Health Economics and Outcomes Research, Sanofi, New Jersey.
Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut.
JAMA Netw Open. 2024 Nov 4;7(11):e2443551. doi: 10.1001/jamanetworkopen.2024.43551.
Beginning in 2005, the US implemented routine immunization of adolescents with a quadrivalent conjugate vaccine (MenACWY) for the prevention of invasive meningococcal disease (IMD).
To assess whether MenACWY immunization was associated with a reduced IMD burden among the US adolescent population and how the downward trajectory of IMD that began in the mid-1990s might have evolved in the absence of vaccination efforts.
DESIGN, SETTING, AND PARTICIPANTS: In this decision analytical study, a bayesian hierarchical Poisson regression model was developed to investigate the potential trajectory of IMD among US adolescents and young adults without vaccination and evaluate the direct association of vaccination with IMD burden. The model included the entire age-stratified US population and was fitted to national incidence data for serogroups C, W, and Y from January 1, 2001, to December 31, 2021, with stratification by vaccination status for IMD cases.
Simulated counterfactual scenario of absent vaccination from 2005 to 2021, while retaining the incidence rate of IMD for unvaccinated individuals estimated during model fitting.
The main outcomes were the estimated numbers of IMD cases and deaths averted by MenACWY vaccination among US adolescents and young adults aged 11 to 23 years.
Among the entire US population from 2005 to 2021, MenACWY vaccination prevented an estimated 172 (95% credible interval [CrI], 85-345) cases of IMD among US adolescents 11 to 15 years of age and 328 (95% CrI, 164-646) cases of IMD among those aged 16 to 23 years. Absent vaccination, the cumulative incidence of IMD in these age groups would have been at least 59% higher than reported over the same period with vaccination. Using case fatality rates of unvaccinated individuals derived from national data, vaccination averted an estimated 16 (95% CrI, 8-31) deaths among adolescents aged 11 to 15 years and 38 (95% CrI, 19-75) deaths among those aged 16 to 23 years.
This decision analytical model suggests that the MenACWY vaccination program in the US was associated with a reduced burden of meningococcal disease. Without vaccination, the incidence rates per 100 000 adolescents and young adults would have been substantially higher than those observed during the vaccine era.
自 2005 年以来，美国为预防侵袭性脑膜炎球菌病（ IMD ），为青少年常规免疫接种了一种四价结合疫苗（MenACWY）。
评估 MenACWY 免疫接种是否与美国青少年人群 IMD 负担的减少有关，以及如果没有疫苗接种工作，90 年代中期开始的 IMD 下降趋势可能会如何演变。
设计、环境和参与者：在这项决策分析研究中，开发了一个贝叶斯分层泊松回归模型，以调查美国青少年和年轻人中没有接种疫苗的 IMD 潜在轨迹，并评估接种与 IMD 负担的直接关联。该模型包括整个年龄分层的美国人口，并根据 IMD 病例的疫苗接种状况进行分层，拟合了 2001 年 1 月 1 日至 2021 年 12 月 31 日期间 C、W 和 Y 血清群的全国发病率数据。
模拟了从 2005 年到 2021 年不存在疫苗接种的假设情况，同时保留了在模型拟合期间估计的未接种人群中 IMD 的发病率。
主要结果是估计在美国青少年和年轻人（11 至 23 岁）中，MenACWY 疫苗接种预防的 IMD 病例数和死亡人数。
在 2005 年至 2021 年期间，整个美国人群中，MenACWY 疫苗接种预防了估计 172 例（95%可信区间[CrI]，85-345）11 至 15 岁青少年 IMD 病例和 328 例（95%CrI，164-646）16 至 23 岁青少年 IMD 病例。如果没有疫苗接种，这两个年龄组的 IMD 累积发病率将比同期报告的接种疫苗高出至少 59%。使用国家数据中推导的未接种个体的病死率，疫苗接种预防了估计 16 例（95%CrI，8-31）11 至 15 岁青少年死亡和 38 例（95%CrI，19-75）16 至 23 岁青少年死亡。
这项决策分析模型表明，美国的 MenACWY 疫苗接种计划与脑膜炎球菌病负担的减少有关。如果没有疫苗接种，每 10 万名青少年和年轻人的发病率将远远高于疫苗接种时代的观察结果。
