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Prezzi A, Saelens X, Vandijck D. Epidemiology of influenza over a ten-year period in Belgium: overview of the historical and current evidence. Virol J 2023; 20:271. [PMID: 37990263 PMCID: PMC10664657 DOI: 10.1186/s12985-023-02238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Generally influenza, a contagious respiratory disease, leads to mild illness, but can present as a severe illness with significant complications for some. It entails significant health challenges and an economic burden. Annual vaccination is considered the most effective preventive measure against influenza, especially in high-risk groups. METHOD Epidemiological, demographic and vaccination data of influenza from 2009-to-2019 is collected from Sciensano, the Belgian Institute for Health. Sciensano monitors influenza virus through two surveillances: the Influenza-Like Illness (ILI) surveillance in primary care and the Severe Acute Respiratory Infections (SARI) surveillance in hospital settings. RESULTS 49.6% [± 8.5] of all ILI-samples tested positive in this period. Influenza A was the dominant circulating type, accounting for 73.7% [± 27.5] of positive samples, while influenza B accounted for 24.3% [± 26.7]. For SARI-surveillance, the average rate of samples tested positive was 36.3% [± 9.3]. Influenza A was responsible for respectively 77.7% [± 23.8] of positive samples and influenza B for 22.2% [± 23.7]. Since 2010, epidemics typically lasted about 9.3 weeks [± 2.7]. From 2012 to 2019 the average vaccine effectiveness was 34.9% [± 15.3]. CONCLUSION Influenza is quickly considered a trivial disease, but can have substantial repercussions. It remains difficult to identify the level of treat of influenza due to antigenic evolution. Measures to prevent, control and treat are needed. Vaccines that provide broader and more durable protection that can be produced more rapidly could be a potential solution.
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Affiliation(s)
- A Prezzi
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - X Saelens
- Department of Biochemistry and Microbiology, Faculty of Sciences, Ghent University, K. L. Ledeganckstraat 35, 9000, Ghent, Belgium
- Flanders Institute for Biotechnology - UGent Center for Medical Biotechnology, Technologiepark 927, B-9052, Ghent (Zwijnaarde), Belgium
| | - D Vandijck
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Belgian Poison Control Center, Bruynstraat 1, 1120, Brussels, Belgium
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Shajahan A, Cai CX, Wolff J, Yang RS, Ivleva VB, Gowetski DB, Gall JGD, Lei QP. Development and validation of a mass spectrometry based analytical method to quantify the ratios in hemagglutinin trimers in quadrivalent influenza nanoparticle vaccine - FluMos-v1. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 15:896-900. [PMID: 36723411 DOI: 10.1039/d2ay01890j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A quadrivalent influenza nanoparticle vaccine (FluMos-v1) offers long-lasting protection against multiple influenza virus strains and is composed of four strains of hemagglutinin trimer (HAT) assembled around a pentamer core. Here we report an LC-MS/MS analytical development and validation method to measure the percentage of each HAT component in FluMos-v1.
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Affiliation(s)
- Asif Shajahan
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - Cindy X Cai
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - Jeremy Wolff
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - R Sylvie Yang
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - Vera B Ivleva
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - Daniel B Gowetski
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - Jason G D Gall
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
| | - Q Paula Lei
- Vaccine Production Program Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Gaithersburg, MD, USA.
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Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs. ENERGY REPORTS 2022; 8. [PMCID: PMC8706030 DOI: 10.1016/j.egyr.2021.12.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The outbreaks of infectious diseases that spread across countries have generally existed for centuries. An example is the occurrence of the COVID-19 pandemic in 2020, which led to the loss of lives and economic depreciation. One of the essential ways of handling the spread of viruses is the discovery and administration of vaccines. However, the major challenges of vaccination programs are associated with the vaccine cold chain management and cold storage facilities. This paper discusses how vaccine cold chain management and cold storage technology can address the challenges of vaccination programs. Specifically, it examines different systems for preserving vaccines in either liquid or frozen form to help ensure that they are not damaged during distribution from manufacturing facilities. Furthermore, A vaccine is likely to provide very low efficacy when it is not properly stored. According to preliminary studies, the inability to store vaccine properly is partly due to the incompetency of many stakeholders, especially in technical matters. The novelty of this study is to thoroughly explore cold storage technology for a faster and more comprehensive vaccine distribution hence it is expected to be one of the reference and inspiration for stakeholders.
