新冠大流行后英国 RSVpreF 疫苗对呼吸道合胞病毒流行的缓解作用：一项建模研究。

Mitigation of respiratory syncytial virus epidemics by RSVpreF vaccines after the COVID-19 pandemic in the UK: a modelling study.

机构信息

WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China.

Department of Genetics, University of Cambridge, Cambridge, UK.

出版信息

Lancet. 2023 Nov;402 Suppl 1:S39. doi: 10.1016/S0140-6736(23)02113-X.

DOI:10.1016/S0140-6736(23)02113-X

PMID:37997080

Abstract

BACKGROUND

The RSVpreF vaccines have breakthrough progress. The respiratory syncytial virus (RSV) vaccine for older adults from GlaxoSmithKline was the first RSV vaccine approved by the US Food and Drug Administration (FDA) in early May 2023, followed by the subsequent FDA approval of Pfizer's RSV vaccines for older adults and pregnant women. We aimed to estimate the public health impact of the potential population-level administrations of the RSVpreF vaccine in the UK.

METHODS

In this modelling study, we used national census and contact survey data to construct an individual-based mathematical model, with interpersonal connections characterising household structure, social settings, and age-specific contact patterns. We considered both within-host viral-load dynamics and between-host RSV transmission. We modelled the coverages of RSV vaccines for older people (age ≥60 years) and pregnant women, using influenza vaccination data from the 2018-19 season. We explored a range of possible transmissibility and estimated the health burden averted by RSVpreF vaccine over a 300-day period as compared with the control scenario without vaccines.

FINDINGS

In a low-transmission scenario (Re=1·2), RSVpreF would avert a total population of 2·35 (95% credible interval [CrI] 1·24-3·77) million infections, 12.80 (95% CrI 8·60-17·06) thousand hospital admissions, and 0·93 (95% CrI 0·69-1·25) thousand deaths, with 1·82 (1·41-2·33) million infections, 12·44 (8·50-16·38) thousand hospital admissions, and 0·93 (0·67-1·23) thousand deaths averted for people aged 60 years and older. In a high-transmission scenario (Re=2·0), RSVpreF would avert 2·01 (1·37-2·68) million infections, 14·67 (10·05-18·33) thousand hospital admissions, and 1·12 (0·80-1·35) thousand deaths. The majority averted would still be among older adults.

INTERPRETATION

Our mathematical models will help improve the vaccine schedules of RSVpreF. Future work will address several limitations when data become available, including the incorporation of population immunity, potential vaccine hesitancy, and other factors affecting vaccine uptake and effectiveness.

FUNDING

Government of the Hong Kong Special Administrative Region, the European Research Council, and Ministry of Science and Technology of the People's Republic of China.

摘要

背景

呼吸道合胞病毒（RSV）preF 疫苗取得突破性进展。葛兰素史克（GSK）公司研发的针对老年人的 RSV 疫苗是 2023 年 5 月初美国食品和药物管理局（FDA）批准的首款 RSV 疫苗，紧随其后的是 FDA 随后批准辉瑞公司针对老年人和孕妇的 RSV 疫苗。我们旨在评估在英国潜在的 RSVpreF 疫苗人群层面接种对公共卫生的影响。

方法

在这项建模研究中，我们使用全国人口普查和接触调查数据构建了一个基于个体的数学模型，人际联系描述了家庭结构、社交环境和特定年龄的接触模式。我们考虑了宿主内病毒载量动态和宿主间 RSV 传播。我们使用 2018-19 年流感疫苗接种数据，对老年人（年龄≥60 岁）和孕妇接种 RSV 疫苗的覆盖率进行建模。我们探讨了一系列可能的传染性，并比较了有无疫苗情况下 RSVpreF 疫苗在 300 天内避免的健康负担。

结果

在低传播情景（Re=1.2）下，RSVpreF 将避免总人口 2.35 百万人（95%可信区间[CrI]1.24-3.77）感染，128000 例（95%CrI 86000-170600）住院和 9300 例（95%CrI 6900-12500）死亡，60 岁及以上人群中可避免 1820000 例（1410000-2330000）感染，1244000 例（850000-1638000）住院和 9300 例（67000-123000）死亡。在高传播情景（Re=2.0）下，RSVpreF 将避免 2010000 例（1370000-2680000）感染，146700 例（100500-183300）住院和 11200 例（8000-13500）死亡。大部分预防感染仍将发生在老年人中。