TY - JOUR
T1 - Assessing the efficiency of catch-up campaigns for the introduction of pneumococcal conjugate vaccine
T2 - A modelling study based on data from PCV10 introduction in Kilifi, Kenya
AU - Flasche, Stefan
AU - Ojal, John
AU - Le Polain de Waroux, Olivier
AU - Otiende, Mark
AU - O'Brien, Katherine L.
AU - Kiti, Moses
AU - Nokes, D. James
AU - Edmunds, W. John
AU - Scott, J. Anthony G.
N1 - Funding Information:
The modelling work was funded by Gavi, the Vaccine Alliance (2001759775 and 50390116); the fieldwork was supported by Gavi and the Wellcome Trust. JAS was supported by a fellowship from the Wellcome Trust (098532). DJN was supported by a Senior Investigator Award from the Wellcome Trust (102975). KOB was supported by a grant from Gavi. OLPW was supported by a doctoral research fellowship from the AXA Research Fund.
Funding Information:
SF has received funding related to pneumococcal vaccine research from the Bill & Melinda Gates Foundation, the World Health Organisation and Gavi, the Vaccine Alliance. KOB has research funding related to pneumococcal vaccine from the National Institutes of Health, GlaxoSmithKline, Pfizer, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance. WJE’s partner works for GlaxoSmithKline. JAS is a member of the Joint Committee of Vaccination and Immunisation, has received financial support for research on pneumococcal vaccines from the Wellcome Trust, the National Institute for Health Research (UK), GAVI, the Vaccine Alliance and PATH Vaccine Solutions and has done consultancy work on pneumococcal vaccines for PATH Vaccine Solutions. All other authors declare that they have no competing interests.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/6/7
Y1 - 2017/6/7
N2 - Background: The World Health Organisation recommends the use of catch-up campaigns as part of the introduction of pneumococcal conjugate vaccines (PCVs) to accelerate herd protection and hence PCV impact. The value of a catch-up campaign is a trade-off between the costs of vaccinating additional age groups and the benefit of additional direct and indirect protection. There is a paucity of observational data, particularly from low- and middle-income countries, to quantify the optimal breadth of such catch-up campaigns. Methods: In Kilifi, Kenya, PCV10 was introduced in 2011 using the three-dose Expanded Programme on Immunisation infant schedule and a catch-up campaign in children <5 years old. We fitted a transmission dynamic model to detailed local data, including nasopharyngeal carriage and invasive pneumococcal disease (IPD), to infer the marginal impact of the PCV catch-up campaign over hypothetical routine cohort vaccination in that setting and to estimate the likely impact of alternative campaigns and their dose efficiency. Results: We estimated that, within 10 years of introduction, the catch-up campaign among children <5 years old prevents an additional 65 (48-84) IPD cases across age groups, compared to PCV cohort introduction alone. Vaccination without any catch-up campaign prevented 155 (121-193) IPD cases and used 1321 (1058-1698) PCV doses per IPD case prevented. In the years after implementation, the PCV programme gradually accrues herd protection, and hence its dose efficiency increases: 10 years after the start of cohort vaccination alone the programme used 910 (732-1184) doses per IPD case averted. We estimated that a two-dose catch-up among children <1 year old uses an additional 910 (732-1184) doses per additional IPD case averted. Furthermore, by extending a single-dose catch-up campaign to children aged 1 to <2 years and subsequently to those aged 2 to <5 years, the campaign uses an additional 412 (296-606) and 543 (403-763) doses per additional IPD case averted. These results were not sensitive to vaccine coverage, serotype competition, the duration of vaccine protection or the relative protection of infants. Conclusions: We find that catch-up campaigns are a highly dose-efficient way to accelerate population protection against pneumococcal disease.
AB - Background: The World Health Organisation recommends the use of catch-up campaigns as part of the introduction of pneumococcal conjugate vaccines (PCVs) to accelerate herd protection and hence PCV impact. The value of a catch-up campaign is a trade-off between the costs of vaccinating additional age groups and the benefit of additional direct and indirect protection. There is a paucity of observational data, particularly from low- and middle-income countries, to quantify the optimal breadth of such catch-up campaigns. Methods: In Kilifi, Kenya, PCV10 was introduced in 2011 using the three-dose Expanded Programme on Immunisation infant schedule and a catch-up campaign in children <5 years old. We fitted a transmission dynamic model to detailed local data, including nasopharyngeal carriage and invasive pneumococcal disease (IPD), to infer the marginal impact of the PCV catch-up campaign over hypothetical routine cohort vaccination in that setting and to estimate the likely impact of alternative campaigns and their dose efficiency. Results: We estimated that, within 10 years of introduction, the catch-up campaign among children <5 years old prevents an additional 65 (48-84) IPD cases across age groups, compared to PCV cohort introduction alone. Vaccination without any catch-up campaign prevented 155 (121-193) IPD cases and used 1321 (1058-1698) PCV doses per IPD case prevented. In the years after implementation, the PCV programme gradually accrues herd protection, and hence its dose efficiency increases: 10 years after the start of cohort vaccination alone the programme used 910 (732-1184) doses per IPD case averted. We estimated that a two-dose catch-up among children <1 year old uses an additional 910 (732-1184) doses per additional IPD case averted. Furthermore, by extending a single-dose catch-up campaign to children aged 1 to <2 years and subsequently to those aged 2 to <5 years, the campaign uses an additional 412 (296-606) and 543 (403-763) doses per additional IPD case averted. These results were not sensitive to vaccine coverage, serotype competition, the duration of vaccine protection or the relative protection of infants. Conclusions: We find that catch-up campaigns are a highly dose-efficient way to accelerate population protection against pneumococcal disease.
KW - Catch-up
KW - Dose efficiency
KW - Impact
KW - PCV
KW - Pneumococcus
KW - Vaccination
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U2 - 10.1186/s12916-017-0882-9
DO - 10.1186/s12916-017-0882-9
M3 - Review article
C2 - 28592303
AN - SCOPUS:85020211475
SN - 1741-7015
VL - 15
JO - BMC medicine
JF - BMC medicine
IS - 1
M1 - 113
ER -