Modeling the impact and cost-effectiveness of next-generation rotavirus vaccine strategies in low- and middle-income countries

项目总结/摘要 尽管口服轮状病毒活疫苗已进入全球90多个国家，但轮状病毒仍然存在。 是儿童严重腹泻的主要原因，也是低收入和低收入国家发病率和死亡率的主要来源。 中等收入国家（LMIC）。轮状病毒疫苗接种有效控制了 轮状病毒相关性胃肠炎（RVGE）在高收入国家，但反应，疗效， 目前口服轮状病毒活疫苗在低中等收入国家中较低，原因有多种，但尚未完全了解。新 可能需要疫苗和方法来克服对当前活的口服轮状病毒的不良免疫应答 疫苗在中低收入国家下一代轮状病毒疫苗，包括新生儿和胃肠外亚单位疫苗， 目前正在马拉维和加纳的现场进行开发和临床试验。模型 需要将这些试验的结果外推到人群水平。我们将使用数学模型， 预测不同轮状病毒疫苗接种策略的潜在影响， 接种疫苗的间接影响。然后，我们将进行经济评估，以确定最具成本效益的 减少轮状病毒引起的腹泻负担的方法。我们开始将重点关注马拉维和加纳， 我们以前已经开发了模型，并有良好的疫苗接种前后监测数据。我们 然后将扩展我们的方法，以预测所有中低收入国家的疫苗影响和成本效益。我们的分析 将有助于更好地确定疫苗反应，免疫持续时间，以及下一代疫苗的价格。 轮状病毒疫苗可能具有成本效益，并将为决策者提供一个有效的平台， LMIC可以用来衡量他们国家不同轮状病毒疫苗接种策略的成本和收益。

PROJECT SUMMARY/ABSTRACT Despite the introduction of live oral rotavirus vaccines into more than 90 countries worldwide, rotavirus remains a leading cause of severe diarrhea in children and a major source of morbidity and mortality in low- and middle-income countries (LMICs). Rotavirus vaccination has been effective at controlling the burden of rotavirus-associated gastroenteritis (RVGE) in high-income countries, but the response, efficacy, and impact of current live oral rotavirus vaccines is lower in LMICs for multiple reasons that are still not fully understood. New vaccines and approaches may be needed to overcome the poor immune response to current live oral rotavirus vaccines in LMICs. Next-generation rotavirus vaccines, including neonatal and parenteral subunit vaccines, are currently in development and undergoing clinical trials at our field sites in Malawi and Ghana. Models are needed to extrapolate the results of these trials to the population level. We will use mathematical models to predict the potential impact of different rotavirus vaccination strategies, accounting for both the direct and indirect effects of vaccination. We will then conduct economic evaluations to determine the most cost-effective approach to reducing the burden of diarrhea due to rotavirus. We will begin by focusing on Malawi and Ghana, where we have previously developed models and have good pre- and post-vaccination surveillance data. We will then extend our approach to predict vaccine impact and cost-effectiveness across all LMICs. Our analyses will help to better define the vaccine response, duration of immunity, and price at which next-generation rotavirus vaccines are likely to be cost-effective, and will provide a validated platform that decision-makers in LMICs can use to weigh the costs and benefits of different rotavirus vaccination strategies in their country.