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Clin Infect Dis. 2020 Jan 6. pii: ciz1241. doi: 10.1093/cid/ciz1241. [Epub ahead of print]

Assessment of the Potential of Vaccination to Combat Antibiotic Resistance in Gonorrhea: A Modeling Analysis to Determine Preferred Product Characteristics.

Whittles LK1,2,3, White PJ1,2,3,4, Didelot X5,6.

Author information

1
Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
2
MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
3
NIHR Health Protection Research Unit in Modelling Methodology, School of Public Health, Imperial College London, London, UK.
4
Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.
5
School of Life Sciences University of Warwick, Coventry, UK.
6
Department of Statistics, University of Warwick, Coventry, UK.

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.

KEYWORDS:

antibiotic resistance; gonorrhea; transmission model; treatment failure; vaccination

PMID:
31905399
DOI:
10.1093/cid/ciz1241

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