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Moore KA, Ostrowsky JT, Kraigsley AM, Mehr AJ, Bresee JS, Friede MH, Gellin BG, Golding JP, Hart PJ, Moen A, Weller CL, Osterholm MT. A Research and Development (R&D) roadmap for influenza vaccines: Looking toward the future. Vaccine 2021; 39:6573-6584. [PMID: 34602302 DOI: 10.1016/j.vaccine.2021.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
Improved influenza vaccines are urgently needed to reduce the burden of seasonal influenza and to ensure a rapid and effective public-health response to future influenza pandemics. The Influenza Vaccines Research and Development (R&D) Roadmap (IVR) was created, through an extensive international stakeholder engagement process, to promote influenza vaccine R&D. The roadmap covers a 10-year timeframe and is organized into six sections: virology; immunology; vaccinology for seasonal influenza vaccines; vaccinology for universal influenza vaccines; animal and human influenza virus infection models; and policy, finance, and regulation. Each section identifies barriers, gaps, strategic goals, milestones, and additional R&D priorities germane to that area. The roadmap includes 113 specific R&D milestones, 37 of which have been designated high priority by the IVR expert taskforce. This report summarizes the major issues and priority areas of research outlined in the IVR. By identifying the key issues and steps to address them, the roadmap not only encourages research aimed at new solutions, but also provides guidance on the use of innovative tools to drive breakthroughs in influenza vaccine R&D.
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Affiliation(s)
- Kristine A Moore
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA; Center for Infectious Disease Research and Policy, C315 Mayo Memorial Building, MMC 263, 420 Delaware Street, SE, Minneapolis, MN 55455, USA.
| | - Julia T Ostrowsky
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Alison M Kraigsley
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Angela J Mehr
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Joseph S Bresee
- The Global Funders Consortium for Universal Influenza Vaccine Development, The Task Force for Global Health, and the US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Ann Moen
- World Health Organization, Geneva, Switzerland
| | | | - Michael T Osterholm
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
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The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia. NPJ Digit Med 2021; 4:125. [PMID: 34404895 PMCID: PMC8371011 DOI: 10.1038/s41746-021-00487-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/24/2021] [Indexed: 02/08/2023] Open
Abstract
The World Health Organization (WHO) recently put forth a Global Strategy on Digital Health 2020–2025 with several countries having already achieved key milestones. We aimed to understand whether and how digital health technologies (DHTs) are absorbed in Africa, tracking Ethiopia as a key node. We conducted a systematic review, searching PubMed-MEDLINE, Embase, ScienceDirect, African Journals Online, Cochrane Central Registry of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to 02 February 2021 for studies of any design that investigated the potential of DHTs in clinical or public health practices in Ethiopia. This review was registered with PROSPERO (CRD42021240645) and it was designed to inform our ongoing DHT-enabled randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT04216420). We found 27,493 potentially relevant citations, among which 52 studies met the inclusion criteria, comprising a total of 596,128 patients, healthy individuals, and healthcare professionals. The studies involved six DHTs: mHealth (29 studies, 574,649 participants); electronic health records (13 studies, 4534 participants); telemedicine (4 studies, 465 participants); cloud-based application (2 studies, 2382 participants); information communication technology (3 studies, 681 participants), and artificial intelligence (1 study, 13,417 participants). The studies targeted six health conditions: maternal and child health (15), infectious diseases (14), non-communicable diseases (3), dermatitis (1), surgery (4), and general health conditions (15). The outcomes of interest were feasibility, usability, willingness or readiness, effectiveness, quality improvement, and knowledge or attitude toward DHTs. Five studies involved RCTs. The analysis showed that although DHTs are a relatively recent phenomenon in Ethiopia, their potential harnessing clinical and public health practices are highly visible. Their adoption and implementation in full capacity require more training, access to better devices such as smartphones, and infrastructure. DHTs hold much promise tackling major clinical and public health backlogs and strengthening the healthcare ecosystem in Ethiopia. More RCTs are needed on emerging DHTs including artificial intelligence, big data, cloud, cybersecurity, telemedicine, and wearable devices to provide robust evidence of their potential use in such settings and to materialize the WHO’s Global Strategy on Digital Health.
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Workplace influenza vaccination to reduce employee absenteeism: An economic analysis from the employers' perspective. Vaccine 2021; 39:2005-2015. [PMID: 33632564 DOI: 10.1016/j.vaccine.2021.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Each year, up to 10% of unvaccinated adults contracts seasonal influenza, with half of this proportion developing symptoms. As a result, employers experience significant economic losses in terms of employee absenteeism. Influenza vaccines can be instrumental in reducing this burden. Workplace vaccination is expected to reduce employee absenteeism more than linearly as a result of positive externalities. It remains unclear whether workplace influenza vaccination yields a positive return on investment. METHODS We simulated the spread of influenza in the seasons 2011-12 up to 2017-18 in Belgium by means of a compartmental transmission model. We accounted for age-specific social contact patterns and included reduced contact behavior when symptomatically infected. We simulated the impact of employer-funded influenza vaccination at the workplace and performed a cost-benefit analysis to assess the employers' return on workplace vaccination. Furthermore, we look into the cost-benefit of rewarding vaccinated employees by offering an additional day off. RESULTS Workplace vaccination reduced the burden of influenza both on the workplace and in the population at large. Compared to the current vaccine coverage - 21% in the population at large - an employee vaccine coverage of 90% could avert an additional 355 000 cases, of which about 150 000 in the employed population and 205 000 in the unemployed population. While seasonal influenza vaccination has been cost-saving on average at about €10 per vaccinated employee, the cost-benefit analysis was prone to between-season variability. CONCLUSIONS Vaccinated employees can serve as a barrier to limit the spread of influenza in the population, reducing the attack rate by 78% at an employee coverage of 90%. While workplace vaccination is relatively inexpensive (due to economies of scale) and convenient, the return on investment is volatile. Government subsidies can be pivotal to encourage employers to provide vaccination at the workplace with positive externalities to society as a whole.
