scholarly journals Optimizing SARS-CoV-2 vaccination strategies in France: Results from a stochastic agent-based model

2021 ◽  
Author(s):  
Nicolas Hoertel ◽  
Martin Blachier ◽  
Frédéric Limosin ◽  
Marina Sánchez Rico ◽  
Carlos Blanco ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Adult Population ◽  
Virus Transmission ◽  
Vaccination Strategy ◽  
Medical Conditions ◽  
Pharmacological Interventions ◽  
Agent Based ◽  
Vaccination Strategies ◽  
Vaccination Acceptance ◽  
Mandatory Vaccination

Abstract The COVID-19 pandemic is a major global societal, economic and health threat. The availability of COVID-19 vaccines has raised hopes for a decline in the pandemic. We built upon a stochastic agent-based microsimulation model of the COVID-19 epidemic in France. We examined the potential impact of different vaccination strategies, defined according to the age, medical conditions, and expected vaccination acceptance of the target non-immunized adult population, on disease cumulative incidence, mortality, and number of hospital admissions. Specifically, we examined whether these vaccination strategies would allow to lift all non-pharmacological interventions (NPIs), based on a sufficiently low cumulative mortality and number of hospital admissions. While vaccinating the full adult non-immunized population, if performed immediately, would be highly effective in reducing incidence, mortality and hospital-bed occupancy, and would allow discontinuing all NPIs, this strategy would require a large number of vaccine doses. Vaccinating only adults at higher risk for severe SARS-CoV-2 infection, i.e. those aged over 65 years or with medical conditions, would be insufficient to lift NPIs. Immediately vaccinating only adults aged over 45 years, or only adults aged over 55 years with mandatory vaccination of those aged over 65 years, would enable lifting all NPIs with a substantially lower number of vaccine doses, particularly with the latter vaccination strategy. Benefits of these strategies would be markedly reduced if the vaccination was delayed, was less effective than expected on virus transmission or in preventing COVID-19 among older adults, or was not widely accepted.

scholarly journals Optimizing SARS-CoV-2 vaccination strategies in France: Results from a stochastic agent-based model

2021 ◽  
Author(s):  
Nicolas Hoertel ◽  
Martin Blachier ◽  
Frédéric Limosin ◽  
Marina Sánchez-Rico ◽  
Carlos Blanco ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Adult Population ◽  
Virus Transmission ◽  
Vaccination Strategy ◽  
Medical Conditions ◽  
Pharmacological Interventions ◽  
Agent Based ◽  
Vaccination Strategies ◽  
Vaccination Acceptance ◽  
Mandatory Vaccination

AbstractThe COVID-19 pandemic is a major global societal, economic and health threat. The availability of COVID-19 vaccines has raised hopes for a decline in the pandemic. We built upon a stochastic agent-based microsimulation model of the COVID-19 epidemic in France. We examined the potential impact of different vaccination strategies, defined according to the age, medical conditions, and expected vaccination acceptance of the target non-immunized adult population, on disease cumulative incidence, mortality, and number of hospital admissions. Specifically, we examined whether these vaccination strategies would allow to lift all non-pharmacological interventions (NPIs), based on a sufficiently low cumulative mortality and number of hospital admissions. While vaccinating the full adult non-immunized population, if performed immediately, would be highly effective in reducing incidence, mortality and hospital-bed occupancy, and would allow discontinuing all NPIs, this strategy would require a large number of vaccine doses. Vaccinating only adults at higher risk for severe SARS-CoV-2 infection, i.e. those aged over 65 years or with medical conditions, would be insufficient to lift NPIs. Immediately vaccinating only adults aged over 45 years, or only adults aged over 55 years with mandatory vaccination of those aged over 65 years, would enable lifting all NPIs with a substantially lower number of vaccine doses, particularly with the latter vaccination strategy. Benefits of these strategies would be markedly reduced if the vaccination was delayed, was less effective than expected on virus transmission or in preventing COVID-19 among older adults, or was not widely accepted.

