PDF(Pubmed)
Abstract：
BACKGROUND: There have been declines in global immunisation coverage due to the COVID-19 pandemic. Recovery has begun but is geographically variable. This disruption has led to under-immunised cohorts and interrupted progress in reducing vaccine-preventable disease burden. There have, so far, been few studies of the effects of coverage disruption on vaccine effects. We aimed to quantify the effects of vaccine-coverage disruption on routine and campaign immunisation services, identify cohorts and regions that could particularly benefit from catch-up activities, and establish if losses in effect could be recovered.
METHODS: For this modelling study, we used modelling groups from the Vaccine Impact Modelling Consortium from 112 low-income and middle-income countries to estimate vaccine effect for 14 pathogens. One set of modelling estimates used vaccine-coverage data from 1937 to 2021 for a subset of vaccine-preventable, outbreak-prone or priority diseases (ie, measles, rubella, hepatitis B, human papillomavirus [HPV], meningitis A, and yellow fever) to examine mitigation measures, hereafter referred to as recovery runs. The second set of estimates were conducted with vaccine-coverage data from 1937 to 2020, used to calculate effect ratios (ie, the burden averted per dose) for all 14 included vaccines and diseases, hereafter referred to as full runs. Both runs were modelled from Jan 1, 2000, to Dec 31, 2100. Countries were included if they were in the Gavi, the Vaccine Alliance portfolio; had notable burden; or had notable strategic vaccination activities. These countries represented the majority of global vaccine-preventable disease burden. Vaccine coverage was informed by historical estimates from WHO-UNICEF Estimates of National Immunization Coverage and the immunisation repository of WHO for data up to and including 2021. From 2022 onwards, we estimated coverage on the basis of guidance about campaign frequency, non-linear assumptions about the recovery of routine immunisation to pre-disruption magnitude, and 2030 endpoints informed by the WHO Immunization Agenda 2030 aims and expert consultation. We examined three main scenarios: no disruption, baseline recovery, and baseline recovery and catch-up.
RESULTS: We estimated that disruption to measles, rubella, HPV, hepatitis B, meningitis A, and yellow fever vaccination could lead to 49 119 additional deaths (95% credible interval [CrI] 17 248-134 941) during calendar years 2020-30, largely due to measles. For years of vaccination 2020-30 for all 14 pathogens, disruption could lead to a 2·66% (95% CrI 2·52-2·81) reduction in long-term effect from 37 378 194 deaths averted (34 450 249-40 241 202) to 36 410 559 deaths averted (33 515 397-39 241 799). We estimated that catch-up activities could avert 78·9% (40·4-151·4) of excess deaths between calendar years 2023 and 2030 (ie, 18 900 [7037-60 223] of 25 356 [9859-75 073]).
CONCLUSIONS: Our results highlight the importance of the timing of catch-up activities, considering estimated burden to improve vaccine coverage in affected cohorts. We estimated that mitigation measures for measles and yellow fever were particularly effective at reducing excess burden in the short term. Additionally, the high long-term effect of HPV vaccine as an important cervical-cancer prevention tool warrants continued immunisation efforts after disruption.
BACKGROUND: The Vaccine Impact Modelling Consortium, funded by Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.
UNASSIGNED: For the Arabic, Chinese, French, Portguese and Spanish translations of the abstract see Supplementary Materials section.