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Modelling the impact of universal influenza vaccines on seasonal influenza with different subtypes. Epidemiol Infect 2021; 149:e253. [PMID: 35903926 PMCID: PMC8697312 DOI: 10.1017/s0950268821002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Several candidates of universal influenza vaccine (UIV) have entered phase III clinical trials, which are expected to improve the willingness and coverage of the population substantially. The impact of UIV on the seasonal influenza epidemic in low influenza vaccination coverage regions like China remains unclear. We proposed a new compartmental model involving the transmission of different influenza subtypes to evaluate the effects of UIV. We calibrated the model by weekly surveillance data of influenza in Xi'an City, Shaanxi Province, China, during 2010/11–2018/19 influenza seasons. We calculated the percentage of averted infections under 2-month (September to October) and 6-month (September to the next February) vaccination patterns with varied UIV effectiveness and coverage in each influenza season, compared with no UIV scenario. A total of 195 766 influenza-like illness (ILI) cases were reported during the nine influenza seasons (2010/11–2018/19), of which the highest ILI cases were among age group 0–4 (59.60%) years old, followed by 5–14 (25.22%), 25–59 (8.19%), 15–24 (3.75%) and ⩾60 (3.37%) years old. The influenza-positive rate for all age groups among ILI cases was 17.51%, which is highest among 5–14 (23.75%) age group and followed by 25–59 (16.44%), 15–24 (16.42%), 0–4 (14.66%) and ⩾60 (13.98%) age groups, respectively. Our model showed that UIV might greatly avert influenza infections irrespective of subtypes in each influenza season. For example, in the 2018/19 influenza season, 2-month vaccination pattern with low UIV effectiveness (50%) and coverage (10%), and high UIV effectiveness (75%) and coverage (30%) could avert 41.6% (95% CI 27.8–55.4%) and 83.4% (80.9–85.9%) of influenza infections, respectively; 6-month vaccination pattern with low and high UIV effectiveness and coverage could avert 32.0% (15.9–48.2%) and 74.2% (69.7–78.7%) of influenza infections, respectively. It would need 11.4% (7.9–15.0%) of coverage to reduce half of the influenza infections for 2-month vaccination pattern with low UIV effectiveness and 8.5% (5.0–11.2%) of coverage with high UIV effectiveness, while it would need 15.5% (8.9–20.7%) of coverage for 6-month vaccination pattern with low UIV effectiveness and 11.2% (6.5–15.0%) of coverage with high UIV effectiveness. We conclude that UIV could significantly reduce the influenza infections even for low UIV effectiveness and coverage. The 2-month vaccination pattern could avert more influenza infections than the 6-month vaccination pattern irrespective of influenza subtype and UIV effectiveness and coverage.
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Talbird SE, La EM, Carrico J, Poston S, Poirrier JE, DeMartino JK, Hogea CS. Impact of population aging on the burden of vaccine-preventable diseases among older adults in the United States. Hum Vaccin Immunother 2020; 17:332-343. [PMID: 32758069 PMCID: PMC7899694 DOI: 10.1080/21645515.2020.1780847] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite vaccination recommendations, the burden of vaccine-preventable diseases remains high in older adults in the United States (US), contributing to substantial morbidity, mortality, and health care resource use and costs. To adequately plan for health care resource needs and to help inform vaccination policies, burden of disease projections that account for population aging over the coming decades are needed. As a first step, this exploratory study projects the burden of influenza, pertussis, herpes zoster, and pneumococcal disease in adults aged 50 y and older in the US, using a population-based modeling framework with separate decision trees for each vaccine-preventable disease. The model uses projected population estimates from the US Census Bureau to account for changes in the US population over time and then calculates expected numbers of cases and associated costs for each disease, keeping current estimates of age-specific disease incidence, vaccine coverage, and efficacy constant over time. This approach was used to focus the exploratory analysis on the burden of disease that may be expected due to population changes alone, assuming that all else remains unchanged. Due to population growth and the shifting age distribution over the next 30 y, the annual societal economic burden for the four vaccine-preventable diseases is projected to increase from approximately $35 billion to $49 billion, resulting in cumulative costs of approximately $1.3 trillion, as well as more than 1 million disease-related deaths. Given such notable burden, further efforts to increase vaccination coverage and effectiveness in older adults are needed.
