Impact of Targeted Tuberculosis Vaccination Among a Mining Population in South Africa: A Model-Based Study.


Shrestha, S; Chihota, V; White, RG; Grant, AD; Churchyard, GJ; Dowdy, DW; (2017) Impact of Targeted Tuberculosis Vaccination Among a Mining Population in South Africa: A Model-Based Study. American journal of epidemiology, 186 (12). pp. 1362-1369. ISSN 0002-9262 DOI: https://doi.org/10.1093/aje/kwx192

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Abstract

Optimizing the use of new tools, such as vaccines, may play a crucial role in reaching global targets for tuberculosis (TB) control. Some of the most promising candidate vaccines target adults, although high-coverage mass vaccinations may be logistically more challenging among this population than among children. Vaccine-delivery strategies that target high-risk groups or settings might yield proportionally greater impact than do those that target the general population. We developed an individual-based TB transmission model representing a hypothetical population consisting of people who worked in South African gold mines or lived in associated labor-sending communities. We simulated the implementation of a postinfection adult vaccine with 60% efficacy and a mean effect duration of 10 years. We then compared the impact of a mine-targeted vaccination strategy, in which miners were vaccinated while in the mines, with that of a community-targeted strategy, in which random individuals within the labor-sending communities were vaccinated. Mine-targeted vaccination averted an estimated 0.37 TB cases per vaccine dose compared with 0.25 for community-targeted vaccination, for a relative efficacy of 1.46 (95% range, 1.13-1.91). The added benefit of mine-targeted vaccination primarily reflected the disproportionate demographic burden of TB among the population of adult males as a whole. As novel vaccines for TB are developed, venue-based vaccine delivery that targets high-risk demographic groups may improve both vaccine feasibility and the impact on transmission.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: TB Centre
PubMed ID: 29253139
URI: http://researchonline.lshtm.ac.uk/id/eprint/4646067

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