新型结核病疫苗在中低收入国家的替代交付策略的影响：建模研究。
The impact of alternative delivery strategies for novel tuberculosis vaccines in low-income and middle-income countries: a modelling study.
机构信息
TB Modelling Group and TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Centre for the 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 Centre, London School of Hygiene & Tropical Medicine, London, UK.
TB Modelling Group and TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Centre for the 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.
出版信息
Lancet Glob Health. 2023 Apr;11(4):e546-e555. doi: 10.1016/S2214-109X(23)00045-1.
BACKGROUND
Tuberculosis is a leading infectious cause of death worldwide. Novel vaccines will be required to reach global targets and reverse setbacks resulting from the COVID-19 pandemic. We estimated the impact of novel tuberculosis vaccines in low-income and middle-income countries (LMICs) in several delivery scenarios.
METHODS
We calibrated a tuberculosis model to 105 LMICs (accounting for 93% of global incidence). Vaccine scenarios were implemented as the base-case (routine vaccination of those aged 9 years and one-off vaccination for those aged 10 years and older, with country-specific introduction between 2028 and 2047, and 5-year scale-up to target coverage); accelerated scale-up similar to the base-case, but with all countries introducing vaccines in 2025, with instant scale-up; and routine-only (similar to the base-case, but including routine vaccination only). Vaccines were assumed to protect against disease for 10 years, with 50% efficacy.
FINDINGS
The base-case scenario would prevent 44·0 million (95% uncertainty range 37·2-51·6) tuberculosis cases and 5·0 million (4·6-5·4) tuberculosis deaths before 2050, compared with equivalent estimates of cases and deaths that would be predicted to occur before 2050 with no new vaccine introduction (the baseline scenario). The accelerated scale-up scenario would prevent 65·5 million (55·6-76·0) cases and 7·9 million (7·3-8·5) deaths before 2050, relative to baseline. The routine-only scenario would prevent 8·8 million (95% uncertainty range 7·6-10·1) cases and 1·1 million (0·9-1·2) deaths before 2050, relative to baseline.
INTERPRETATION
Our results suggest novel tuberculosis vaccines could have substantial impact, which will vary depending on delivery strategy. Including a one-off vaccination campaign will be crucial for rapid impact. Accelerated introduction-at a pace similar to that seen for COVID-19 vaccines-would increase the number of lives saved before 2050 by around 60%. Investment is required to support vaccine development, manufacturing, prompt introduction, and scale-up.
FUNDING
WHO (2020/985800-0).
TRANSLATIONS
For the French, Spanish, Italian and Dutch translations of the abstract see Supplementary Materials section.
背景
结核病是全球主要的传染病死因。为了实现全球目标并扭转因 COVID-19 大流行而造成的倒退，需要开发新型结核病疫苗。我们在几种交付方案中评估了新型结核病疫苗在低收入和中等收入国家（LMIC）中的影响。
方法
我们使用结核病模型对 105 个 LMIC（占全球发病总数的 93%）进行了校准。疫苗方案的实施情况为：基本方案（对 9 岁儿童进行常规接种，对 10 岁及以上儿童进行一次性接种，各国在 2028 年至 2047 年之间引入疫苗，并在 5 年内扩大到目标覆盖范围）；加速扩大规模与基本方案类似，但所有国家都在 2025 年引入疫苗，实现即时扩大规模；仅常规接种（与基本方案类似，但仅包括常规接种）。假设疫苗能保护 10 年，有效率为 50%。
结果
与没有新疫苗引入（基线方案）的情况下预计 2050 年前发生的病例和死亡预测相比，基本方案将在 2050 年前预防 4400 万（95%置信区间 3720 万至 5160 万）例结核病病例和 500 万（460 万至 540 万）例结核病死亡。加速扩大规模方案将在 2050 年前预防 6550 万（5560 万至 7600 万）例病例和 790 万（730 万至 850 万）例死亡。仅常规接种方案将在 2050 年前预防 880 万（760 万至 1010 万）例病例和 110 万（0.90 万至 1.20 万）例死亡。
解释
我们的研究结果表明，新型结核病疫苗可能产生重大影响，但其效果将取决于交付策略。包括一次性疫苗接种活动对于快速产生影响至关重要。类似 COVID-19 疫苗的加速引入速度将使 2050 年前拯救的生命数量增加约 60%。需要投资来支持疫苗开发、制造、及时推出和扩大规模。
资助
世卫组织（2020/985800-0）。
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