Park Hailey J, Tan Sophia T, León Tomás M, Jain Seema, Schechter Robert, Lo Nathan C
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
California Department of Public Health, Richmond, California, USA.
Open Forum Infect Dis. 2023 Aug 9;10(9):ofad415. doi: 10.1093/ofid/ofad415. eCollection 2023 Sep.
Uptake of coronavirus disease 2019 (COVID-19) bivalent vaccines and the 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 and determine what proportion of severe COVID-19 is avertable with these interventions.
This modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from 23 July 2022 to 23 January 2023. We used a quasi-Poisson regression model calibrated to recent historical data to predict future COVID-19 outcomes and modeled the impact of increasing uptake (up to 70% coverage) of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups. Risk groups were 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).
The model predicted that increased uptake of bivalent COVID-19 boosters and nirmatrelvir-ritonavir (up to 70% coverage) in all eligible persons could avert an estimated 15.7% (95% uncertainty interval [UI], 11.2%-20.7%; NNT: 17 310) and 23.5% (95% UI, 13.1%-30.0%; NNT: 67) of total COVID-19-related deaths, respectively. In the high-risk group of persons ≥65 years old alone, increased uptake of bivalent boosters and nirmatrelvir-ritonavir could avert an estimated 11.9% (95% UI, 8.4%-15.1%; NNT: 2757) and 22.8% (95% UI, 12.7%-29.2%; NNT: 50) of total COVID-19-related deaths, respectively.
These findings suggest that prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among older age groups (≥65 years) would be most effective (based on NNT) but would not address the entire burden of severe COVID-19.
2019冠状病毒病（COVID-19）二价疫苗和口服药物奈玛特韦-利托那韦（Paxlovid）在美国的接种率一直很低。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，并确定这些干预措施可避免的严重COVID-19病例的比例。
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COVID-19病例、住院、死亡和疫苗接种的个人层面数据。我们使用了一个根据近期历史数据校准的准泊松回归模型来预测未来的COVID-19结果，并模拟了在不同风险群体的急性疾病期间增加二价COVID-19疫苗和奈玛特韦-利托那韦的接种率（高达70%覆盖率）的影响。风险群体根据年龄（≥50岁、≥65岁、≥75岁）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）来定义。我们预测了可避免的COVID-19病例、住院和死亡的数量以及治疗所需人数（NNT）。
该模型预测，在所有符合条件的人群中增加二价COVID-19加强针和奈玛特韦-利托那韦的接种率（高达70%覆盖率），分别可避免估计15.7%（95%不确定区间[UI]，11.2%-20.7%；NNT：17310）和总COVID-19相关死亡人数的23.5%（95%UI，13.1%-30.0%；NNT：67）。仅在≥65岁的高危人群中，增加二价加强针和奈玛特韦-利托那韦的接种率分别可避免估计11.9%（95%UI，8.4%-15.1%；NNT：2757）和总COVID-19相关死亡人数的22.8%（95%UI，12.7%-29.2%；NNT：50）。
这些发现表明，在老年人群体（≥65岁）中优先接种二价加强针和奈玛特韦-利托那韦将是最有效的（基于NNT），但无法解决严重COVID-19的全部负担。
