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Prioritizing children, elderly more beneficial during influenza vaccine shortages
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When vaccine supplies are limited during influenza pandemics, prioritizing high-risk groups, followed by children and the elderly for vaccination improved epidemiologic and economic outcomes for vaccine interventions, according to a study published in PLOS Computational Biology.
“While the Advisory Committee on Immunization Practices (ACIP) recommendations for the 2015-2016 influenza season partially account for risk of transmission, such as influenza-immunized individuals caring for immunosuppressed persons are recommended to avoid such contact with persons for 7 days after vaccination, they do not address prioritization of influenza vaccination among subpopulations,” Nargesalsadat Dorratoltaj, MPH, PhD, from the department of population health sciences at Virginia Polytechnic Institute, and colleagues wrote.
To assess the monetary and epidemiologic influence of various influenza vaccine administration strategies during pandemics in Chicago and to support potential interventions, the researchers simulated a pandemic using agent-based transmission dynamic modeling. Scenarios that implemented multiple vaccine interventions for catastrophic (30.15%), strong (21.96%) and moderate (11.73%) outbreaks were compared against a coverage of 40%, an efficacy of 40% and a unit cost of $28.62.
Dorratoltaj and colleagues also examined compliance, efficacy and start date for influenza vaccination using sensitivity analysis. For a group to be prioritized, risk of death, total deaths, net benefits and return on investment were considered.
Those aged 65 years or older were at the highest risk of influenza-related death during a catastrophic pandemic; however, those aged 0 to 19 years were the highest risk during a moderate or strong pandemic. The highest number of deaths and net benefits total are those that are considered high-risk between the ages of 20 to 64 years in all pandemics, and the best return investment was observed in individuals between the ages of 0 and 19 years in all pandemics.
Based on the data analyzed, the researchers determined that vaccination interventions and prioritization were warranted and cost-saving for the high-risk groups within each age group. Children, who may experience more contact with others who may be infected in a school scenario, had higher attack rates and were recommended to be prioritized below those at high-risk, along with those aged 65 years and older.
“This study can be extended to analyze for a range of vaccine compliance and efficacy values at different attack rates of influenza pandemics in different rural and urban areas of the United States and at the country level, to infer objective prioritization criteria for influenza vaccine interventions among different risk and age groups,” Dorratoltaj and colleagues wrote. — by Katherine Bortz
Disclosure: Please see the full study for a list of all relevant financial disclosures.
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