Background
Mosquito-borne and sexually-transmitted Zika virus infection has become widespread across Central and South America as well as in the Caribbean. Over 30 Zika vaccine candidates are under active development.
Objective
To quantify the impact of Zika vaccine prioritization of females aged 9–49, followed by males aged 9–49, on the incidence of prenatal Zika infections.
Design
We developed a compartmental model of Zika transmission between mosquitoes and humans calibrated to empirical estimates of country-specific mosquito density. Mosquitoes were stratified into susceptible, exposed, or infected classes; humans were stratified into susceptible, exposed, infected, recovered, or vaccinated classes. We further incorporated age-specific rates of fertility, Zika sexual transmission, and country-specific demographics.
Setting
34 countries or territories in the Americas with documented Zika outbreaks.
Target population
Males and females aged 9–49.
Interventions
Age- and gender-targeted immunization using a Zika vaccine with efficacy ranging from 60–90%.
Measurements
Annual prenatal Zika infections
Results
For a base-case vaccine efficacy of 75% and vaccination coverage of 90%, immunizing females aged 9–49, the WHO target population, would reduce the incidence of prenatal infections by at least 94%, depending on the country-specific Zika attack rate. In regions where an outbreak is not expected for at least ten years, vaccination of females aged 15–29 is more efficient than vaccinating women over 30 years.
Limitations
Population-level modeling may not capture all local and neighborhood-level heterogeneity in mosquito abundance or Zika incidence.
Conclusions
A Zika vaccine of moderate to high efficacy has the potential of virtually eliminating prenatal infections through a combination of direct protection and transmission reduction. Efficiency of age-specific Zika vaccination targeting depends on timing of future outbreaks.
Funding
National Institutes of Health