scholarly journals Public health impact of delaying second dose of BNT162b2 or mRNA-1273 covid-19 vaccine: simulation agent based modeling study

BMJ ◽  
2021 ◽  
pp. n1087
Author(s):  
Santiago Romero-Brufau ◽  
Ayush Chopra ◽  
Alex J Ryu ◽  
Esma Gel ◽  
Ramesh Raskar ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Vaccination Strategy ◽  
Population Based ◽  
Agent Based Modeling ◽  
Sensitivity Analyses ◽  
Agent Based ◽  
Cumulative Mortality ◽  
Vaccination Rates ◽  
Dose Strategy ◽  
Modeling Study

AbstractObjectiveTo estimate population health outcomes with delayed second dose versus standard schedule of SARS-CoV-2 mRNA vaccination.DesignSimulation agent based modeling study.SettingSimulated population based on real world US county.ParticipantsThe simulation included 100 000 agents, with a representative distribution of demographics and occupations. Networks of contacts were established to simulate potentially infectious interactions though occupation, household, and random interactions.InterventionsSimulation of standard covid-19 vaccination versus delayed second dose vaccination prioritizing the first dose. The simulation runs were replicated 10 times. Sensitivity analyses included first dose vaccine efficacy of 50%, 60%, 70%, 80%, and 90% after day 12 post-vaccination; vaccination rate of 0.1%, 0.3%, and 1% of population per day; assuming the vaccine prevents only symptoms but not asymptomatic spread (that is, non-sterilizing vaccine); and an alternative vaccination strategy that implements delayed second dose for people under 65 years of age, but not until all those above this age have been vaccinated.Main outcome measuresCumulative covid-19 mortality, cumulative SARS-CoV-2 infections, and cumulative hospital admissions due to covid-19 over 180 days.ResultsOver all simulation replications, the median cumulative mortality per 100 000 for standard dosing versus delayed second dose was 226 v 179, 233 v 207, and 235 v 236 for 90%, 80%, and 70% first dose efficacy, respectively. The delayed second dose strategy was optimal for vaccine efficacies at or above 80% and vaccination rates at or below 0.3% of the population per day, under both sterilizing and non-sterilizing vaccine assumptions, resulting in absolute cumulative mortality reductions between 26 and 47 per 100 000. The delayed second dose strategy for people under 65 performed consistently well under all vaccination rates tested.ConclusionsA delayed second dose vaccination strategy, at least for people aged under 65, could result in reduced cumulative mortality under certain conditions.

scholarly journals Avian influenza vaccines: a practical review in relation to their application in the field with a focus on the Asian experience

2008 ◽  
Vol 137 (1) ◽  
pp. 1-21 ◽  
Author(s):  
M. PEYRE ◽  
G. FUSHENG ◽  
S. DESVAUX ◽  
F. ROGER
Keyword(s):  
Avian Influenza ◽  
Negative Impact ◽  
Virus Transmission ◽  
Vaccination Strategy ◽  
Antigenic Drift ◽  
South East Asia ◽  
Viral Strain ◽  
Disease Epidemiology ◽  
Vaccination Strategies ◽  
Special Circumstances

SUMMARYVaccination can be a useful tool for the control of avian influenza (AI) outbreaks, but its use is prohibited in most of the countries worldwide because of its interference with AI surveillance tests and its negative impact on poultry trade. AI vaccines currently in use in the field increase host resistance to the disease but have a limited impact on the virus transmission. To control or eradicate the disease, a carefully conceived vaccination strategy must be accompanied by strict biosecurity measures. Some countries have authorized vaccination under special circumstances with contradictory results, from control and disease eradication (Italy) to endemicity and antigenic drift of the viral strain (Mexico). Extensive vaccination programmes are ongoing in South East Asia to control the H5N1 epidemic. This review provides practical information on the available AI vaccines and associated diagnostic tests, the vaccination strategies applied in Asia and their impact on the disease epidemiology.

