Park Hailey J, Tan Sophia T, León Tomás M, Jain Seema, Schechter Robert, Lo Nathan C
Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA.
California Department of Public Health, Richmond, CA, USA.
medRxiv. 2023 May 21:2023.05.18.23289533. doi: 10.1101/2023.05.18.23289533.
Uptake of COVID-19 bivalent vaccines and oral medication nirmatrelvir-ritonavir (Paxlovid) has remained low across the United States. Assessing the public health impact of increasing uptake of these interventions in key risk groups can guide further public health resources and policy.
This modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from July 23, 2022 to January 23, 2023. We modeled the impact of additional uptake of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups defined by age (50+, 65+, 75+ years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 cases, hospitalizations, and deaths and number needed to treat (NNT).
For both bivalent vaccines and nirmatrelvir-ritonavir, the most efficient strategy (based on NNT) for averting severe COVID-19 was targeting the 75+ years group. We predicted that perfect coverage of bivalent boosters in the 75+ years group would avert 3,920 hospitalizations (95%UI: 2,491-4,882; 7.8% total averted; NNT 387) and 1,074 deaths (95%UI: 774-1,355; 16.2% total averted; NNT 1,410). Perfect uptake of nirmatrelvir-ritonavir in the 75+ years group would avert 5,644 hospitalizations (95%UI: 3,947-6,826; 11.2% total averted; NNT 11) and 1,669 deaths (95%UI: 1,053-2,038; 25.2% total averted; NNT 35).
These findings suggest prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among the oldest age groups would be efficient and have substantial public health impact in reducing the burden of severe COVID-19, but would not address the entire burden of severe COVID-19.
美国各地新冠病毒二价疫苗和口服药物奈玛特韦-利托那韦（帕罗韦德）的接种率一直很低。评估在关键风险群体中增加这些干预措施的接种对公共卫生的影响，可以为进一步的公共卫生资源和政策提供指导。
这项建模研究使用了加利福尼亚州公共卫生部提供的2022年7月23日至2023年1月23日期间关于新冠病毒病例、住院、死亡和疫苗接种的个人层面数据。我们对不同风险群体（按年龄划分：50岁以上、65岁以上、75岁以上）和疫苗接种状况（所有人、仅接种过基础系列疫苗、之前接种过疫苗）在急性疾病期间额外接种新冠病毒二价疫苗和奈玛特韦-利托那韦的影响进行了建模。我们预测了避免的新冠病毒病例、住院和死亡数量以及治疗所需人数（NNT）。
对于二价疫苗和奈玛特韦-利托那韦，避免严重新冠病毒感染的最有效策略（基于NNT）是针对75岁以上人群。我们预测，75岁以上人群二价加强针的完美覆盖率将避免3920例住院（95%不确定区间：2491 - 4882；总共避免7.8%；NNT为387）和1074例死亡（95%不确定区间：774 - 1355；总共避免16.2%；NNT为1410）。75岁以上人群完美服用奈玛特韦-利托那韦将避免5644例住院（95%不确定区间：3947 - 6826；总共避免11.2%；NNT为11）和1669例死亡（95%不确定区间：1053 - 2038；总共避免25.2%；NNT为35）。
这些发现表明，在最年长的年龄组中优先接种二价加强针和服用奈玛特韦-利托那韦将是有效的，并且在减轻严重新冠病毒感染负担方面具有重大的公共卫生影响，但无法解决严重新冠病毒感染的全部负担。
