Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Vaccine. 2019 Oct 23;37(45):6787-6792. doi: 10.1016/j.vaccine.2019.09.038. Epub 2019 Sep 24.
Streptococcus pneumoniae is a common human commensal that causes a sizeable part of the overall childhood mortality in low income settings. Populations affected by humanitarian crises are at especially high risk, because a multitude of risk factors that are enhanced during crises increase pneumococcal transmission and disease severity. Pneumococcal conjugate vaccines (PCVs) provide effective protection and have been introduced into the majority of routine childhood immunisation programmes globally, though several barriers have hitherto limited their uptake during humanitarian crises. When PCV coverage cannot be sustained during crises or when PCV has not been part of routine programmes, mass vaccination campaigns offer a quick acting and programmatically feasible bridging solution until services can be restored. However, we currently face a paucity of evidence on which to base the structure of such campaigns. We believe that, now that PCV can be procured at a substantially reduced price through the Humanitarian Mechanism, this lack of information is a remaining hurdle to PCV use in humanitarian crises. Considering the difficulties in conducting research in crises, we propose an evidence generation pathway consisting of primary data collection in combination with mathematical modelling followed by quasi-experimental evaluation of a PCV intervention, which can inform on optimal vaccination strategies that consider age targeting, dosing regimens and impact duration.
肺炎链球菌是一种常见的人类共生菌，在低收入环境中导致了相当一部分儿童总死亡率。受人道主义危机影响的人群面临着特别高的风险，因为在危机期间，许多风险因素会加剧肺炎球菌的传播和疾病的严重程度。肺炎球菌结合疫苗（PCV）提供了有效的保护，已经在全球大多数常规儿童免疫规划方案中引入，尽管在人道主义危机期间，有几个障碍限制了其采用。当危机期间无法维持 PCV 覆盖率或 PCV 未纳入常规方案时，大规模疫苗接种运动提供了一种快速有效的临时解决方案，直到服务能够恢复。然而，我们目前缺乏基于该结构的大规模疫苗接种运动的证据。我们认为，现在通过人道主义机制可以以大幅降低的价格采购 PCV，因此，在人道主义危机中使用 PCV 的信息仍然是一个障碍。考虑到在危机中进行研究的困难，我们提出了一个证据生成途径，包括在结合数学建模的情况下进行原始数据收集，然后对 PCV 干预措施进行准实验评估，从而为考虑年龄目标、剂量方案和影响持续时间的最佳疫苗接种策略提供信息。
