The King Laboratory
of Theoretical Ecology & Evolution
at the University of Michigan

Impact of targeted tuberculosis vaccination among mining population in South Africa: a model-based study

S. Shrestha, V. Chihota, R. G. White, A. D. Grant, G. J. Churchyard, and D. W. Dowdy
American Journal of Epidemiology 2017.

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.

The official version of the paper is here.  

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