METHODS: For this modelling study, we used modelling groups from the Vaccine Impact Modelling Consortium from 112 low-income and middle-income countries to estimate vaccine effect for 14 pathogens. One set of modelling estimates used vaccine-coverage data from 1937 to 2021 for a subset of vaccine-preventable, outbreak-prone or priority diseases (ie, measles, rubella, hepatitis B, human papillomavirus [HPV], meningitis A, and yellow fever) to examine mitigation measures, hereafter referred to as recovery runs. The second set of estimates were conducted with vaccine-coverage data from 1937 to 2020, used to calculate effect ratios (ie, the burden averted per dose) for all 14 included vaccines and diseases, hereafter referred to as full runs. Both runs were modelled from Jan 1, 2000, to Dec 31, 2100. Countries were included if they were in the Gavi, the Vaccine Alliance portfolio; had notable burden; or had notable strategic vaccination activities. These countries represented the majority of global vaccine-preventable disease burden. Vaccine coverage was informed by historical estimates from WHO-UNICEF Estimates of National Immunization Coverage and the immunisation repository of WHO for data up to and including 2021. From 2022 onwards, we estimated coverage on the basis of guidance about campaign frequency, non-linear assumptions about the recovery of routine immunisation to pre-disruption magnitude, and 2030 endpoints informed by the WHO Immunization Agenda 2030 aims and expert consultation. We examined three main scenarios: no disruption, baseline recovery, and baseline recovery and catch-up.
RESULTS: We estimated that disruption to measles, rubella, HPV, hepatitis B, meningitis A, and yellow fever vaccination could lead to 49 119 additional deaths (95% credible interval [CrI] 17 248-134 941) during calendar years 2020-30, largely due to measles. For years of vaccination 2020-30 for all 14 pathogens, disruption could lead to a 2·66% (95% CrI 2·52-2·81) reduction in long-term effect from 37 378 194 deaths averted (34 450 249-40 241 202) to 36 410 559 deaths averted (33 515 397-39 241 799). We estimated that catch-up activities could avert 78·9% (40·4-151·4) of excess deaths between calendar years 2023 and 2030 (ie, 18 900 [7037-60 223] of 25 356 [9859-75 073]).
CONCLUSIONS: Our results highlight the importance of the timing of catch-up activities, considering estimated burden to improve vaccine coverage in affected cohorts. We estimated that mitigation measures for measles and yellow fever were particularly effective at reducing excess burden in the short term. Additionally, the high long-term effect of HPV vaccine as an important cervical-cancer prevention tool warrants continued immunisation efforts after disruption.
BACKGROUND: The Vaccine Impact Modelling Consortium, funded by Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.
UNASSIGNED: For the Arabic, Chinese, French, Portguese and Spanish translations of the abstract see Supplementary Materials section.
摘要：
背景：由于COVID-19大流行，全球免疫覆盖率有所下降。复苏已经开始，但在地理上是可变的。这种破坏导致免疫不足的人群，并中断了减少疫苗可预防疾病负担的进展。有,到目前为止,关于覆盖率中断对疫苗效果的影响的研究很少。我们旨在量化疫苗覆盖率中断对常规和运动免疫服务的影响，确定可能特别受益于追赶活动的队列和地区，并确定是否可以收回有效的损失。
方法：对于这项建模研究，我们使用来自112个低收入和中等收入国家的疫苗影响模型联盟的模型组,评估了14种病原体的疫苗效果.一组建模估计使用了1937年至2021年的疫苗覆盖率数据，用于可预防疫苗的子集，容易爆发或优先疾病(即，麻疹,风疹,乙型肝炎，人乳头瘤病毒[HPV]，脑膜炎A,和黄热病)以检查缓解措施，以下称为恢复运行。第二组估计是使用1937年至2020年的疫苗覆盖率数据进行的，用于计算效果比（即，避免的每剂量负担)所有14种疫苗和疾病，以下称为全面运行。两次运行均从2000年1月1日至2100年12月31日进行建模。如果他们在加维，疫苗联盟投资组合；负担显著；或有显著的战略疫苗接种活动。这些国家占全球疫苗可预防疾病负担的大多数。疫苗覆盖率是根据世卫组织-儿童基金会国家免疫覆盖率估计的历史估计和世卫组织免疫数据库提供的数据，直至2021年。从2022年起,我们根据关于竞选频率的指导来估计覆盖范围，关于常规免疫恢复到破坏前程度的非线性假设，世卫组织《2030年免疫议程》目标和专家磋商会通知2030年终点。我们研究了三种主要情况：没有中断，基线恢复，以及基线恢复和追赶。
结果：我们估计麻疹的破坏，风疹,HPV,乙型肝炎，脑膜炎A,在2020-30日历年期间，黄热病疫苗接种可能导致49119例额外死亡（95%可信区间[CrI]17248-134941），主要是由于麻疹。对于所有14种病原体的疫苗接种2020-30年，中断可导致长期效应减少2·66%(95%CrI2·52-2·81),从避免37378194例死亡(34450249-40241202)减少至避免36410559例死亡(33515397-39241799).我们估计，在2023年至2030年之间，追赶活动可以避免78·9%(40·4-151·4)的超额死亡(即，18900[7037-60223]of25356[9859-75073]）。
结论：我们的结果强调了追赶活动时机的重要性，考虑估计的负担，以提高受影响队列的疫苗覆盖率。我们估计，麻疹和黄热病的缓解措施在短期内在减轻超额负担方面特别有效。此外,HPV疫苗作为一种重要的宫颈癌预防工具具有较高的长期效果,因此需要在中断后继续进行免疫接种.
