Plans-Rubió Pedro
Department of Health, General Direction of Public Health, Travessera de les Corts 131-159, 08028 Barcelona, Spain.
Vaccine. 2004 Sep 28;22(29-30):4002-13. doi: 10.1016/j.vaccine.2004.03.048.
The prevalence of seropositive individuals that makes costs of vaccinating all individuals equal to that for screening and vaccination of susceptible individuals is defined as the critical prevalence of antibodies (p*). Screening and vaccination is more efficient when the prevalence of seropositive individuals (p) in the population is higher than p*. In this study, the formula to obtain p* was derived from the cost-effectiveness equations, showing that it depends on screening and vaccination costs, programme compliance, screening test performance, vaccine efficacy and disease costs. The formula was used to determine the least costly vaccination strategy for hepatitis A and B, varicella, measles and tetanus in adults and adolescents in Catalonia. The least costly vaccination strategy was vaccination without screening (since p was lower than p*) for hepatitis B, measles and tetanus in adults and adolescents (5-14 years) and for hepatitis A in individuals aged 5-24 years, and screening and vaccination (since p was higher than p*) for varicella in adults and adolescents and for hepatitis A in adults aged >24 years. Vaccination strategies based on the critical prevalence of antibodies could maximize the immunity level in the community from available resources.
使对所有个体进行疫苗接种的成本等于对易感个体进行筛查和疫苗接种成本的血清学阳性个体的流行率被定义为抗体的临界流行率（p*）。当人群中血清学阳性个体的流行率（p）高于p时，筛查和疫苗接种更为有效。在本研究中，获得p的公式是从成本效益方程推导出来的，表明它取决于筛查和疫苗接种成本、项目依从性、筛查测试性能、疫苗效力和疾病成本。该公式用于确定加泰罗尼亚成年人和青少年中甲型和乙型肝炎、水痘、麻疹和破伤风的成本最低的疫苗接种策略。成本最低的疫苗接种策略是，对于成年人和青少年（5至14岁）中的乙型肝炎、麻疹和破伤风以及5至24岁个体中的甲型肝炎，不进行筛查直接接种疫苗（因为p低于p*）；对于成年人和青少年中的水痘以及24岁以上成年人中的甲型肝炎，进行筛查并接种疫苗（因为p高于p*）。基于抗体临界流行率的疫苗接种策略可以从可用资源中使社区的免疫水平最大化。
