Assessment of the potential of vaccination to combat antibiotic resistance in gonorrhea: a modeling analysis to determine preferred product characteristics
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Supporting information
Author(s)
Whittles, Lilith K
White, Peter J
Didelot, Xavier
Type
Journal Article
Abstract
BACKGROUND: Gonorrhea incidence is increasing rapidly in many countries, whilst antibiotic resistance is making treatment more difficult. Combined with evidence that MeNZB and Bexsero meningococcal vaccines are likely partially-protective against gonorrhea, this has renewed interest in a gonococcal vaccine, and several candidates are in development. Key questions are how protective a vaccine needs to be, how long protection needs to last, and how should it be targeted. We assessed vaccination's potential impact, and the feasibility of achieving WHO's target 90% reduction in gonorrhea incidence 2016-2030, by comparing realistic vaccination strategies under a range of scenarios of vaccine efficacy and duration of protection, and emergence of extensively-resistant gonorrhea. METHODS: We developed a stochastic transmission-dynamic model, incorporating asymptomatic and symptomatic infection and heterogeneous sexual behavior in men-who-have-sex-with-men (MSM). We used data from England, which has a comprehensive, consistent nationwide surveillance system. Using particle Markov Chain Monte Carlo methods we fitted the model to gonorrhea incidence in 2008-17, and then used Bayesian forecasting to examine an extensive range of scenarios. RESULTS: Even in the worst-case scenario of untreatable infection emerging, the WHO target is achievable if all MSM attending sexual health clinics receive a vaccine offering ≥52% protection for ≥6 years. A vaccine conferring 31% protection (as estimated for MeNZB) for 2-4 years, could reduce incidence in 2030 by 45% in the worst-case scenario, and by 75% if >70% of resistant gonorrhea remains treatable. CONCLUSIONS: Even a partially-protective vaccine, delivered through a realistic targeting strategy, could substantially reduce gonorrhea incidence, despite antibiotic resistance.
Date Issued
2020-10-15
Date Acceptance
2020-01-02
Citation
Clinical Infectious Diseases, 2020, 71 (8), pp.1912-1919
ISSN
1058-4838
Publisher
Oxford University Press (OUP)
Start Page
1912
End Page
1919
Journal / Book Title
Clinical Infectious Diseases
Volume
71
Issue
8
Copyright Statement
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
National Institute for Health Research
Medical Research Council (MRC)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31905399
PII: 5697289
Grant Number
HPRU-2012-10080
MR/R015600/1
Subjects
antibiotic resistance
gonorrhea
transmission model
treatment failure
vaccination
Publication Status
Published
Coverage Spatial
United States
Article Number
ARTN ciz1241
Date Publish Online
2020-01-06