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Estimates of the Public Health Impact of a Pediatric Vaccination Program Using an Intranasal Tetravalent Live-Attenuated Influenza Vaccine in Belgium

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Abstract

Objectives

Our objectives were to estimate the public health outcomes of vaccinating Belgian children using an intranasal tetravalent live-attenuated influenza vaccine (QLAIV) combined with current coverage of high-risk/elderly individuals using the trivalent inactivated vaccine.

Methods

We used a deterministic, age-structured, dynamic model to simulate seasonal influenza transmission in the Belgian population under the current coverage or after extending vaccination with QLAIV to healthy children aged 2–17 years. Differential equations describe demographic changes, exposure to infectious individuals, infection recovery, and immunity dynamics. The basic reproduction number (R 0) was calibrated to the observed number of influenza doctor visits/year. Vaccine efficacy was 80 % (live-attenuated) and 59–68 % (inactivated). The 10-year incidence of symptomatic influenza was calculated with different coverage scenarios (add-on to current coverage).

Results

Model calibration yielded R 0 = 1.1. QLAIV coverage of 75 % of those aged 2–17 years averted 374,000 symptomatic cases/year (57 % of the current number), 244,000 of which were among adults (indirect effect). Vaccinating 75 % of those aged 2–11 years and 50 % of those aged 12–17 years averted 333,200 cases/year (213,000 adult cases/year). Vaccinating only healthy children aged 2–5 years generated direct protection but limited indirect protection, even with 90 % coverage (40,800 averted adult cases/year; –8.4 %). Targeting all children averted twice as many high-risk cases as targeting high-risk children only (8485 vs. 4965/year with 75 % coverage). Sensitivity analyses showed the robustness of results.

Conclusions

The model highlights the direct and indirect protection benefits when vaccinating healthy children with QLAIV in Belgium. Policies targeting only high-risk individuals or the youngest provide limited herd protection, as school-age children are important influenza vectors in the community.

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Authorship

ME and OD conceptualised the study, carried out the simulations, and interpreted the results. MS designed and developed the simulation tool and provided technical support. LG provided local data input, analysed the simulation results, and drafted the manuscript. ML and SDSM provided expertise and guidance on data input and assumptions. All authors critically appraised, corrected, and validated the manuscript.

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Authors and Affiliations

  1. IMS Health Real-World Evidence Solutions, Corporate Village, Davos Building, Da Vincilaan 7, 1935, Zaventem, Belgium

    Laetitia Gerlier & Mark Lamotte

  2. S.A. AstraZeneca N.V., Uccle, Belgium

    Sofia Dos Santos Mendes

  3. Bielefeld University, Bielefeld, Germany

    Oliver Damm

  4. ExploSYS GmbH, Leinfelden-Echterdingen, Germany

    Markus Schwehm

  5. Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany

    Martin Eichner

  6. Epimos GmbH, Dusslingen, Germany

    Martin Eichner

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  1. Laetitia Gerlier
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  2. Mark Lamotte
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  3. Sofia Dos Santos Mendes
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  4. Oliver Damm
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  5. Markus Schwehm
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  6. Martin Eichner
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Corresponding author

Correspondence to Laetitia Gerlier.

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Funding

This study was funded by an unrestricted grant from S.A. AstraZeneca N.V., Belgium.

Conflict of interest

LG and ML are employees of IMS Health, which has received consulting fees from AstraZeneca. SDSM is an employee of AstraZeneca. OD has conducted studies for and received honoraria from Herescon GmbH, which has received research support and consulting fees from AstraZeneca and MedImmune. MS is employee and shareholder of ExploSYS GmbH, which has received payments from Epimos GmbH, a contract research and consulting institute, which has received research support and consulting fees from AstraZeneca. ME is partner and shareholder of the contract research and consulting institute Epimos GmbH, which has received consulting fees and research support from AstraZeneca, Novartis, and GlaxoSmithKline.

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Gerlier, L., Lamotte, M., Dos Santos Mendes, S. et al. Estimates of the Public Health Impact of a Pediatric Vaccination Program Using an Intranasal Tetravalent Live-Attenuated Influenza Vaccine in Belgium. Pediatr Drugs 18, 303–318 (2016). https://doi.org/10.1007/s40272-016-0180-6

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