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首页> 外文期刊>Vaccine >Modelling the effect of discontinuing universal Bacillus Calmette-Guérin vaccination in an intermediate tuberculosis burden setting
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Modelling the effect of discontinuing universal Bacillus Calmette-Guérin vaccination in an intermediate tuberculosis burden setting

机译：塑造植物膨胀植物植物中的效果造型中中间结核负荷造成的抗性疫苗接种

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BackgroundBacillus Calmette-Guérin (BCG) vaccination is a widely-used public health intervention for tuberculosis (TB) control. In Taiwan, like other intermediate TB burden settings, steadily declining TB incidence raises important questions on whether universal BCG vaccination should be discontinued. Recent surveys on adverse events following immunisation, such as BCG-induced osteomyelitis/osteitis, also suggest a need to re-evaluate the vaccination programme.MethodsWe developed an age-structured transmission dynamic model, calibrated to population demography and age-specific TB notification rates in Taiwan. We adopted ‘weak-protection’ and ‘strong-protection’ scenarios, representing a range of characteristics including the duration of BCG protection and vaccine efficacies against TB infection and progression. We estimated averted disability-adjusted life years (DALYs) and incremental costs over 10?years after discontinuing universal BCG vaccination in 2018, 2035, and 2050. We also examined the potential impact of ‘surveillance-guided’ discontinuation, triggered once notification rates fall to a given threshold.ResultsIn the weak-protection scenario, discontinuing BCG would result in 2.8 (95% uncertainty range: 2.3, 3.1) additional notified TB cases and ?4.1 (?7.7, 0.8) net averted DALYs over 2018–2027. In the strong-protection scenario, 82.9 (72.6, 91.6) additional cases and ?402.7 (?506.6, ?301.2) averted DALYs would be reported, suggesting a robustly negative health impact. However, in this vaccine scenario, there could be an overall health benefit if BCG is discontinued once TB notification falls below 5 per 100,000 population. The most influential vaccine characteristic for the net health impact is the vaccine efficacy against progression to pulmonary TB. In financial terms, the eliminated cost of the vaccination programme substantially outweighed the incremental cost for TB treatment regardless of BCG protection.ConclusionsBCG discontinuation may be warranted in intermediate burden settings, depending on the quality of vaccine protection, and the potential for refocusing on other TB control activities for earlier detection and treatment.
机译：BackgroundBacillus卡介苗（BCG）疫苗是结核病（TB）控制的一种广泛使用的公共卫生干预措施。在台湾，与其他中级结核病负担设置一样，TB发病率的稳步下降提出了关于是否应停止普遍BCG疫苗接种的重要问题。近期对免疫发生后的不良事件的调查，例如BCG诱导的骨髓炎/骨质炎，也表明需要重新评估疫苗接种计划..近奇地区的疫苗接种程序发达了年龄结构的传播动态模型，校准了人口或特定年龄特定的TB通知率在台湾。我们采用了“弱势保护”和“强势保护”情景，代表了一系列特征，包括BCG保护持续时间和针对TB感染和进展的疫苗效率。我们估计避免了避免的残疾人调整后的生命年份（DALYS）和增量成本超过10？年度在2018年，2035年和2050年停止了通用BCG疫苗接种后。我们还研究了“监督引导的”中断的潜在影响，一旦通知率下降到threshold.ResultsIn弱保护情形下给出的，停止BCG将导致2.8（95％的不确定性范围：2.3，3.1）的附加呈报结核病和4.1（7.7，0.8？）净避免疾病负担在2018年至2027年？在强势保护场景中，82.9（72.6,91.6）额外的案例和？402.7（？506.6，？301.2）将报告避免达尔多斯，表明强大的负面健康影响。然而，在这种疫苗场景中，如果在TB通知下降到每10万人10％以下的TB通知低于5，则可能存在整体健康效益。净健康影响最有影响力的疫苗特征是疫苗效果对肺结核的进展。在财务方面，无论BCG保护如何，疫苗接种计划的消除成本大幅超过了TB处理的增量成本。如果疫苗保护的质量，可以在中间负荷环境中担保中间负荷设定的ConclusionsBCG停止，以及在其他TB上重新聚焦的可能性对早期检测和治疗的控制活动。

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