scholarly journals Using Novel, Agent-Based Periodic Mobility Model with Super Spreaders to Analyze Vaccination Strategies for COVID-19

2021 ◽  
Author(s):  
Mathew K Jacob ◽  
Eva Xueyao Guo
Keyword(s):  
Vaccination Strategy ◽  
Human Movement ◽  
The Elderly ◽  
Mobility Model ◽  
Limited Resources ◽  
Agent Based ◽  
Vaccination Strategies ◽  
Periodic Movement ◽  
Vaccine Availability ◽  
Novel Agent

Background: With the innovation of vaccines to fight against the COVID-19 pandemic, following an effective vaccination strategy is crucial in mitigating deaths and hospitalizations and offering the greatest protection to a community or locality within the early months of vaccine-availability, when resources may be scarce. By using a novel agent-based periodic mobility model that captures periodic movement, which attempts to model human movement patterns, super spreaders, and ICU hospitalizations, this study attempts to find the best strategy for vaccinating individuals to mitigate the damage of COVID-19. Results: This study found that a vaccination strategy that first vaccinates the elderly would be most effective at mitigating deaths and lowering the ICU hospitalization peak during the first two months of vaccine rollout. Conclusion: For communities that are early in their vaccine campaign or that have limited resources for vaccination, we recommend that they prioritize vaccinating the elderly who are more susceptible to COVID-19 first.

Disability and psychiatric disorders in an urban community: measurement, prevalence and outcomes

1998 ◽  
Vol 28 (3) ◽  
pp. 509-517 ◽  
Author(s):  
S. S. BASSETT ◽  
G. A. CHASE ◽  
M. F. FOLSTEIN ◽  
D. A. REGIER
Keyword(s):  
Psychiatric Disorders ◽  
Service Utilization ◽  
Adult Population ◽  
Diagnostic Category ◽  
Psychiatric Evaluation ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Sampling Weights ◽  
Co Morbidity ◽  
Specific Disability

Background. The purpose of this analysis was to examine: (1) the prevalence of psychiatric disorders among disabled people, using seven different measures of disability; (2) variation in disability between and within psychiatric diagnostic categories; and (3) relationship of diagnosis and disability to health service utilization.Method. Data were drawn from Phase I and Phase II of the Eastern Baltimore Mental Health Survey, part of the Epidemiologic Catchment Area Program (ECA) conducted in 1980–1 to survey mental morbidity within the adult population. A total of 810 individuals received both a household interview and a standardized clinical psychiatric evaluation. Estimated prevalence rates were computed using appropriate survey sampling weights.Results. Prevalence of disability ranged from 2·5 to 19·5%, varying with specific disability measure. Among those classified as disabled by any of the measures examined, 56 to 92% had a psychiatric disorder and serious chronic medical conditions were present in the majority of these cases (54 to 78%). Disability was expressed differently among the various diagnostic groups. Diagnostic category and disability were significant independent predictors of medical service utilization and receipt of disability payments.Conclusions. The majority of disabled adults living in the community have diagnosable psychiatric disorders, with the majority of these individuals suffering from significant chronic medical conditions as well, thus making co-morbidity the norm.

From epidemiology to public health decision making: analysis on IMD & vaccination strategy in Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Igidbashian ◽  
F Caracci ◽  
P Bonanni ◽  
P Castiglia ◽  
M Conversano ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Adult Population ◽  
Vaccination Strategy ◽  
Healthcare Services ◽  
Steady Increase ◽  
Vaccine Preventable Disease ◽  
Preventable Disease ◽  
Italian Regions ◽  
Age Range

