Whittles, Lilith K., White, Peter J. and Didelot, Xavier (2020) Assessment of the potential of vaccination to combat antibiotic resistance in gonorrhea : a modeling analysis to determine preferred product characteristics. Clinical Infectious Diseases, 71 (8). pp. 1912-1919. ciz1241. doi:10.1093/cid/ciz1241

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Abstract

Abstract Background Gonorrhea incidence is increasing rapidly in many countries, whilst antibiotic resistance is making treatment more difficult. Combined with evidence that MeNZB and Bexsero meningococcal vaccines are likely partially-protective against gonorrhea, this has renewed interest in a gonococcal vaccine, and several candidates are in development. Key questions are how protective a vaccine needs to be, how long protection needs to last, and how should it be targeted. We assessed vaccination’s potential impact, and the feasibility of achieving WHO’s target 90% reduction in gonorrhea incidence 2016-2030, by comparing realistic vaccination strategies under a range of scenarios of vaccine efficacy and duration of protection, and emergence of extensively-resistant gonorrhea. Methods We developed a stochastic transmission-dynamic model, incorporating asymptomatic and symptomatic infection and heterogeneous sexual behavior in men-who-have-sex-with-men (MSM). We used data from England, which has a comprehensive, consistent nationwide surveillance system. Using particle Markov Chain Monte Carlo methods we fitted the model to gonorrhea incidence in 2008-17, and then used Bayesian forecasting to examine an extensive range of scenarios. Results Even in the worst-case scenario of untreatable infection emerging, the WHO target is achievable if all MSM attending sexual health clinics receive a vaccine offering ≥52% protection for ≥6 years. A vaccine conferring 31% protection (as estimated for MeNZB) for 2-4 years, could reduce incidence in 2030 by 45% in the worst-case scenario, and by 75% if >70% of resistant gonorrhea remains treatable. Conclusions Even a partially-protective vaccine, delivered through a realistic targeting strategy, could substantially reduce gonorrhea incidence, despite antibiotic resistance.

Item Type:	Journal Article
Subjects:	Q Science > QR Microbiology R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science > Life Sciences (2010- ) Faculty of Science > Statistics
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Gonorrhea -- Vaccination , Drug resistance in microorganisms, Gonorrhea -- Treatment, Gonorrhea -- Diagnosis, Antibiotics
Journal or Publication Title:	Clinical Infectious Diseases
Publisher:	University of Chicago Press
ISSN:	1058-4838
Official Date:	15 October 2020
Dates:	Date Event 15 October 2020 Published 6 January 2020 Available 2 January 2020 Accepted
Volume:	71
Number:	8
Page Range:	pp. 1912-1919
Article Number:	ciz1241
DOI:	10.1093/cid/ciz1241
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Copyright Holders:	© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID MR/R015600/1 [MRC] Medical Research Council http://dx.doi.org/10.13039/501100000265 UNSPECIFIED Department for International Development http://dx.doi.org/10.13039/501100000278 HPRU-2012-10080 National Institute for Health Research http://dx.doi.org/10.13039/501100000272 HPRU-2012-10080 Public Health England http://dx.doi.org/10.13039/501100002141
Related URLs:	http://creativecommons.org/licenses/by/4...

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