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Proc Natl Acad Sci U S A. 2018 May 15;115(20):5151-5156. doi: 10.1073/pnas.1802479115. Epub 2018 Apr 30.

Optimizing the impact of low-efficacy influenza vaccines.

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Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.
Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331.
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201.
Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610


The efficacy of influenza vaccines varies from one year to the next, with efficacy during the 2017-2018 season anticipated to be lower than usual. However, the impact of low-efficacy vaccines at the population level and their optimal age-specific distribution have yet to be ascertained. Applying an optimization algorithm to a mathematical model of influenza transmission and vaccination in the United States, we determined the optimal age-specific uptake of low-efficacy vaccine that would minimize incidence, hospitalization, mortality, and disability-adjusted life-years (DALYs), respectively. We found that even relatively low-efficacy influenza vaccines can be highly impactful, particularly when vaccine uptake is optimally distributed across age groups. As vaccine efficacy declines, the optimal distribution of vaccine uptake shifts toward the elderly to minimize mortality and DALYs. Health practitioner encouragement and concerted recruitment efforts are required to achieve optimal coverage among target age groups, thereby minimizing influenza morbidity and mortality for the population overall.


DALY; age structured; hospitalization; mathematical model; vaccination

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