Abstract Introduction Invasive Meningococcal Disease (IMD) is one of the most severe vaccine-preventable disease, with high fatality rate and severe sequelae in up to 20% of survivors. MenB, MenC and MenACWY vaccines are available in Italy, but recommendations vary among Italian regions in terms of type of vaccines and targeted age groups. The aim of the study is to describe epidemiology of IMDs in order to provide the best vaccination strategy. Methods IMDs surveillance data in the period 2011-2017 from the Italian National Health Institute were explored. Excel was used to present trend analysis, stratifying by age and serogroups. Results In Italy, during the period 2011-2017, IMDs overall incidence increased from 0.25 cases/100,000 inhabitants in 2011 to 0.33 in 2017. Most cases after 2013 were caused by non-B serogroups (52%, 52%, 66%, 64%, 59% from 2013 to 2017). Although incidence is highest in 1 years old children, the number of cases is highest in the age range 25-64. The number of cases in this age-range had a steady increase after 2013 (36 cases in 2011, 79 in 2017), with serogroups C, W and Y present in more than 65% of cases in 25+ age ranges after 2012. Conclusions IMD is a rare but severe vaccine-preventable disease. The key role of public health is to monitor disease serogroups, trends and outbreaks and strengthen methodological evidence-based tools for decision-making processes, public health policies, planning of healthcare services and intervention measures, including immunization. The increase in incidence shown in the period 2011-2017 in Italy, although probably due to better surveillance, highlighted the high circulation also of non-B serogroups and the importance of the disease in the adult population. Based on our analysis we believe that anti-meningococcal vaccination plan in Italy should include the highest number of preventable serogroups and be aimed to the whole population through a multicohort strategy, including boosters in children and in adults. Key messages Anti-meningococcal vaccination plan in Italy should include all the preventable serogroups and be aimed to the whole population with a multicohort strategy including boosters in children and in adults. The increase in incidence of IMD in the period 2011-2017 in Italy highlighted the high circulation also of non-B serogroups and the importance of the disease in the adult population.

scholarly journals The Public Health Impact of Delaying a Second Dose of the BNT162b2 or mRNA-1273 COVID-19 Vaccine

2021 ◽  
Author(s):  
Santiago Romero-Brufau ◽  
Ayush Chopra ◽  
Alex J Ryu ◽  
Esma Gel ◽  
Ramesh Raskar ◽  
...  
Keyword(s):  
Vaccination Strategy ◽  
Population Level ◽  
Health Impact ◽  
Vaccination Rate ◽  
Agent Based Modeling ◽  
Sensitivity Analyses ◽  
Agent Based ◽  
Cumulative Mortality ◽  
Vaccination Rates ◽  
The Public

AbstractObjectivesTo estimate population health outcomes under delayedsecond dose versus standard schedule SARS-CoV-2 mRNA vaccination.DesignAgent-based modeling on a simulated population of 100,000 based on a real-world US county. The simulation runs were replicated 10 times. To test the robustness of these findings, simulations were performed under different estimates for single-dose efficacy and vaccine administration rates, and under the possibility that a vaccine prevents only symptoms but not asymptomatic spread.Settingpopulation level simulation.Participants100,000 agents are included in the simulation, with a representative distribution of demographics and occupations. Networks of contacts are established to simulate potentially infectious interactions though occupation, household, and random interactionsInterventionswe simulate standard Covid-19 vaccination, versus delayed-second-dose vaccination prioritizing first dose. Sensitivity analyses include first-dose vaccine efficacy of 70%, 80% and 90% after day 12 post-vaccination; vaccination rate of 0.1%, 0.3%, and 1% of population per day; assuming the vaccine prevents only symptoms but not asymptomatic spread; and an alternative vaccination strategy that implements delayed-second-dose only for those under 65 years of age.Main outcome measurescumulative Covid-19 mortality over 180 days, cumulative infections and hospitalizations.ResultsOver all simulation replications, the median cumulative mortality per 100,000 for standard versus delayed second dose was 226 vs 179; 233 vs 207; and 235 vs 236; for 90%, 80% and 70% first-dose efficacy, respectively. The delayed-second-dose strategy was optimal for vaccine efficacies at or above 80%, and vaccination rates at or below 0.3% population per day, both under sterilizing and non-sterilizing vaccine assumptions, resulting in absolute cumulative mortality reductions between 26 and 47 per 100,000. The delayed-second-dose for those under 65 performed consistently well under all vaccination rates tested.ConclusionsA delayed-second-dose vaccination strategy, at least for those under 65, could result in reduced cumulative mortality under certain conditions.

