：
3.7
通讯作者：
Nguyen VH
中科院分区：
文献类型：
--
作者：
Coudeville L;Van Rie A;Getsios D;Caro JJ;Crépey P;Nguyen VH
先前对成人和青少年百日咳疫苗接种策略的经济评估得出了不同的结论。先前的研究仅使用静态方法，未能分析包括群体免疫带来的间接益处以及疫苗接种对疾病发病率随时间演变的影响。我们使用能够考虑百日咳传播的动态区室模型评估了不同百日咳疫苗接种策略的影响。然后，我们将结果与经济数据结合起来，估计美国青少年和成人百日咳免疫策略的相对成本效益。该分析比较了针对青少年、新生儿父母（即茧策略）或不同年龄段成年人的计划组合。如果青少年或成人没有接种疫苗，成人百日咳发病率预计将在 20 年内增加一倍以上。除了儿童和青少年疫苗接种之外，基于 1) 茧策略和单次加强剂量或 2) 十年一次的常规疫苗接种，实施成人计划，从长远来看，可以使所有年龄组的百日咳发病率保持在较低水平（分别为每 10 万人年 30 例和 20 例）。这些策略还将导致百日咳成本显着降低（-77% 至 -80% 之间，包括额外的疫苗接种成本）。以单次加强剂量为补充的茧策略是最具成本效益的策略，而从长远来看，十年一次的成人疫苗接种稍微更有效。通过提供高水平的疾病控制，实施成人百日咳疫苗接种计划似乎具有很高的成本效益，并且通常可以节省成本。
Prior economic evaluations of adult and adolescent vaccination strategies against pertussis have reached disparate conclusions. Using static approaches only, previous studies failed to analytically include the indirect benefits derived from herd immunity as well as the impact of vaccination on the evolution of disease incidence over time. We assessed the impact of different pertussis vaccination strategies using a dynamic compartmental model able to consider pertussis transmission. We then combined the results with economic data to estimate the relative cost-effectiveness of pertussis immunization strategies for adolescents and adults in the US. The analysis compares combinations of programs targeting adolescents, parents of newborns (i.e. cocoon strategy), or adults of various ages. In the absence of adolescent or adult vaccination, pertussis incidence among adults is predicted to more than double in 20 years. Implementing an adult program in addition to childhood and adolescent vaccination either based on 1) a cocoon strategy and a single booster dose or 2) a decennial routine vaccination would maintain a low level of pertussis incidence in the long run for all age groups (respectively 30 and 20 cases per 100,000 person years). These strategies would also result in significant reductions of pertussis costs (between −77% and −80% including additional vaccination costs). The cocoon strategy complemented by a single booster dose is the most cost-effective one, whereas the decennial adult vaccination is slightly more effective in the long run. By providing a high level of disease control, the implementation of an adult vaccination program against pertussis appears to be highly cost-effective and often cost-saving.
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