Optimizing the use of new tools, such as vaccines, may play a crucial role in reaching global targets for tuberculosis (TB) control. Some of the most promising candidate vaccines target adults. However, high-coverage mass vaccinations may be logistically more challenging for adults than for children. Vaccine delivery strategies targeting high-risk groups or settings might yield proportionally greater impact than strategies that target the general population. We developed an individual-based TB transmission model representing a hypothetical population consisting of South African gold miners and the associated labor-sending communities. We simulated implementation of a post-infection adult vaccine with 60% efficacy and mean 10-year duration of effect, and compared the impact of a mine-targeted vaccination strategy, where miners were vaccinated while in the mines, against a community-targeted strategy, where random individuals within the labor-sending communities were vaccinated. Mine-targeted vaccination averted an estimated 0.37 TB cases per vaccine dose, versus 0.25 for community-targeted vaccination, for a relative efficacy of 1.46 (95% range: 1.13-1.91). The added benefit of mine-targeted vaccination primarily reflected the disproportionate demographic burden of TB among adult males as a whole. As novel vaccines for TB are developed, venue-based vaccine delivery targeting high-risk demographic groups may improve both feasibility and transmission impact.

© 2024 Aaron A. King
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