National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
IBM Research Laboratory, Melbourne, Australia.
J Infect Dis. 2020 Mar 5;221(Suppl 1):S86-S93. doi: 10.1093/infdis/jiz402.
Several cytomegalovirus (CMV) vaccine candidates are under development. To reduce the burden of congenital CMV infection, potential strategies under consideration include vaccination of adult women, adolescent girls, and/or young children (both sexes).
We reviewed 5 studies that used infectious disease modeling to assess the potential impact of vaccination for preventing congenital CMV infection. All models assumed CMV vaccination would prevent primary infection and 2 models also assumed prevention of reinfections and reactivations.
Despite differences in structure, assumptions, and population data, infant vaccination (both sexes) was the optimal strategy in all models, but in 1 model vaccinating seronegative women at 19-21 years of age was also optimal (for duration of vaccine protection ≥8 years). In 3 models, infant vaccination increased average age at primary infection as a result of decreased secondary transmission (herd immunity) combined with waning vaccine-induced immunity. This effect could increase the risk of congenital CMV infections in populations where primary CMV infection occurs early in childhood but could be minimized by administering a second dose of vaccine during adolescence.
Understanding vaccine efficacy and duration of immunity, and how these might vary depending on CMV serostatus and age at vaccination, will be key to defining CMV vaccination strategies.
目前有几种巨细胞病毒 (CMV) 疫苗正在研发中。为了降低先天性 CMV 感染的负担，正在考虑的潜在策略包括对成年女性、青春期少女和/或幼儿（两性）进行疫苗接种。
我们回顾了 5 项使用传染病模型评估预防先天性 CMV 感染的疫苗接种潜在影响的研究。所有模型均假设 CMV 疫苗接种可预防原发性感染，其中 2 个模型还假设可预防再感染和再激活。
尽管结构、假设和人群数据存在差异，但在所有模型中，婴儿（两性）接种疫苗都是最佳策略，但在 1 个模型中，对 19-21 岁的血清阴性妇女进行疫苗接种也是最佳策略（疫苗保护期≥8 年）。在 3 个模型中，由于继发传播（群体免疫）减少和疫苗诱导的免疫力减弱，婴儿接种疫苗使原发性感染的平均年龄增加。这种影响可能会增加在儿童早期发生原发性 CMV 感染的人群中先天性 CMV 感染的风险，但通过在青春期接种第二剂疫苗可以最小化这种风险。
了解疫苗的效力和免疫持续时间，以及这些因素如何根据 CMV 血清状态和接种疫苗时的年龄而变化，将是确定 CMV 疫苗接种策略的关键。