scholarly journals Evaluation of COVID-19 vaccination strategies with a delayed second dose

PLoS Biology ◽  
2021 ◽  
Vol 19 (4) ◽  
pp. e3001211
Author(s):  
Seyed M. Moghadas ◽  
Thomas N. Vilches ◽  
Kevin Zhang ◽  
Shokoofeh Nourbakhsh ◽  
Pratha Sah ◽  
...  
Keyword(s):  
Program Effectiveness ◽  
Credible Interval ◽  
The United States ◽  
Optimal Time ◽  
Time Interval ◽  
Policy Debate ◽  
Agent Based ◽  
Vaccination Strategies ◽  
Supply And Distribution ◽  
The Impact

Two of the Coronavirus Disease 2019 (COVID-19) vaccines currently approved in the United States require 2 doses, administered 3 to 4 weeks apart. Constraints in vaccine supply and distribution capacity, together with a deadly wave of COVID-19 from November 2020 to January 2021 and the emergence of highly contagious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants, sparked a policy debate on whether to vaccinate more individuals with the first dose of available vaccines and delay the second dose or to continue with the recommended 2-dose series as tested in clinical trials. We developed an agent-based model of COVID-19 transmission to compare the impact of these 2 vaccination strategies, while varying the temporal waning of vaccine efficacy following the first dose and the level of preexisting immunity in the population. Our results show that for Moderna vaccines, a delay of at least 9 weeks could maximize vaccination program effectiveness and avert at least an additional 17.3 (95% credible interval [CrI]: 7.8–29.7) infections, 0.69 (95% CrI: 0.52–0.97) hospitalizations, and 0.34 (95% CrI: 0.25–0.44) deaths per 10,000 population compared to the recommended 4-week interval between the 2 doses. Pfizer-BioNTech vaccines also averted an additional 0.60 (95% CrI: 0.37–0.89) hospitalizations and 0.32 (95% CrI: 0.23–0.45) deaths per 10,000 population in a 9-week delayed second dose (DSD) strategy compared to the 3-week recommended schedule between doses. However, there was no clear advantage of delaying the second dose with Pfizer-BioNTech vaccines in reducing infections, unless the efficacy of the first dose did not wane over time. Our findings underscore the importance of quantifying the characteristics and durability of vaccine-induced protection after the first dose in order to determine the optimal time interval between the 2 doses.

P3347Pre-hospital time and 30-day mortality in patients with presumed heart conditions or dyspnea: a registry-based cohort study of patients requiring a highest priority emergency medical response

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E H A Mills ◽  
K Aasbjerg ◽  
S M Hansen ◽  
K B Ringgren ◽  
M Dahl ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Charlson Comorbidity Index Score ◽  
Medical Conditions ◽  
Medical Response ◽  
Ambulance Dispatch ◽  
Heart Condition

