Modelling the global burden of drug-resistant tuberculosis avertable by a post-exposure vaccine

Abstract

There have been notable advances in the development of vaccines against active tuberculosis (TB) disease for adults and adolescents. Using mathematical models, we seek to estimate the potential impact of a post-exposure TB vaccine, having 50% efficacy in reducing active disease, on global rifampicin-resistant (RR-) TB burden. In 30 countries that together accounted for 90% of global RR-TB incidence in 2018, a future TB vaccine could avert 10% (95% credible interval: 9.7–11%) of RR-TB cases and 7.3% (6.6–8.1%) of deaths over 2020–2035, with India, China, Indonesia, Pakistan, and the Russian Federation having the greatest contribution. This impact would increase to 14% (12–16%) and 31% (29–33%) respectively, when combined with improvements in RR-TB diagnosis and treatment relative to a scenario of no vaccine and no such improvements. A future TB vaccine could have important implications for the global control of RR-TB, especially if implemented alongside enhancements in management of drug resistance.

Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study

“…Introduction of routine TCV vaccination with a catch-up campaign up to age 15 years was predicted to avert 42•5 million (95% PI 24•8-62•9 million) cases of typhoid fever with FQNS and 21•2 million (95% PI 16•4-26•5 million) cases with multidrug resistance over 10 years (appendix pp [16][17][18][19][20][21]. Overall, 53•5 million (95% PI 37•3-75•3 million) cases of antimicrobialresistant typhoid fever could be prevented (table 3).…”

“…16 Other studies have estimated that vaccination against Streptococcus pneumoniae, rotavirus, and Mycobacterium tuberculosis can potentially prevent millions of cases that would otherwise be treated with antibiotics, especially when paired with other interventions. 17,18 In this Article, we combine model predictions of the effect of TCV on typhoid fever with country-specific estimates of the burden of antimicrobial resistance (FQNS and multidrug resistance) to predict the number of antimicrobial-resistant typhoid fever cases, deaths, and disability-adjusted life years (DALYs) that can potentially be averted through TCV roll-out. The results can guide the prioritisation of TCV introduction in countries eligible for support from Gavi.…”

Cost-effectiveness of routine adolescent vaccination with an M72/AS01E-like tuberculosis vaccine in South Africa and India

“…One previous paper used M72/AS01 E results to estimate the epidemiological impact of a vaccine with post-infection efficacy on the MDR-tuberculosis epidemic 9 , and one other considered the cost-effectiveness of such a vaccine in China and India 11 , but both studies assessed the impact of routine adolescent vaccination accompanied by regular all-adult mass vaccination campaigns. No previous studies have explored the cost-effectiveness of only routine adolescent vaccination, which would be much more straightforward to implement through existing platforms than recurrent large all-adult mass campaigns, so may be an attractive option for TB vaccine implementation in resource-limited settings.…”

“…Previous work has estimated the epidemiological impact of hypothetical or pipeline vaccines to prevent tuberculosis infection and/or disease 6 – 8 , including the impact of a post-exposure vaccine on drug-resistant tuberculosis 9 , 10 , and when delivered via routine immunisation of 9-year-olds accompanied by recurring mass campaigns to adolescents/adults 10 , 11 . Routine immunisation of only adolescents could prove more feasible and cost-effective than large mass campaigns, but the cost-effectiveness of such an approach has not been explored; in particular, it is critical to understand the age groups in which vaccination will be most cost-effective.…”

The value of multimodal ultrasonography in differential diagnosis of tuberculous and non-tuberculous superficial lymphadenitis

“…China has one of the world’s largest prevalence rates of TB, and learning from an institution where complex evaluative protocols for possible TB lymphadenitis in a stream-lined fashion may benefit management in both China and other countries including India, Indonesia, Pakistan, and the Russia where prevalence continues to be high [ 5 , 6 ].…”