Analyzing Adult Pneumococcal Vaccination Implementation in the Underserved

摘要 疾控中心建议接种23价肺炎球菌多糖疫苗(PPSV23)和13价肺炎球菌多糖疫苗。 65岁≥成人接种肺炎球菌结合疫苗(PCV13)。然而，PCV13在老年人中使用，现在记录- 建议在免疫能力共享决策的基础上，不得大幅增加间接 (群体免疫)保护儿童免受PCV13的使用；最近的分析表明，这两种疫苗的使用都是昂贵的- 对健康几乎没有好处。服务不足的少数族裔成年人面临更大的风险，他们较少出现空虚。 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- 肺炎链球菌疾病中有40-49%是由类型病引起的，疫苗接种量仍然不够理想。致信地址 这些问题，更多的血清型正在被添加到结合疫苗中，而政策制定者正在辩论是否需要 成人结合使用，给儿童接种疫苗带来间接效果。一种成人配方疫苗，以提高亲和力 可以考虑采取保护措施。提高成人疫苗接种率的策略没有得到充分利用，但可能是 改善肺炎球菌疾病保护的首选方法，特别是在服务不足的少数族裔老年人中。 为了进行调查，我们将使用决策分析建模来检查推荐疫苗的变化和- 旨在解决次优疫苗接种策略和低疫苗接种率的发明方案。这一努力将使- CIDATE战略：a)改善所有老年人对肺炎球菌病的保护；b)减少疫苗接种 以及未得到充分服务的少数民族的疾病差异。成人肺炎链球菌病的潜在变化 将检查其他间接儿童疫苗接种效果。我们将综合可用的数据和每一个- 通过对不确定性进行严格建模来形成预测，以帮助制定政策并为研究资源提供信息 分配。将模拟儿科和成人疫苗形成的潜在变化。具体目标是：1) 评估高价结合疫苗对儿童肺炎球菌疾病的影响及其结果 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，同时考虑到儿童接种疫苗的影响，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量的计划。 我们将通过马尔科夫模型比较服务不足的少数群体和普通人群的疫苗接种策略。 基于模型的成本效益分析，结合概率敏感性分析和信息价值分析。 SIS以确定所偏爱的战略并确定未来研究的有价值的领域。我们还将创新地 考虑一种成人配方的结合疫苗，旨在缓解种族疾病差异。因为疾控中心vac- 引用评价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。

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.