Analyzing Adult Pneumococcal Vaccination Implementation in the Underserved

分析服务欠缺地区成人肺炎球菌疫苗的实施情况

• 批准号: 10621757
• 负责人: KENNETH J SMITH
• 金额: $ 39.75万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10621757
• 关键词: Address; Adult; Area; Child; Childhood; Clinical Trials; Conjugate Vaccines; Cost Effectiveness Analysis; Data; Decision Analysis; Decision Modeling; Disease; Disparate; Effectiveness; Elderly; Epidemiology; Evaluation; Future; General Population; Health Benefit; Herd Immunity; Immunocompetent; Incidence; Manufacturer; Minority Groups; Modeling; Pneumococcal Infections; Pneumococcal conjugate vaccine; Pneumococcal vaccine; Policies; Policy Maker; Policy Making; Polysaccharides; Polyvalent pneumococcal vaccine; Population; Public Health; Race; Recommendation; Resource Allocation; Resources; Risk; Serotyping; Streptococcus pneumoniae; Techniques; Testing; Uncertainty; Update; Vaccinated; Vaccination; Vaccine Design; Vaccines; Work; cohort; cost; cost effectiveness; disease disparity; disorder risk; economic evaluation; human old age (65+); implementation strategy; improved; innovation; intervention cost; intervention program; markov model; novel; novel vaccines; programs; public health relevance; shared decision making; underserved minority; uptake; vaccination strategy; vaccine acceptance; vaccine formulation; Address; Adult; Area; Child; Childhood; Clinical Trials; Conjugate Vaccines; Cost Effectiveness Analysis; Data; Decision Analysis; Decision Modeling; Disease; Disparate; Effectiveness; Elderly; Epidemiology; Evaluation; Future; General Population; Health Benefit; Herd Immunity; Immunocompetent; Incidence; Manufacturer; Minority Groups; Modeling; Pneumococcal Infections; Pneumococcal conjugate vaccine; Pneumococcal vaccine; Policies; Policy Maker; Policy Making; Polysaccharides; Polyvalent pneumococcal vaccine; Population; Public Health; Race; Recommendation; Resource Allocation; Resources; Risk; Serotyping; Streptococcus pneumoniae; Techniques; Testing; Uncertainty; Update; Vaccinated; Vaccination; Vaccine Design; Vaccines; Work; cohort; cost; cost effectiveness; disease disparity; disorder risk; economic evaluation; human old age (65+); implementation strategy; improved; innovation; intervention cost; intervention program; markov model; novel; novel vaccines; programs; public health relevance; shared decision making; underserved minority; uptake; vaccination strategy; vaccine acceptance; vaccine formulation

Abstract CDC recommends both the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged ≥65 years. However, PCV13 use in seniors, now rec- ommended in the immunocompetent based on shared decision making, may not substantially add to indirect (herd immunity) protection from childhood PCV13 use; recent analyses show use of both vaccines to be expen- sive with little added health benefit. Underserved minority adults, who are at greater risk, are less often vac- cinated and more often infected with non-vaccine pneumococcal serotypes. In all US adults, non-vaccine sero- type disease accounts for 40-49% of pneumococcal disease and vaccine uptake remains suboptimal. To address these issues, more serotypes are being added to conjugate vaccines while policymakers debate the need for adult conjugate use, given childhood vaccination indirect effects. An adult-formulated vaccine to improve pro- tection could be considered. Strategies to improve adult vaccination uptake are underused but could be the preferred way to improve pneumococcal disease protection, particularly in underserved minority seniors. To investigate, we will use decision analysis modeling to examine changes in recommended vaccines and in- tervention programs to address suboptimal vaccination strategies and low vaccine uptake. This effort will elu- cidate strategies to: a) improve pneumococcal disease protection in all older adults and b) decrease vaccination and disease disparities in underserved minorities. Potential changes in adult pneumococcal disease due to ad- ditional indirect childhood vaccination effects will be examined. We will synthesize available data and per- form projections with rigorous modeling of uncertainty to assist policymaking and inform research resource allocation. Potential changes to pediatric and adult vaccine formations will be modeled. Specific aims are to: 1) estimate the impact of higher valency conjugate vaccines on pneumococcal disease in children and resulting indirect effects on disease incidence and serotype distribution in US seniors; and 2) compare pneumococcal vaccination strategies in seniors, while accounting for childhood vaccination effects, examining higher valency vaccines, adult-formulated vaccine, and PPSV23 only, with and without programs to increase vaccine uptake. Vaccination strategies in underserved minority and general population cohorts will be compared via Markov model-based cost-effectiveness analysis, with probabilistic sensitivity analysis and value of information analy- sis to determine favored strategies and identify valuable areas for future research. We will also innovatively consider an adult-formulated conjugate vaccine designed to mitigate racial disease disparities. Since CDC vac- cination evaluations increasingly consider economic analyses, analysis results can be used, as previously, to assist vaccination recommendation decisions and potentially change policy to better protect the underserved.

抽象的 CDC建议使用23个价值肺炎球菌多糖疫苗（PPSV23）和13价值 年龄≥65岁的成年人的肺炎球菌结合疫苗（PCV13）。但是，PCV13用于老年人，现在是 基于共同决策制定的免疫能力派发，可能不会大大增加间接 （牛群免疫）免受儿童时期PCV13的保护；最近的分析表明，两种疫苗的使用都可以探索 - 很少有健康益处。服务不足的少数民族面临更大的风险，较少的经常 粘粘，经常被非疫苗肺炎球菌血清型感染。在美国所有成年人中，非疫苗 类型疾病占肺炎球菌疾病的40-49％，疫苗摄取仍然是最佳的。解决 这些问题，在政策制定者辩论需要的同时，正在添加更多的血清型 鉴于儿童期疫苗间接影响，成人共轭使用。一种成人形成的疫苗，以改善促疫苗 可以考虑进行调查。改善成人疫苗接种摄取的策略是未充分利用的，但可能是 改善肺炎球菌疾病保护的首选方法，特别是在服务不足的少数族裔老年人中。 为了进行调查，我们将使用决策分析模型来检查建议的疫苗和IN-的变化 解决次优疫苗策略和低疫苗吸收的计划计划。这项努力将使 提示策略：a）改善所有老年人的肺炎球菌疾病保护，b）减少疫苗接种 以及服务不足的少数民族的疾病分布。由于AD引起的成年肺炎球菌疾病的潜在变化 将检查双向间接疫苗接种效应。我们将合成可用的数据和每个 对不确定性进行严格建模以协助决策并为研究资源提供信息的形式预测 分配。小儿和成人疫苗形成的潜在变化将进行建模。具体目的是：1） 估计较高的价值结合疫苗对儿童肺炎球菌疾病的影响 对美国老年人的疾病事件和血清型分布的间接影响； 2）比较肺炎 老年人的疫苗接种策略，同时考虑了儿童疫苗接种影响，研究了较高的价值 疫苗，成年疫苗和PPSV23仅具有增加疫苗摄取的计划。 将通过马尔可夫比较服务不足的少数民族和一般人群的疫苗接种策略 基于模型的成本效益分析，通过概率灵敏度分析和信息分析的价值 - SIS确定有利的策略并确定未来研究的宝贵领域。我们还将创新 考虑一种旨在减轻赛车疾病分布的成年成年结合疫苗。由于cdc vac- 机构评估越来越多地考虑经济分析，可以像以前一样使用分析结果 协助疫苗接种建议决策并有可能改变政策，以更好地保护服务不足。