Model-informed COVID-19 vaccine prioritization strategies by age and serostatus.
Model-informed COVID-19 vaccine prioritization strategies by age and serostatus.
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DOI：
10.1126/science.abe6959
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发表时间：
2021-02-26
期刊：
影响因子：
--
通讯作者：
Larremore DB
中科院分区：
文献类型：
--
作者：
Bubar KM;Reinholt K;Kissler SM;Lipsitch M;Cobey S;Grad YH;Larremore DB
严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）疫苗供应有限，可能会有很高的需求，那么应该如何优先分配疫苗？Bubar等人在不同国家建立了模型，研究疫苗特性的不确定性如何影响减少死亡和传播的优先策略（见菲茨帕特里克和Galvani的观点）。在该模型中，疫苗效力及其减少疾病和/或阻断传播的能力与年龄相关的易感性、病死率和免疫力下降的变化有关。在几乎所有情况下，减少死亡需要将疫苗分发给最有死亡风险的人，通常是60岁以上的人和患有合并症的人。如果疫苗在老年人中泄漏或效果不佳，那么可以优先考虑年轻群体。为了增加可用剂量，应进一步优先考虑血清反应阴性的个体。《科学》杂志，本期第916页;另见第916页：为降低死亡率，对最有死亡风险的血清反应阴性者进行疫苗接种：那些有合并症的人和60岁以上的人。严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）疫苗的初始供应有限，这就提出了如何优先安排可用剂量的问题。我们使用了一个数学模型来比较五个年龄分层的优先级策略。优先接种20至49岁成人的高效传播阻断疫苗可最大限度地减少累积发病率，但在大多数情况下，优先接种60岁以上成人的疫苗可最大限度地减少死亡率和寿命损失。使用个体水平的血清学检测将剂量重新定向到血清阴性个体，改善了每剂疫苗的边际影响，同时可能减少COVID-19影响中现有的不公平现象。尽管最大影响优先战略在各国、传播率、疫苗接种推广速度和自然获得性免疫估计数之间大致一致，但该框架可用于比较不同背景下优先战略的影响。
There is likely to be high demand for the limited supplies of vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), so how should vaccine distribution be prioritized? Bubar et al. modeled across countries how uncertainty about a vaccine's characteristics affects prioritization strategies for reducing deaths and transmission (see the Perspective by Fitzpatrick and Galvani). In the model, vaccine efficacy and its ability to reduce disease and/or block transmission was accounted for in relation to age-related variations in susceptibility, fatality rates, and immune decline. In almost all circumstances, reducing fatalities required distributing the vaccine to those who are most at risk of death, usually persons over 60 years of age and those with comorbidities. If a vaccine is leaky or poorly efficacious in older adults, then priority could be given to younger age groups. To increase the available doses, further priority should be given to seronegative individuals. Science, this issue p. 916; see also p. To minimize mortality, vaccinate seronegative persons most at risk of death: those with comorbidities and those 60+ years of age. Limited initial supply of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine raises the question of how to prioritize available doses. We used a mathematical model to compare five age-stratified prioritization strategies. A highly effective transmission-blocking vaccine prioritized to adults ages 20 to 49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults greater than 60 years old. Use of individual-level serological tests to redirect doses to seronegative individuals improved the marginal impact of each dose while potentially reducing existing inequities in COVID-19 impact. Although maximum impact prioritization strategies were broadly consistent across countries, transmission rates, vaccination rollout speeds, and estimates of naturally acquired immunity, this framework can be used to compare impacts of prioritization strategies across contexts.
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DOI：
10.1093/infdis/jiaa691
发表时间：
2021-02-13
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
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