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Same influenza vaccination strategies but different outcomes across US cities?

ABSTRACT: This research aimed to determine if the same influenza vaccination strategies would have the same level of effectiveness when applied to two different US metropolitan areas, Miami and Seattle, where the composition of the population differs significantly in age distribution and household size distribution.We used an individual-based network modeling approach in which every pair of individuals connected in the social network is represented. Factorial design experiments were performed to estimate the impact of age-targeted vaccination strategies to control the transmission of a 'flu-like' virus.The findings showed that: (1) age composition of the city matters in determining the effectiveness of a vaccination strategy and (2) vaccinating school children outperforms every other strategy.The most significant policy implication of this research is that there may not be a universal vaccination strategy that works across all cities with the same level of effectiveness. Secondly, given the important role of school children in the transmission of influenza, the US Government should consider the vaccination of school children a top priority.

SUBMITTER: Taylor C

PROVIDER: S-EPMC2941528 | biostudies-literature | 2010 Sep

REPOSITORIES: biostudies-literature

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Same influenza vaccination strategies but different outcomes across US cities?

Taylor Claudia C Marathe Achla A Beckman Richard R

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 20100901 9

<h4>Objectives</h4>This research aimed to determine if the same influenza vaccination strategies would have the same level of effectiveness when applied to two different US metropolitan areas, Miami and Seattle, where the composition of the population differs significantly in age distribution and household size distribution.<h4>Methods</h4>We used an individual-based network modeling approach in which every pair of individuals connected in the social network is represented. Factorial design expe ...[more]

PMID: 20643569

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Project description:BACKGROUND: All influenza pandemic plans advocate pandemic vaccination. However, few studies have evaluated the cost-effectiveness of different vaccination strategies. This paper compares the economic outcomes of vaccination compared with treatment with antiviral agents alone, in Singapore. METHODOLOGY: We analyzed the economic outcomes of pandemic vaccination (immediate vaccination and vaccine stockpiling) compared with treatment-only in Singapore using a decision-based model to perform cost-benefit and cost-effectiveness analyses. We also explored the annual insurance premium (willingness to pay) depending on the perceived risk of the next pandemic occurring. PRINCIPAL FINDINGS: The treatment-only strategy resulted in 690 deaths, 13,950 hospitalization days, and economic cost of USD$497 million. For immediate vaccination, at vaccine effectiveness of >55%, vaccination was cost-beneficial over treatment-only. Vaccine stockpiling is not cost-effective in most scenarios even with 100% vaccine effectiveness. The annual insurance premium was highest with immediate vaccination, and was lower with increased duration to the next pandemic. The premium was also higher with higher vaccine effectiveness, attack rates, and case-fatality rates. Stockpiling with case-fatality rates of 0.4-0.6% would be cost-beneficial if vaccine effectiveness was >80%; while at case-fatality of >5% stockpiling would be cost-beneficial even if vaccine effectiveness was 20%. High-risk sub-groups warrant higher premiums than low-risk sub-groups. CONCLUSIONS: The actual pandemic vaccine effectiveness and lead time is unknown. Vaccine strategy should be based on perception of severity. Immediate vaccination is most cost-effective, but requires vaccines to be available when required. Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective. Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.

Project description:BACKGROUND: A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. METHODS: A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. RESULTS: Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination further improved effectiveness and cost effectiveness. CONCLUSIONS: The effectiveness and cost effectiveness consequences of the time-critical interplay of pandemic dynamics, vaccine availability and intervention timing has been quantified. For moderate and extreme pandemics, vaccination combined with rapidly activated antiviral and social distancing interventions of sufficient duration is cost effective from the perspective of life years saved.

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Same influenza vaccination strategies but different outcomes across US cities?

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Same influenza vaccination strategies but different outcomes across US cities?

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