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Affiliation(s)
- Sandra E Talbird
- Health Economics, RTI Health Solutions , Research Triangle Park, NC, USA
| | - Elizabeth M La
- Health Economics, RTI Health Solutions , Research Triangle Park, NC, USA
| | - Justin Carrico
- Health Economics, RTI Health Solutions , Research Triangle Park, NC, USA
| | - Sara Poston
- US Health Outcomes & Epidemiology, Vaccines, GSK , Philadelphia, PA, USA
| | | | | | - Cosmina S Hogea
- Global Value Evidence and Outcomes, Oncology,GSK, Philadelphia, PA, USA
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Ostrowsky J, Arpey M, Moore K, Osterholm M, Friede M, Gordon J, Higgins D, Molto-Lopez J, Seals J, Bresee J. Tracking progress in universal influenza vaccine development. Curr Opin Virol 2020; 40:28-36. [PMID: 32279026 DOI: 10.1016/j.coviro.2020.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/08/2023]
Abstract
Conventional influenza vaccines are designed to stimulate neutralizing antibodies against immunodominant but highly variable hemagglutinin antigens. Inherent limitations include suboptimal protection against rapidly changing seasonal influenza viruses and a lack of protection against antigenically novel pandemic influenza. New technologies for developing influenza vaccines that induce more broadly protective and durable immunity are a growing area of research and focus on a variety of approaches, including targeting conserved antigens and stimulating cross-reactive T cell responses. This review highlights a new effort to track the development of universal influenza vaccine technologies. The Universal Influenza Vaccine Technology Landscape is intended to provide stakeholders and funders with a common source of information to monitor research progress and identify opportunities for informed investments and collaboration.
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Affiliation(s)
- Julie Ostrowsky
- Center for Infectious Disease Research and Policy, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Meredith Arpey
- Center for Infectious Disease Research and Policy, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Kristine Moore
- Center for Infectious Disease Research and Policy, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Michael Osterholm
- Center for Infectious Disease Research and Policy, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Martin Friede
- Initiative for Vaccine Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Jennifer Gordon
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, 5601 Fishers Lane, Rockville, MD 20852, USA
| | - Deborah Higgins
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Seattle, Washington 98121, USA
| | - Julia Molto-Lopez
- Directorate-General for Research and Innovation, European Commission, rue Champ de Mars 21, 1050 Brussels, Belgium
| | - Jonathan Seals
- Office of Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, 330 Independence Ave SW, Washington DC 20201, USA
| | - Joseph Bresee
- Global Funders Consortium for Universal Influenza Vaccine Development, Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
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Sah P, Alfaro-Murillo JA, Fitzpatrick MC, Neuzil KM, Meyers LA, Singer BH, Galvani AP. Future epidemiological and economic impacts of universal influenza vaccines. Proc Natl Acad Sci U S A 2019; 116:20786-20792. [PMID: 31548402 PMCID: PMC6789917 DOI: 10.1073/pnas.1909613116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The efficacy of influenza vaccines, currently at 44%, is limited by the rapid antigenic evolution of the virus and a manufacturing process that can lead to vaccine mismatch. The National Institute of Allergy and Infectious Diseases (NIAID) recently identified the development of a universal influenza vaccine with an efficacy of at least 75% as a high scientific priority. The US Congress approved $130 million funding for the 2019 fiscal year to support the development of a universal vaccine, and another $1 billion over 5 y has been proposed in the Flu Vaccine Act. Using a model of influenza transmission, we evaluated the population-level impacts of universal influenza vaccines distributed according to empirical age-specific coverage at multiple scales in the United States. We estimate that replacing just 10% of typical seasonal vaccines with 75% efficacious universal vaccines would avert ∼5.3 million cases, 81,000 hospitalizations, and 6,300 influenza-related deaths per year. This would prevent over $1.1 billion in direct health care costs compared to a typical season, based on average data from the 2010-11 to 2018-19 seasons. A complete replacement of seasonal vaccines with universal vaccines is projected to prevent 17 million cases, 251,000 hospitalizations, 19,500 deaths, and $3.5 billion in direct health care costs. States with high per-hospitalization medical expenses along with a large proportion of elderly residents are expected to receive the maximum economic benefit. Replacing even a fraction of seasonal vaccines with universal vaccines justifies the substantial cost of vaccine development.
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Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Jorge A Alfaro-Murillo
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Lauren A Meyers
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
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