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Article: Optimizing the dose of pre-pandemic influenza vaccines to reduce the infection attack rate

TitleOptimizing the dose of pre-pandemic influenza vaccines to reduce the infection attack rate
Authors
Issue Date2007
PublisherPublic Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676
Citation
Plos Medicine, 2007, v. 4 n. 6, p. 1032-1040 How to Cite?
Abstract
Background: The recent spread of avian influenza in wild birds and poultry may be a precursor to the emergence of a 1918-like human pandemic. Therefore, stockpiles of human pre-pandemic vaccine (targeted at avian strains) are being considered. For many countries, the principal constraint for these vaccine stockpiles will be the total mass of antigen maintained. We tested the hypothesis that lower individual doses (i.e., less than the recommended dose for maximum protection) may provide substantial extra community-level benefits because they would permit wider vaccine coverage for a given total size of antigen stockpile. Methods and Findings: We used a mathematical model to predict infection attack rates under different policies. The model incorporated both an individual's response to vaccination at different doses and the process of person-to-person transmission of pandemic influenza. We found that substantial reductions in the attack rate are likely if vaccines are given to more people at lower doses. These results are applicable to all three vaccine candidates for which data are available. As a guide to the magnitude of the effect, we simulated epidemics based on historical studies of immunogenicity. For example, for one of the vaccines for which data are available, the attack rate would drop from 67.6% to 58.7% if 160 out of the total US population of 300 million were given an optimal dose rather than 20 out of 300 million given the maximally protective dose (as promulgated in the US National Pandemic Preparedness Plan). Our results are conservative with respect to a number of alternative assumptions about the precise nature of vaccine protection. We also considered a model variant that includes a single high-risk subgroup representing children. For smaller stockpile sizes that allow vaccine to be offered only to the high-risk group at the optimal dose, the predicted benefits of using the homogenous model formed a lower bound in the presence of a risk group, even when the high-risk group was twice as infective and twice as susceptible. Conclusions: In addition to individual-level protection (i.e., vaccine efficacy), the population-level implications of pre-pandemic vaccine programs should be considered when deciding on stockpile size and dose. Our results suggest that a lower vaccine dose may be justified in order to increase population coverage, thereby reducing the infection attack rate overall. © 2007 Riley et al.
Persistent Identifierhttp://hdl.handle.net/10722/144858
ISSN
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorRiley, Sen_HK
dc.contributor.authorWu, JTen_HK
dc.contributor.authorLeung, GMen_HK
dc.date.accessioned2012-02-17T06:12:51Z-
dc.date.available2012-02-17T06:12:51Z-
dc.date.issued2007en_HK
dc.identifier.citationPlos Medicine, 2007, v. 4 n. 6, p. 1032-1040en_HK
dc.identifier.issn1549-1277en_HK
dc.identifier.urihttp://hdl.handle.net/10722/144858-
dc.description.abstractBackground: The recent spread of avian influenza in wild birds and poultry may be a precursor to the emergence of a 1918-like human pandemic. Therefore, stockpiles of human pre-pandemic vaccine (targeted at avian strains) are being considered. For many countries, the principal constraint for these vaccine stockpiles will be the total mass of antigen maintained. We tested the hypothesis that lower individual doses (i.e., less than the recommended dose for maximum protection) may provide substantial extra community-level benefits because they would permit wider vaccine coverage for a given total size of antigen stockpile. Methods and Findings: We used a mathematical model to predict infection attack rates under different policies. The model incorporated both an individual's response to vaccination at different doses and the process of person-to-person transmission of pandemic influenza. We found that substantial reductions in the attack rate are likely if vaccines are given to more people at lower doses. These results are applicable to all three vaccine candidates for which data are available. As a guide to the magnitude of the effect, we simulated epidemics based on historical studies of immunogenicity. For example, for one of the vaccines for which data are available, the attack rate would drop from 67.6% to 58.7% if 160 out of the total US population of 300 million were given an optimal dose rather than 20 out of 300 million given the maximally protective dose (as promulgated in the US National Pandemic Preparedness Plan). Our results are conservative with respect to a number of alternative assumptions about the precise nature of vaccine protection. We also considered a model variant that includes a single high-risk subgroup representing children. For smaller stockpile sizes that allow vaccine to be offered only to the high-risk group at the optimal dose, the predicted benefits of using the homogenous model formed a lower bound in the presence of a risk group, even when the high-risk group was twice as infective and twice as susceptible. Conclusions: In addition to individual-level protection (i.e., vaccine efficacy), the population-level implications of pre-pandemic vaccine programs should be considered when deciding on stockpile size and dose. Our results suggest that a lower vaccine dose may be justified in order to increase population coverage, thereby reducing the infection attack rate overall. © 2007 Riley et al.en_HK
dc.languageeng-
dc.publisherPublic Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676en_HK
dc.relation.ispartofPLoS Medicineen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong Licenseen_US
dc.subject.meshCommunicable Disease Control - methods-
dc.subject.meshDisease Outbreaks - prevention and control-
dc.subject.meshInfluenza Vaccines - administration and dosage - immunology-
dc.subject.meshInfluenza in Birds - immunology-
dc.subject.meshInfluenza, Human - immunology-
dc.titleOptimizing the dose of pre-pandemic influenza vaccines to reduce the infection attack rateen_HK
dc.typeArticleen_HK
dc.identifier.emailRiley, S:sriley@hkucc.hku.hk, steven.riley@hku.hken_HK
dc.identifier.emailWu, JT:joewu@hkucc.hku.hken_HK
dc.identifier.emailLeung, GM:gmleung@hku.hken_HK
dc.identifier.authorityRiley, S=rp00511en_HK
dc.identifier.authorityWu, JT=rp00517en_HK
dc.identifier.authorityLeung, GM=rp00460en_HK
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1371/journal.pmed.0040218en_HK
dc.identifier.pmid17579511-
dc.identifier.pmcidPMC1892041-
dc.identifier.scopuseid_2-s2.0-34347257116en_HK
dc.identifier.hkuros128678-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34347257116&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume4en_HK
dc.identifier.issue6en_HK
dc.identifier.spage1032en_HK
dc.identifier.epage1040en_HK
dc.identifier.isiWOS:000247476300016-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridRiley, S=7102619416en_HK
dc.identifier.scopusauthoridWu, JT=7409256423en_HK
dc.identifier.scopusauthoridLeung, GM=7007159841en_HK

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