Streptococcus pneumoniae is a major cause of morbidity and mortality; pneumococcal polysaccharide vaccination (PPV) to prevent invasive pneumococcal disease (IPD) has been recommended for all persons aged >65 and for younger persons with comorbidities. However, IPD prevention is less than optimal, due in part to infections in persons without vaccine indication and waning immunity after PPV. Recent changes in pneumococcal serotype epidemiology resulting from the childhood pneumococcal conjugate vaccine (PCV) further complicate vaccine policy decision making. IPD due to PCV-related pneumococcal serotypes has significantly decreased in adults but much less so in those with comorbid conditions, prompting investigation of other vaccination strategies, including PPV every 10-15 years and the addition of adult PCV. Clinical trials testing multiple vaccination regiments would be difficult, expensive, and perhaps unhelpful, given rapid epidemiologic changes. Modeling techniques, synthesizing existing data and projecting likely future scenarios could be useful in determining vaccination strategy feasibility and pointing out areas of uncertainty where further data collection would be most valuable. To this end, we propose to: 1) forecast changes in adult pneumococcal serotype epidemiology resulting from childhood PCV using an infectious disease transmission dynamic model and 2) calculate the effectiveness and cost-effectiveness of alternative adult pneumococcal vaccination strategies incorporating forecasted PCV epidemiologic effects. Areas of data uncertainty will be fully incorporated in the model using recently developed analytic frameworks, which will allow probabilistic representation of results and, through value of information analysis techniques, provide evidence-based guidance for optimal future research resource allocation.

Public Health Relevance

Disease due to Streptococcus pneumoniae continues to be a significant public health issue, and improvements in preventive strategies are needed. This research will produce a mathematical model to assist pneumococcal vaccine policymaking, particularly in prioritizing and allocating resources to future research efforts. ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
1R01AI076256-01A1
Application #
7523081
Study Section
Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
Program Officer
Khambaty, Farukh M
Project Start
2008-09-15
Project End
2012-08-31
Budget Start
2008-09-15
Budget End
2009-08-31
Support Year
1
Fiscal Year
2008
Total Cost
$227,250
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Michaelidis, Constantinos I; Fine, Michael J; Lin, Chyongchiou Jeng et al. (2016) The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis. BMC Infect Dis 16:655
Michaelidis, Constantinos I; Kern, Melissa S; Smith, Kenneth J (2015) Cost-Effectiveness of Decision Support Strategies in Acute Bronchitis. J Gen Intern Med 30:1505-10
Michaelidis, Constantinos I; Zimmerman, Richard K; Nowalk, Mary Patricia et al. (2014) Cost-effectiveness of procalcitonin-guided antibiotic therapy for outpatient management of acute respiratory tract infections in adults. J Gen Intern Med 29:579-86
Smith, Kenneth J; Nowalk, Mary Patricia; Raymund, Mahlon et al. (2013) Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults. Vaccine 31:3950-6
Lin, Chyongchiou Jeng; Zimmerman, Richard K; Smith, Kenneth J (2013) Cost-effectiveness of pneumococcal and influenza vaccination standing order programs. Am J Manag Care 19:e30-7
Smith, Kenneth J; Wateska, Angela; Nowalk, M Patricia et al. (2013) Cost-effectiveness of procalcitonin-guided antibiotic use in community acquired pneumonia. J Gen Intern Med 28:1157-64
Michaelidis, Constantinos I; Zimmerman, Richard K; Nowalk, Mary Patricia et al. (2013) Cost-effectiveness of a program to eliminate disparities in pneumococcal vaccination rates in elderly minority populations: an exploratory analysis. Value Health 16:311-7
Smith, Kenneth J; Wateska, Angela R; Nowalk, Mary Patricia et al. (2013) Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults. Am J Prev Med 44:373-81
Smith, Kenneth J; Wateska, Angela R; Nowalk, Mary Patricia et al. (2012) Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. JAMA 307:804-12
Smith, Kenneth J; Lee, Bruce Y; Nowalk, Mary Patricia et al. (2010) Cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Vaccine 28:7620-5

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