A marginal benefit approach for vaccinating influenza "superspreaders".

TitleA marginal benefit approach for vaccinating influenza "superspreaders".
Publication TypeJournal Article
Year of Publication2014
AuthorsSkene KJ, A Paltiel D, Shim E, Galvani AP
JournalMed Decis Making
Volume34
Issue4
Pagination536-49
Date Published2014 May
ISSN1552-681X
Abstract

BACKGROUND: There is widespread recognition that interventions targeting "superspreaders" are more effective at containing epidemics than strategies aimed at the broaderPOPULATION: However, little attention has been devoted to determining optimal levels of coverage for targeted vaccination strategies, given the nonlinear relationship between program scale and the costs and benefits of identifying and successfully administering vaccination to potential superspreaders.METHODS: We developed a framework for such an assessment derived from a transmission model of seasonal influenza parameterized to emulate typical seasonal influenza epidemics in the US. We used this framework to estimate how the marginal benefit of expanded targeted vaccination changes with the proportion of the target population already vaccinated.RESULTS: The benefit of targeting additional superspreaders varies considerably as a function of both the baseline vaccination coverage and proximity to the herd immunity threshold. The general form of the marginal benefit function starts low, particularly for severe epidemics, increases monotonically until its peak at the point of herd immunity, and then plummets rapidly. We present a simplified transmission model, primarily designed to convey qualitative insight rather than quantitative precision. With appropriate contact data, future work could address more complex population structures, such as age structure and assortative mixing patterns. Our illustrative example highlights the general economic and epidemiological findings of our method but does not address intervention design, policy, and resource allocation issues related to practical implementation of this particular scenario.CONCLUSIONS: Our approach offers a means of estimating willingness to pay for search costs associated with targeted vaccination of superspreaders, which can inform policies regarding whether a targeted intervention should be implemented and, if so, up to what levels.

DOI10.1177/0272989X14523502
Alternate JournalMed Decis Making
PubMed ID24740238
PubMed Central IDPMC4209160
Grant List5U54GM088491-02 / GM / NIGMS NIH HHS / United States
R01 DA015612 / DA / NIDA NIH HHS / United States
R01DA015612 / DA / NIDA NIH HHS / United States
U01 105627 / / PHS HHS / United States
U01 GM105627 / GM / NIGMS NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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