Abstract Introduction Centralization of emergency care is expected to increase average pre-hospital time for patients, leading to concerns about possible adverse outcomes for patients. Prior studies have found increased mortality for patients with prolonged transport following acute myocardial infarction. Purpose Examine the association between total pre-hospital time (from dispatch to hospital arrival) and mortality for patients, depending on the condition presumed by the emergency dispatcher (presumed heart condition, dyspnea or non-specific medial conditions). Methods Pre-hospital registry data from a Danish region from 2006–2012 was used. This contained information on ambulance dispatch priority, ambulance times, and patient condition, as well if procedures consistent with cardiac arrest (CPR or shock) were performed. We included patients with both highest priority dispatch and transport to the hospital. Linkage to nationwide registries of hospital admissions, comorbidities and mortality was performed. Logistic regression was used for analysis. Results 95% of total pre-hospital times were below 84 minutes. 30-day mortality was highest among patients with dyspnea (36.6%). Compared to pre-hospital times of 0–30 min, odds ratios of 30-day mortality for times >60 min were: for presumed heart conditions 0.54 [95% CI 0.38–0.77] (p<0.001), for dyspnea 0.98 [95% CI 0.65–1.47] and for other medical conditions 1.14 [95% CI 0.98–1.32] Patient characteristics and outcomes according to the presumed aetiology of the priority 1 emergency dispatch Presumed heart condition Dyspnea Other medical conditions N 1836 1101 11538 Age, median {IQR} 66.4 {55.3, 76.8} 70.5 {56.8, 80.8} 61.5 {40.3, 75.8} Male, n (%) 1194 (65.0) 585 (53.1) 6172 (53.5) 10-year Charlson comorbidity index score ≥3, n (%) 744 (40.5) 613 (55.7) 4311 (37.6) Response time, median {IQR} 9 {5, 13} 9 {5, 13} 8 {5, 13} Total pre-hospital time, median {IQR} 49{37,61} 45{34, 58} 46{34,58} Cardiac arrest procedures during transport, n (%) 266 (14.5) 133 (12.1) 844 (7.3) Cardiovascular diagnosis (DI00-DI99), n (%) 962 (52.4) 282 (25.6) 3285 (28.5) Respiratory diagnosis (DJ00-DJ99), n (%) 82 (4.5) 430 (39.1) 1036 (9.0) 1-day mortality, n (%) 289 (15.7) 225 (20.4) 1311 (11.4) 30-day mortality, n (%) 402 (21.9) 403 (36.6) 2264 (19.6) Logistic regression, 30-day mortality Conclusion No overall association between total pre-hospital time and mortality, however for presumed heart conditions longer times may improve survival. Acknowledgement/Funding Program for clinical research infrastructure (PROCRIN) established by the Lundbeck and Novo Nordisk foundations & The Danish Heart Foundation

scholarly journals Combined healthy lifestyle factors and risk of all-cause and cardiovascular first hospitalization

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Bonaccio ◽  
A Di Castelnuovo ◽  
S Costanzo ◽  
M Persichillo ◽  
A De Curtis ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Cox Regression ◽  
Healthy Lifestyle ◽  
Adult Population ◽  
Population Based ◽  
Lifestyle Factors ◽  
Inflammatory Biomarkers ◽  
Healthy Lifestyles ◽  
Italian Population ◽  
The Impact

Abstract Background We aimed to explore the association of combined healthy lifestyles with risk of first hospitalization for all-cause, cardiovascular disease (CVD), ischemic heart disease (IHD) and stroke in a southern Italian population-based cohort. We also investigated several biological mechanisms possibly on the pathway between lifestyles and health outcomes. Methods Longitudinal analysis on 23,161 men and women (aged≥35 y) recruited in the Moli-sani Study (2005-2010). We defined 4 healthy lifestyle factors as abstention from smoking; high adherence to Mediterranean diet; physical activity; absence of abdominal obesity. First hospital admissions for any and CVD-related causes were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 7.2 y, we ascertained a total of 9,482 hospitalizations, 3,556 CVD, 939 IHD and 589 stroke-related hospital admissions. Adherence to all four healthy lifestyles, compared with none or 1, was associated with lower risk of hospitalization for any cause (HR = 0.82; 0.74-0.90), CVD (HR = 0.81;0.69-0.95) and IHD (HR = 0.63; 0.44-0.90) and, to a less extent, with stroke hospitalizations. Inflammatory biomarkers (e.g. C-reactive protein) were likely to partly explain the association between lifestyles and all-cause (14%) or CVD (15%) hospitalizations, while inflammation played a leading role towards risk of IHD (30%) and stroke-related hospital admissions (21%). Conclusions The impact of combined 4 healthy lifestyles on first hospitalization risk was considerable. Inflammatory biomarkers explained a large proportion of this association. Key messages Improvements to lifestyle reduce the risk of hospitalizations in a general adult population. Achieving a greater number of healthy behaviours has the potential to reduce the burden of hospitalizations and the associated healthcare costs.

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