David P. Durham, PhD; Meagan C. Fitzpatrick, PhD; Martial L. Ndeffo-Mbah, PhD; Alyssa S. Parpia, MPH; Nelson L. Michael, MD, PhD; Alison P. Galvani, PhD
Disclaimer: The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Army or Department of Defense.
Grant Support: By grants U01 GM087719 and U01 GM105627 from the National Institutes of Health (NIH). Dr. Fitzpatrick was also supported by grant T32 AI007524 from the NIH. Simulations were run on the Yale University Biomedical High Performance Computing Center, which is supported by NIH grants RR19895 and RR029676-01.
Disclosures: Dr. Durham reports grants from the NIH during the conduct of the study. Dr. Fitzpatrick reports grants from the NIH during the conduct of the study and personal fees from Merck and Sanofi Pasteur outside the submitted work. Dr. Michael reports grants from the Department of Defense and Department of the Army paid to Walter Reed Army Institute of Research during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0641.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not applicable. Statistical code and data set: Available at https://github.com/davidpdurham/ZikaVaccination.
Requests for Single Reprints: Alison P. Galvani, PhD, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, 135 College Street, New Haven, CT 06510; e-mail, email@example.com.
Current Author Addresses: Drs. Durham, Fitzpatrick, Ndeffo-Mbah, and Galvani and Ms. Parpia: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, 135 College Street, New Haven, CT 06510.
Dr. Michael: U.S. Military HIV Research Program, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Bethesda, MD 20817.
Author Contributions: Conception and design: D.P. Durham, M.C. Fitzpatrick, A.P. Galvani, M.L. Ndeffo-Mbah, N.L. Michael.
Analysis and interpretation of the data: D.P. Durham, M.C. Fitzpatrick, A.P. Galvani, A.S. Parpia, N.L. Michael.
Drafting of the article: D.P. Durham, A.P. Galvani, M.L. Ndeffo-Mbah, N.L. Michael.
Critical revision of the article for important intellectual content: D.P. Durham, M.C. Fitzpatrick, A.P. Galvani, M.L. Ndeffo-Mbah, A.S. Parpia, N.L. Michael.
Final approval of the article: D.P. Durham, M.C. Fitzpatrick, M.L. Ndeffo-Mbah, A.S. Parpia, N.L. Michael, A.P. Galvani.
Statistical expertise: D.P. Durham.
Obtaining of funding: A.P. Galvani.
Administrative, technical, or logistic support: D.P. Durham.
Collection and assembly of data: D.P. Durham, A.S. Parpia.
Mosquito-borne and sexually transmitted Zika virus has become widespread across Central and South America and the Caribbean. Many Zika vaccine candidates are under active development.
To quantify the effect of Zika vaccine prioritization of females aged 9 to 49 years, followed by males aged 9 to 49 years, on incidence of prenatal Zika infections.
A compartmental model of Zika transmission between mosquitoes and humans was developed and calibrated to empirical estimates of country-specific mosquito density. Mosquitoes were stratified into susceptible, exposed, and infected groups; humans were stratified into susceptible, exposed, infected, recovered, and vaccinated groups. Age-specific fertility rates, Zika sexual transmission, and country-specific demographics were incorporated.
34 countries and territories in the Americas with documented Zika outbreaks.
Males and females aged 9 to 49 years.
Age- and sex-targeted immunization using a Zika vaccine with 75% efficacy.
Annual prenatal Zika infections.
For a base-case vaccine efficacy of 75% and vaccination coverage of 90%, immunizing females aged 9 to 49 years (the World Health Organization 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 10 years, vaccination of women aged 15 to 29 years is more efficient than that of women aged 30 years or older.
Population-level modeling may not capture all local and neighborhood-level heterogeneity in mosquito abundance or Zika incidence.
A Zika vaccine of moderate to high efficacy may virtually eliminate prenatal infections through a combination of direct protection and transmission reduction. Efficiency of age-specific targeting of Zika vaccination depends on the timing of future outbreaks.
National Institutes of Health.
Durham DP, Fitzpatrick MC, Ndeffo-Mbah ML, Parpia AS, Michael NL, Galvani AP. Evaluating Vaccination Strategies for Zika Virus in the Americas. Ann Intern Med. 2018;168:621–630. doi: 10.7326/M17-0641
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Published: Ann Intern Med. 2018;168(9):621-630.
Published at www.annals.org on 3 April 2018
Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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