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Assessing the efficiency of catch-up campaigns for the introduction of pneumococcal conjugate vaccine : a modelling study based on data from PCV10 introduction in Kilifi, Kenya
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Flasche, Stefan, Ojal, John, Le Polain de Waroux, Olivier, Otiende, Mark, O’Brien, Katherine L., Kiti, Moses, Nokes, D. James, Edmunds, W John and Scott, J. Anthony G. (2017) Assessing the efficiency of catch-up campaigns for the introduction of pneumococcal conjugate vaccine : a modelling study based on data from PCV10 introduction in Kilifi, Kenya. BMC Medicine, 15 (1). 113. doi:10.1186/s12916-017-0882-9
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Official URL: http://dx.doi.org/10.1186/s12916-017-0882-9
Abstract
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.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine | ||||||
| Divisions: | Faculty of Science > Life Sciences (2010- ) | ||||||
| Library of Congress Subject Headings (LCSH): | Streptococcus pneumoniae -- Vaccination -- Kilifi District (Kenya), World Health Organisation | ||||||
| Journal or Publication Title: | BMC Medicine | ||||||
| Publisher: | BioMed Central Ltd. | ||||||
| ISSN: | 1741-7015 | ||||||
| Official Date: | 7 June 2017 | ||||||
| Dates: |
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| Date of first compliant deposit: | 9 June 2017 | ||||||
| Volume: | 15 | ||||||
| Number: | 1 | ||||||
| Article Number: | 113 | ||||||
| DOI: | 10.1186/s12916-017-0882-9 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| Funder: | Gavi, the Vaccine Alliance (GVA), Wellcome Trust (London, England), AXA Group. Research Fund | ||||||
| Grant number: | 001759775 and 50390116 (GVA), 98532, 102975 Wellcome Trust (London, England) |
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