背景：疫苗影响模型联盟，由Gavi资助,疫苗联盟和比尔及梅琳达·盖茨基金会。
■对于阿拉伯语，中文,法语,摘要的葡萄牙语和西班牙语翻译见补充材料部分。
方法：对于这项建模研究，我们使用来自112个低收入和中等收入国家的疫苗影响模型联盟的模型组,评估了14种病原体的疫苗效果.一组建模估计使用了1937年至2021年的疫苗覆盖率数据，用于可预防疫苗的子集，容易爆发或优先疾病(即，麻疹,风疹,乙型肝炎，人乳头瘤病毒[HPV]，脑膜炎A,和黄热病)以检查缓解措施，以下称为恢复运行。第二组估计是使用1937年至2020年的疫苗覆盖率数据进行的，用于计算效果比（即，避免的每剂量负担)所有14种疫苗和疾病，以下称为全面运行。两次运行均从2000年1月1日至2100年12月31日进行建模。如果他们在加维，疫苗联盟投资组合；负担显著；或有显著的战略疫苗接种活动。这些国家占全球疫苗可预防疾病负担的大多数。疫苗覆盖率是根据世卫组织-儿童基金会国家免疫覆盖率估计的历史估计和世卫组织免疫数据库提供的数据，直至2021年。从2022年起,我们根据关于竞选频率的指导来估计覆盖范围，关于常规免疫恢复到破坏前程度的非线性假设，世卫组织《2030年免疫议程》目标和专家磋商会通知2030年终点。我们研究了三种主要情况：没有中断，基线恢复，以及基线恢复和追赶。
结果：我们估计麻疹的破坏，风疹,HPV,乙型肝炎，脑膜炎A,在2020-30日历年期间，黄热病疫苗接种可能导致49119例额外死亡（95%可信区间[CrI]17248-134941），主要是由于麻疹。对于所有14种病原体的疫苗接种2020-30年，中断可导致长期效应减少2·66%(95%CrI2·52-2·81),从避免37378194例死亡(34450249-40241202)减少至避免36410559例死亡(33515397-39241799).我们估计，在2023年至2030年之间，追赶活动可以避免78·9%(40·4-151·4)的超额死亡(即，18900[7037-60223]of25356[9859-75073]）。
结论：我们的结果强调了追赶活动时机的重要性，考虑估计的负担，以提高受影响队列的疫苗覆盖率。我们估计，麻疹和黄热病的缓解措施在短期内在减轻超额负担方面特别有效。此外,HPV疫苗作为一种重要的宫颈癌预防工具具有较高的长期效果,因此需要在中断后继续进行免疫接种.
背景：疫苗影响模型联盟，由Gavi资助,疫苗联盟和比尔及梅琳达·盖茨基金会。
■对于阿拉伯语，中文,法语,摘要的葡萄牙语和西班牙语翻译见补充材料部分。
