Potential impact of a maternal vaccine for RSV: A mathematical modelling study

Hogan, Alexandra B.; Campbell, Patricia T.; Blyth, Christopher C; Lim, Faye Janice; Fathima, Parveen; Davis, Stephanie; Moore, Hannah C; Glass, Kathryn

doi:10.1016/j.vaccine.2017.09.043

Cited by 39 publications

(79 citation statements)

References 40 publications

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“…In the base case, we used the WHO preferred product characteristics and other literature to assume 70% efficacy (range 50-90% for scenario analysis) for both the maternal vaccine and mAb among the newborns [12,15,25,26]. Recently, topline results of the first RSV maternal immunisation phase 3 trial (Prepare™) have been made public, and we applied the data in the scenario analyses.…”

Section: Intervention Characteristicsmentioning

confidence: 99%

“…More than one third of the RSV-associated disease burden occurs in the first year of life. Using a 3% discount rate, the treatment costs total $611 million [95% PI 327-1110 13 15 Discounted YLDs 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] 26 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] 12 [8][9][10][11][12][13][14][15][16][17][18] 13 [9][10][11][12][13][14]…”

Section: Disease Burdenmentioning

confidence: 99%

See 1 more Smart Citation

Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries

Xiao

Willem

Antillón

et al. 2020

BMC Med

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Background: Respiratory syncytial virus (RSV) frequently causes acute lower respiratory infection in children under 5, representing a high burden in Gavi-eligible countries (mostly low-income and lower-middle-income). Since multiple RSV interventions, including vaccines and monoclonal antibody (mAb) candidates, are under development, we aim to evaluate the key drivers of the cost-effectiveness of maternal vaccination and infant mAb for 72 Gavi countries. Methods: A static Multi-Country Model Application for RSV Cost-Effectiveness poLicy (MCMARCEL) was developed to follow RSV-related events monthly from birth until 5 years of age. MCMARCEL was parameterised using countryand age-specific demographic, epidemiological, and cost data. The interventions' level and duration of effectiveness were guided by the World Health Organization's preferred product characteristics and other literature. Maternal vaccination and mAb were assumed to require single-dose administration at prices assumed to align with other Gavi-subsidised technologies. The effectiveness and the prices of the interventions were simultaneously varied in extensive scenario analyses. Disability-adjusted life years (DALYs) were the primary health outcomes for cost-effectiveness, integrated with probabilistic sensitivity analyses and Expected Value of Partially Perfect Information analysis.

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Section: Intervention Characteristicsmentioning

confidence: 99%

Section: Disease Burdenmentioning

confidence: 99%

Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries

Xiao

Willem

Antillón

et al. 2020

BMC Med

View full text Add to dashboard Cite

show abstract

“…One modelling study of maternal vaccine impact in England estimated that a seasonal immunisation programme could prevent 8.5 hospitalisations per 1000 vaccine courses administered [12], and a study based in Kilifi, Kenya, found that RSV infant infection could be reduced by up to 35% if maternal antibody protection duration is boosted to a total of 8 months [16]. Previously, we developed an age-structured, deterministic, compartmental model of RSV transmission, validated using RSV hospitalisation records for Western Australia, and estimated that a maternal vaccine could reduce infant RSV hospitalisations by up to 46% [17].…”

Section: Introductionmentioning

confidence: 99%

Modelling the household-level impact of a maternal respiratory syncytial virus (RSV) vaccine in a high-income setting

Campbell

Geard

Hogan

2020

BMC Med

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Background Respiratory syncytial virus (RSV) infects almost all children by the age of 2 years, with the risk of hospitalisation highest in the first 6 months of life. Development and licensure of a vaccine to prevent severe RSV illness in infants is a public health priority. A recent phase 3 clinical trial estimated the efficacy of maternal vaccination at 39% over the first 90 days of life. Households play a key role in RSV transmission; however, few estimates of population-level RSV vaccine impact account for household structure. Methods We simulated RSV transmission within a stochastic, individual-based model framework, using an existing demographic model, structured by age and household and parameterised with Australian data, as an exemplar of a high-income country. We modelled vaccination by immunising pregnant women and explicitly linked the immune status of each mother-infant pair. We quantified the impact on children for a range of vaccine properties and uptake levels. Results We found that a maternal immunisation strategy would have the most substantial impact in infants younger than 3 months, reducing RSV infection incidence in this age group by 16.6% at 70% vaccination coverage. In children aged 3–6 months, RSV infection was reduced by 5.3%. Over the first 6 months of life, the incidence rate for infants born to unvaccinated mothers was 1.26 times that of infants born to vaccinated mothers. The impact in older age groups was more modest, with evidence of infections being delayed to the second year of life. Conclusions Our findings show that while individual benefit from maternal RSV vaccination could be substantial, population-level reductions may be more modest. Vaccination impact was sensitive to the extent that vaccination prevented infection, highlighting the need for more vaccine trial data.

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“…Virus isolates can be classified into two antigenically and genetically distinct groups (RSV-A and RSV-B) and consecutive seasons are not only characterized by a change in the dominant group, but also changes to the genotype composition [12,13]. Though several studies have predicted a maternal vaccination would be effective [14][15][16] by extending the duration of protection by passive immunity early in life, the vaccination of older children has also been theorized as an effective alternative or complementary strategy by producing a heard immunity effect [17][18][19][20]. Elder and, particularly, school going children have been shown in previous work to be associated with increased risk of infant (sibling) infection [21][22][23][24] -though no direct infection link between the older siblings and the infant was confirmed -and have been identified as drivers of the initial epidemic phase [25].…”

Section: Introductionmentioning

confidence: 99%

Integrating epidemiological and genetic data with different sampling intensities into a dynamic model of respiratory syncytial virus transmission

Kombe

Agoti

Munywoki

et al. 2020

Preprint

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Background: Respiratory syncytial virus (RSV) is responsible for a significant burden of acute respiratory illness in children under 5 years old. Prior to rolling out any vaccination program, identification of the source of infant infections could further guide vaccination strategies. Methods: We extended a dynamic model calibrated at the individual host level initially fit to social-temporal data on shedding patterns to include whole genome sequencing data available at a lower sampling intensity. Results: In this study population of 493 individuals with 55 infants under the age of 1 year distributed across 47 households, we found that 52% of RSV-B and 60% of RSV-A cases arose from infection within the household. Forty-five percent of infant infections appeared to occur in the household, of which 68% were a result of transmission from a child aged between 2 and 13 years living in the same household as the infant. Conclusion: These results further highlight the importance of pre-school and school-aged children in RSV transmission, particularly the role they play in directly infecting the household infant. These age groups are a potential RSV vaccination target group.

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Potential impact of a maternal vaccine for RSV: A mathematical modelling study

Cited by 39 publications

References 40 publications

Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries

Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries

Modelling the household-level impact of a maternal respiratory syncytial virus (RSV) vaccine in a high-income setting

Integrating epidemiological and genetic data with different sampling intensities into a dynamic model of respiratory syncytial virus transmission

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