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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.

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



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.


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.


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.


Even a partially-protective vaccine, delivered through a realistic targeting strategy, could substantially reduce gonorrhea incidence, despite antibiotic resistance.


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


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