Dosing interval strategies for two-dose COVID-19 vaccination in 13 middle-income countries of Europe: Health impact modelling and benefit-risk analysis.
| Title: | Dosing interval strategies for two-dose COVID-19 vaccination in 13 middle-income countries of Europe: Health impact modelling and benefit-risk analysis. |
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| Authors: | Liu Y; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Pearson CAB; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Sandmann FG; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Statistics, Modelling and Economics Department, National Infection Service, UK Health Security Agency (UK HSA), London, United Kingdom.; Barnard RC; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Kim JH; International Vaccine Institute, Seoul, South Korea.; Flasche S; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Jit M; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Statistics, Modelling and Economics Department, National Infection Service, UK Health Security Agency (UK HSA), London, United Kingdom.; Abbas K; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. |
| Corporate Authors: | CMMID COVID-19 Working Group |
| Source: | The Lancet regional health. Europe [Lancet Reg Health Eur] 2022 Jun; Vol. 17, pp. 100381. Date of Electronic Publication: 2022 Apr 11. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: [Oxford] Country of Publication: England NLM ID: 101777707 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2666-7762 (Electronic) Linking ISSN: 26667762 NLM ISO Abbreviation: Lancet Reg Health Eur Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Oxford] : Elsevier Ltd., [2020]- |
| Abstract: | Background: In settings where the COVID-19 vaccine supply is constrained, extending the intervals between the first and second doses of the COVID-19 vaccine may allow more people receive their first doses earlier. Our aim is to estimate the health impact of COVID-19 vaccination alongside benefit-risk assessment of different dosing intervals in 13 middle-income countries (MICs) of Europe.; Methods: We fitted a dynamic transmission model to country-level daily reported COVID-19 mortality in 13 MICs in Europe (Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Republic of Moldova, Russian Federation, Serbia, North Macedonia, Turkey, and Ukraine). A vaccine product with characteristics similar to those of the Oxford/AstraZeneca COVID-19 (AZD1222) vaccine was used in the base case scenario and was complemented by sensitivity analyses around efficacies similar to other COVID-19 vaccines. Both fixed dosing intervals at 4, 8, 12, 16, and 20 weeks and dose-specific intervals that prioritise specific doses for certain age groups were tested. Optimal intervals minimise COVID-19 mortality between March 2021 and December 2022. We incorporated the emergence of variants of concern (VOCs) into the model and conducted a benefit-risk assessment to quantify the tradeoff between health benefits versus adverse events following immunisation.; Findings: In all countries modelled, optimal strategies are those that prioritise the first doses among older adults (60+ years) or adults (20+ years), which lead to dosing intervals longer than six months. In comparison, a four-week fixed dosing interval may incur 10.1% [range: 4.3% - 19.0%; n = 13 (countries)] more deaths. The rapid waning of the immunity induced by the first dose (i.e. with means ranging 60-120 days as opposed to 360 days in the base case) resulted in shorter optimal dosing intervals of 8-20 weeks. Benefit-risk ratios were the highest for fixed dosing intervals of 8-12 weeks.; Interpretation: We infer that longer dosing intervals of over six months could reduce COVID-19 mortality in MICs of Europe. Certain parameters, such as rapid waning of first-dose induced immunity and increased immune escape through the emergence of VOCs, could significantly shorten the optimal dosing intervals.; Funding: World Health Organization.; (© 2022 The Authors. Published by Elsevier Ltd.) |
| Competing Interests: | We declare no competing interests. |
| Grant Information: | MR/P014658/1 United Kingdom MRC_ Medical Research Council; MR/S003975/1 United Kingdom MRC_ Medical Research Council; R01 AI141534 United States AI NIAID NIH HHS; MC_PC_19065 United Kingdom MRC_ Medical Research Council; United Kingdom WT_ Wellcome Trust |
| Contributed Indexing: | Keywords: AEFI, Adverse events following immunisation; COVID-19; MIC, Middle income country; Mathematical modelling; Public health intervention; Quantitative methods; SARS-CoV-2; VE, Vaccine Efficacy; VOC, Variant of Concern; Vaccine policy |
| Entry Date(s): | Date Created: 20220418 Latest Revision: 20250530 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC8996067 |
| DOI: | 10.1016/j.lanepe.2022.100381 |
| PMID: | 35434685 |
| Database: | MEDLINE |
Journal Article