Evaluating strategies to improve rotavirus vaccine impact during the second year of life in Malawi.

Female Humans Incidence Infant Malawi Male Models, Theoretical Rotavirus / immunology Rotavirus Infections / immunology Rotavirus Vaccines / immunology

Journal

Science translational medicine
ISSN: 1946-6242
Titre abrégé: Sci Transl Med
Pays: United States
ID NLM: 101505086

Informations de publication

Date de publication:
14 08 2019
Historique:
received: 05 10 2018
revised: 08 02 2019
accepted: 25 07 2019
entrez: 16 8 2019
pubmed: 16 8 2019
medline: 28 7 2020
Statut: ppublish

Résumé

Rotavirus vaccination has substantially reduced the incidence of rotavirus-associated gastroenteritis (RVGE) in high-income countries, but vaccine impact and estimated effectiveness are lower in low-income countries for reasons that are poorly understood. We used mathematical modeling to quantify rotavirus vaccine impact and investigate reduced vaccine effectiveness, particularly during the second year of life, in Malawi, where vaccination was introduced in October 2012 with doses at 6 and 10 weeks. We fitted models to 12 years of prevaccination data and validated the models against postvaccination data to evaluate the magnitude and duration of vaccine protection. The observed rollout of vaccination in Malawi was predicted to lead to a 26 to 77% decrease in the overall incidence of moderate-to-severe RVGE in 2016, depending on assumptions about waning of vaccine-induced immunity and heterogeneity in vaccine response. Vaccine effectiveness estimates were predicted to be higher among 4- to 11-month-olds than 12- to 23-month-olds, even when vaccine-induced immunity did not wane, due to differences in the rate at which vaccinated and unvaccinated individuals acquire immunity from natural infection. We found that vaccine effectiveness during the first and second years of life could potentially be improved by increasing the proportion of infants who respond to vaccination or by lowering the rotavirus transmission rate. An additional dose of rotavirus vaccine at 9 months of age was predicted to lead to higher estimated vaccine effectiveness but to only modest (5 to 16%) reductions in RVGE incidence over the first 3 years after introduction, regardless of assumptions about waning of vaccine-induced immunity.

Identifiants

DOI: 10.1126/scitranslmed.aav6419 PMID: 31413144 PMC: PMC7083214
pubmed: 31413144
pii: 11/505/eaav6419
doi: 10.1126/scitranslmed.aav6419
pmc: PMC7083214
mid: NIHMS1573828
pii:
doi:

Substances chimiques

Rotavirus Vaccines 0

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Wellcome Trust
ID : 091909/Z/10/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 201945/Z/16/Z
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : R01 AI112970
Pays : United States
Organisme : Wellcome Trust
ID : 102466/Z/13/A
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom

Informations de copyright

Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

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Auteurs

Virginia E Pitzer (VE)

Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT 06520-8034, USA. virginia.pitzer@yale.edu.
ORCID: 0000-0003-1015-2289

Aisleen Bennett (A)

Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre 3, Malawi.
Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK.
ORCID: 0000-0003-4240-1972

Naor Bar-Zeev (N)

Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre 3, Malawi.
International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA.
ORCID: 0000-0003-0570-4624

Khuzwayo C Jere (KC)

Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre 3, Malawi.
Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK.
Department of Medical Laboratory Sciences, College of Medicine, University of Malawi, Blantyre 3, Malawi.
ORCID: 0000-0003-3376-8529

Benjamin A Lopman (BA)

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Epidemiology Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA.
ORCID: 0000-0002-9238-0068

Joseph A Lewnard (JA)

Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
ORCID: 0000-0002-8505-8839

Umesh D Parashar (UD)

Epidemiology Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA.
ORCID: 0000-0002-9684-9425

Nigel A Cunliffe (NA)

Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK.

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