Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.
Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331.
Proc Natl Acad Sci U S A. 2018 May 15;115(20):5151-5156. doi: 10.1073/pnas.1802479115. Epub 2018 Apr 30.
The efficacy of influenza vaccines varies from one year to the next, with efficacy during the 2017-2018 season anticipated to be lower than usual. However, the impact of low-efficacy vaccines at the population level and their optimal age-specific distribution have yet to be ascertained. Applying an optimization algorithm to a mathematical model of influenza transmission and vaccination in the United States, we determined the optimal age-specific uptake of low-efficacy vaccine that would minimize incidence, hospitalization, mortality, and disability-adjusted life-years (DALYs), respectively. We found that even relatively low-efficacy influenza vaccines can be highly impactful, particularly when vaccine uptake is optimally distributed across age groups. As vaccine efficacy declines, the optimal distribution of vaccine uptake shifts toward the elderly to minimize mortality and DALYs. Health practitioner encouragement and concerted recruitment efforts are required to achieve optimal coverage among target age groups, thereby minimizing influenza morbidity and mortality for the population overall.
流感疫苗的效果每年都有所不同，预计 2017-2018 季节的效果将低于往常。然而，低效率疫苗在人群中的影响及其最佳的年龄特异性分布尚未确定。我们应用优化算法对美国流感传播和疫苗接种的数学模型进行了分析，以确定可分别将发病率、住院率、死亡率和伤残调整生命年（DALY）降至最低的低效率疫苗的最佳年龄特异性接种率。我们发现，即使是相对低效的流感疫苗也可能具有高度的影响力，特别是当疫苗接种在年龄组之间得到最佳分布时。随着疫苗效力的下降，疫苗接种的最佳分布会向老年人转移，以最大程度地降低死亡率和 DALY。需要卫生保健从业者的鼓励和协调一致的招募努力，以在目标年龄组中实现最佳覆盖率，从而最大程度地降低整个人群的流感发病率和死亡率。
