Evaluating vaccination strategies for reducing infant respiratory syncytial virus infection in low-income settings

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• 作者：Piero Poletti (1) (2)
  Stefano Merler (2)
  Marco Ajelli (2)
  Piero Manfredi (3)
  Patrick K Munywoki (4)
  D James Nokes (4) (5)
  Alessia Melegaro (1)
  
  1. Dondena Centre for Research on Social Dynamics and Public Policy ; Department of Policy Analysis and Public Management ; Universit谩 Commerciale L. Bocconi ; via Rontgen n. 1 ; Milan ; Italy
  2. Center for Information Technology ; Bruno Kessler Foundation ; via Sommarive ; 18 ; Trento ; Italy
  3. Department of Statistics and Mathematics Applied to Economics ; University of Pisa ; via Ridolfi 10 ; Pisa ; Italy
  4. Kenyan Medical Research Institute (KEMRI) - Wellcome Trust Research Programme ; Centre for Geographic Medicine Research (Coast) ; Hospital Road ; Kilifi ; Kenya
  5. School of Life Sciences and WIDER ; University of Warwick ; Coventry CV4 7AL ; Warwick ; UK
  
• 关键词：Computational models ; Infectious diseases ; RSV ; Vaccination ; Household transmission
• 刊名：BMC Medicine
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：13
• 期：1
• 全文大小：1,642 KB
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• 刊物主题：Medicine/Public Health, general; Biomedicine general;
• 出版者：BioMed Central
• ISSN：1741-7015

文摘

Background Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease and related hospitalization of young children in least developed countries. Individuals are repeatedly infected, but it is the first exposure, often in early infancy, that results in the vast majority of severe RSV disease. Unfortunately, due to immunological immaturity, infants are a problematic RSV vaccine target. Several trials are ongoing to identify a suitable candidate vaccine and target group, but no immunization program is yet in place. Methods In this work, an individual-based model that explicitly accounts for the socio-demographic population structure is developed to investigate RSV transmission patterns in a rural setting of Kenya and to evaluate the potential effectiveness of alternative population targets in reducing RSV infant infection. Results We find that household transmission is responsible for 39% of infant infections and that school-age children are the main source of infection within the household, causing around 55% of cases. Moreover, assuming a vaccine-induced protection equivalent to that of natural infection, our results show that annual vaccination of students is the only alternative strategy to routine immunization of infants able to trigger a relevant and persistent reduction of infant infection (on average, of 35.6% versus 41.5% in 10 years of vaccination). Interestingly, if vaccination of pregnant women boosts maternal antibody protection in infants by an additional 4 months, RSV infant infection will be reduced by 31.5%. Conclusions These preliminary evaluations support the efforts to develop vaccines and related strategies that go beyond targeting vaccines to those at highest risk of severe disease.