在美国，A、B、C、W 和 Y 五价疫苗的潜在公共卫生影响。
Potential public health impact of a A, B, C, W, and Y pentavalent vaccine in the United States.
机构信息
Patient Health and Impact, Pfizer Inc, Collegeville, PA, USA.
Health Economics, Pharmerit - an OPEN Health Company, Bethesda, MD, USA.
出版信息
Postgrad Med. 2022 May;134(4):341-348. doi: 10.1080/00325481.2021.1876478. Epub 2021 Feb 22.
OBJECTIVE
Globally, 5 serogroups (A, B, C, W, and Y) cause the majority of invasive meningococcal disease (IMD). Vaccines targeting these serogroups are currently part of the US adolescent immunization platform, which includes 1 + 1 dosing of a MenACWY vaccine routinely at ages 11 and 16 years and 2 doses of a MenB vaccine at age 16-23 years under shared clinical decision-making between the patient and healthcare provider. In 2018, MenACWY vaccination coverage was 86.6% for ≥1 dose and 50.8% for ≥2 doses, whereas MenB vaccination coverage was 17.2% for ≥1 dose and <50% for completion of the multidose series. A pentavalent MenABCWY vaccine could simplify immunization schedules and improve vaccination coverage. We estimated the public health impact of a pentavalent MenABCWY vaccine using a model that considers meningococcal carriage and vaccination coverage.
METHODS
A population-based dynamic model estimated the 10-year reduction in IMD from implementing a MenABCWY vaccine within the existing US meningococcal immunization platform. Five vaccination schedules (4 new, 1 existing) were examined to estimate the impact of different recommendations on the overall reduction in the number of IMD cases. Sensitivity analyses were performed by varying vaccination coverage at age 16 years.
RESULTS
The existing schedule and coverage of MenACWY and MenB vaccines (total 4 doses) could potentially avert 165 IMD cases over 10 years versus no vaccination. Assuming similar MenABCWY and MenACWY vaccination coverage rates at age 16 years, replacing 1 or more MenACWY and/or MenB doses with MenABCWY could avert more cases, ranging from 189 to 256. The most beneficial MenABCWY vaccine schedule was 2 doses at age 11 years and 1 dose at age 16 years.
CONCLUSIONS
Replacing one or more MenACWY/MenB vaccine doses with MenABCWY could reduce IMD caused by all 5 meningococcal serogroups among the US adolescent population, while also reducing the number of injections required.
目的
在全球范围内，有 5 个血清群（A、B、C、W 和 Y）导致了大多数侵袭性脑膜炎球菌病（ IMD ）。针对这些血清群的疫苗目前是美国青少年免疫计划的一部分，该计划包括在 11 岁和 16 岁时常规接种 1+1 剂 MenACWY 疫苗，以及在 16-23 岁时根据患者和医疗保健提供者之间的共同临床决策接种 2 剂 MenB 疫苗。2018 年，≥1 剂 MenACWY 疫苗接种覆盖率为 86.6%，≥2 剂接种覆盖率为 50.8%，而≥1 剂 MenB 疫苗接种覆盖率为 17.2%，多剂系列完成率<50%。一种五价 MenABCWY 疫苗可以简化免疫计划并提高疫苗接种覆盖率。我们使用考虑脑膜炎球菌携带和疫苗接种覆盖率的模型来估计五价 MenABCWY 疫苗的公共卫生影响。
方法
基于人群的动态模型估计了在美国现有的脑膜炎球菌免疫计划框架内实施 MenABCWY 疫苗后，10 年内 IMD 减少的情况。检查了 5 种疫苗接种方案（4 种新方案，1 种现有方案），以估计不同建议对总体减少 IMD 病例数的影响。通过改变 16 岁时的疫苗接种覆盖率进行了敏感性分析。
结果
现有方案和 MenACWY 和 MenB 疫苗（共 4 剂）的接种覆盖率有可能在 10 年内预防 165 例 IMD 病例，而不进行疫苗接种。假设 16 岁时 MenABCWY 和 MenACWY 的接种率相似，用 MenABCWY 替代 1 剂或多剂 MenACWY 和/或 MenB 可以预防更多病例，范围从 189 例到 256 例。最有益的 MenABCWY 疫苗接种方案是在 11 岁时接种 2 剂，在 16 岁时接种 1 剂。
结论
用 MenABCWY 替代 1 剂或多剂 MenACWY/MenB 疫苗可以减少美国青少年人群中所有 5 种脑膜炎球菌血清群引起的 IMD ，同时减少所需的注射次数。
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