Med Decis Making - Too much of a good thing? When to stop catch-up vaccination.

Tópicos

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Resumo

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; in addition, the number of infected individuals decreases, so each unvaccinated person faces a lower risk of infection. This article 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.

Resumo Limpo

th centuri death rang serious infecti diseas decreas dramat due develop safe effect vaccin howev infant immun coverag increas margin sinc s mani peopl remain suscept vaccineprevent diseas catchup vaccin age group beyond infanc can attract effect mean immun peopl miss earlier howev newborn vaccin rate increas catchup vaccin becom less attract number suscept peopl decreas cost find vaccin unvaccin person may increas addit number infect individu decreas unvaccin person face lower risk infect articl present general framework determin optim time discontinu catchup vaccin program use costeffect framework consid cost per qualityadjust life year gain catchup vaccin effort function newborn immun rate time consequ diseas preval incid illustr result exampl hepat b catchup vaccin china contrast result dynam model approach approach ignor impact vaccin futur diseas incid latter approach like simpler decis maker understand implement lower data requir

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