Too Much of a Good Thing? When to Stop Catch-Up Vaccination

Abstract

During the 20th century, deaths from a range of serious infectious diseases decreased dramatically due to the development of safe and effective vaccines. However, infant immunization coverage has increased only marginally since the 1960s, and many people remain susceptible to vaccine-preventable diseases. “Catch-up vaccination” for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as newborn vaccination rates increase, catch-up vaccination becomes less attractive: the number of susceptible people decreases, so the cost to find and vaccinate each unvaccinated person may increase; additionally, the number of infected individuals decreases, so each unvaccinated person faces a lower risk of infection. This paper presents a general framework for determining the optimal time to discontinue a catch-up vaccination program. We use a cost-effectiveness framework: we consider the cost per quality-adjusted life year gained of catch-up vaccination efforts, as a function of newborn immunization rates over time and consequent disease prevalence and incidence. We illustrate our results with the example of hepatitis B catch-up vaccination in China. We contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on future disease incidence. The latter approach is likely to be simpler for decision makers to understand and implement because of lower data requirements.

Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low‐ and Middle‐Income Countries: A Systematic Literature Review

“…The database searches identified 2260 published studies for screening (Figure ). A total of 57 DT‐EEs were identified for the all‐disease review (Agusto and Adekunle, ; Alistar et al ., , ; Babigumira et al ., ; Bärnighausen et al ., ; Bishai et al ., ; Briët et al ., ; Briet and Chitnis, ; Briët and Penny, ; Carrasco et al ., ; Ciaranello et al ., ; Cremin et al ., ; Crowell et al ., ; Durham et al ., ; Dye, ; Eaton et al ., ; Enns et al ., ; Fitzpatrick et al ., ; Freiesleben de Blasio et al ., ; Giglio et al ., ; Gomez et al ., ; Granich et al ., ; Hontelez et al ., , ; Hutton and Brandeau, ; Kato et al ., ; Kawai et al ., ; Keebler et al ., ; Levin et al ., ; Li et al ., ; Long and Stavert, ; Luz et al ., ; Maire et al ., ; Mbah et al ., , ; Mbonigaba, ; Menzies et al ., ; Nichols et al ., ; Okell et al ., ; Okosun et al ., , ; Okosun and Makinde, ; Palombi et al ., ; Prinja et al ., ; Ross et al ., ; Sardar et al ., ; Sartori et al ., ; Scott Braithwaite et al ., ; Stuckey et al ., ; Terris‐Prestholt et al ., ; Vanni et al ., ; Verguet et al ., ; von Wyl et al ., ; Wagner and Blower, ; Walensky et al ., , ; Winetsky et al ., ).…”

“…The database searches identified 2260 published studies for screening ( Figure 1). A total of 57 DT-EEs were identified for the all-disease review (Agusto and Adekunle, 2014;Alistar et al, 2014aAlistar et al, , 2014bBabigumira et al, 2011;Bärnighausen et al, 2012;Bishai et al, 2011;Briet and Chitnis, 2013;Carrasco et al, 2011;Ciaranello et al, 2011;Cremin et al, 2013;Crowell et al, 2013;Durham et al, 2013;Dye, 2013;Eaton et al, 2014;Enns et al, 2011;Fitzpatrick et al, 2014;Freiesleben de Blasio et al, 2014;Giglio et al, 2012;Gomez et al, 2012;Granich et al, 2012;Hontelez et al, 2011Hontelez et al, , 2013Hutton and Brandeau, 2013;Kato et al, 2013;Kawai et al, 2012;Keebler et al, 2014;Levin et al, 2011;Li et al, 2012;Long and Stavert, 2013;Luz et al, 2011;Maire et al, 2011;Mbah et al, 2013aMbah et al, , 2013bMbonigaba, 2013;Menzies et al, 2012;Nichols et al, 2013;Okell et al, 2014;Okosun et al, 2011Okosun et al, , 2013Okosun and Makinde, 2012;…”

HIV Treatment and Prevention

“…We assume that λ i ( x i ) is a nonnegative, nondecreasing linear function, 39, 41, 42 given by λ i ( x i )=α i x i − β i . Thus, the incremental cost is incurred when coverage exceeds a threshold level β i / α i .…”

Creating impact with operations research in health: making room for practice in academia

“…I also worked to identify interesting theoretical problems arising from the practical problems I was working on. For example, our analyses of the costs and benefits of various HIV prevention programs led to work developing theoretical models for optimal control of epidemics [12-15]; our analysis of how best to control the spread of HIV among networks of individuals with concurrent sexual partners [16] led to theoretical studies of how to model and assess behavior in such networks [17, 18]; and our analyses of hepatitis B catch-up vaccination (vaccinating individuals who did not receive the vaccine at birth) [19] led to the development of a theoretical model for when to stop catch-up vaccination when newborn vaccination rates are increasing over time [20]. …”