Alternative Strategies for Adult Pneumococcal Vaccination

描述(申请人提供)：肺炎链球菌是发病率和死亡率的主要原因；肺炎球菌多糖疫苗(PPV)预防侵袭性肺炎球菌病(IPD)已被推荐给所有65岁的人和患有合并症的年轻人。然而，IPD的预防并不是最理想的，部分原因是没有疫苗适应症的人受到感染，以及PPV后免疫力减弱。由儿童肺炎球菌结合疫苗(PCV)引起的肺炎球菌血清型流行病学最近的变化进一步使疫苗政策决策复杂化。由于PCV相关肺炎球菌血清型导致的IPD在成人中显著减少，但在合并疾病的人中减少得多，这促使人们研究其他疫苗接种策略，包括每10-15年接种一次PPV和增加成人PCV。考虑到流行病学的快速变化，测试多种疫苗接种方案的临床试验将是困难、昂贵的，甚至可能无济于事。建模技术、综合现有数据和预测未来可能的情景可能有助于确定疫苗接种战略的可行性，并指出进一步收集数据最有价值的不确定领域。为此，我们建议：1)使用传染病传播动力学模型预测儿童PCV引起的成人肺炎球菌血清型流行病学的变化；2)计算结合预测的PCV流行病学影响的替代成人肺炎球菌疫苗接种策略的有效性和成本效益。将使用最近开发的分析框架将数据不确定领域完全纳入模型，这将使结果能够以概率表示，并通过信息分析技术的价值，为未来研究资源的最佳分配提供基于证据的指导。公共卫生相关性肺炎链球菌引起的疾病仍然是一个重大的公共卫生问题，需要改进预防策略。这项研究将产生一个数学模型，以帮助肺炎球菌疫苗政策的制定，特别是在确定优先顺序和为未来的研究工作分配资源方面。

DESCRIPTION (provided by applicant): Streptococcus pneumoniae is a major cause of morbidity and mortality; pneumococcal polysaccharide vaccination (PPV) to prevent invasive pneumococcal disease (IPD) has been recommended for all persons aged >65 and for younger persons with comorbidities. However, IPD prevention is less than optimal, due in part to infections in persons without vaccine indication and waning immunity after PPV. Recent changes in pneumococcal serotype epidemiology resulting from the childhood pneumococcal conjugate vaccine (PCV) further complicate vaccine policy decision making. IPD due to PCV-related pneumococcal serotypes has significantly decreased in adults but much less so in those with comorbid conditions, prompting investigation of other vaccination strategies, including PPV every 10-15 years and the addition of adult PCV. Clinical trials testing multiple vaccination regiments would be difficult, expensive, and perhaps unhelpful, given rapid epidemiologic changes. Modeling techniques, synthesizing existing data and projecting likely future scenarios could be useful in determining vaccination strategy feasibility and pointing out areas of uncertainty where further data collection would be most valuable. To this end, we propose to: 1) forecast changes in adult pneumococcal serotype epidemiology resulting from childhood PCV using an infectious disease transmission dynamic model and 2) calculate the effectiveness and cost-effectiveness of alternative adult pneumococcal vaccination strategies incorporating forecasted PCV epidemiologic effects. Areas of data uncertainty will be fully incorporated in the model using recently developed analytic frameworks, which will allow probabilistic representation of results and, through value of information analysis techniques, provide evidence-based guidance for optimal future research resource allocation. PUBLIC HEALTH RELEVANCE Disease due to Streptococcus pneumoniae continues to be a significant public health issue, and improvements in preventive strategies are needed. This research will produce a mathematical model to assist pneumococcal vaccine policymaking, particularly in prioritizing and allocating resources to future research efforts.