Predicting and monitoring variations in the effects of vaccines against RSV

Yale University, New Haven CT

Investigators

Linked publications & trials

Abstract

Project Summary/Abstract Respiratory syncytial virus (RSV) causes a large burden of infections in both infants and older adults. Several alternative strategies for preventing RSV have recently been approved. A variety of products and approaches are available, including vaccinating mothers to protect infants, administering extended half-life immunoprophylaxis to infants, and directly immunizing older adults. There is an urgent need to determine the delivery strategies that will reduce overall disease burden and address disparities in disease burden among different socioeconomic groups, and to generate timely estimates of effectiveness and safety of these interventions as they are introduced. This renewal application builds on the success of our current project examining spatial heterogeneity in RSV dynamics and the potential impact of RSV vaccines. Disease dynamics and the impact of vaccines are often characterized at aggregated state or national levels. However, this aggregation ignores important variability in disease burden between socioeconomic groups. We will use routinely collected administrative healthcare data from the United States that represent a broad range of epidemiological settings. We will test specific hypotheses about disparities in disease burden by severity level and the implications of this variation for vaccine impact and cost-effectiveness. In Aim 1, we will use statistical models to quantify variability in the burden of RSV infections among outpatients, inpatients, those admitted to the intensive care unit, and those dying from RSV according to area-based quantiles of socioeconomic status. Understanding these patterns will help to inform projections of the impact of different prevention strategies. In Aim 2, we will use transmission models to predict the potential impact of different intervention strategies across age and socioeconomic groups. In Aim 3, we will use cost-effectiveness analyses to identify the optimal strategies for infants and for older adults, and we will evaluate the equity implications by quantifying the costs and benefits of different RSV prevention strategies by socioeconomic group. Finally, in Aim 4, we will extend a novel analytical framework that will allow for efficient and rigorous evaluations of vaccine effectiveness and safety, including against rare outcomes, by integrating observational data and trial data. Together the proposed work will provide critical data on the potential impacts of different RSV prevention strategies and evaluations of effectiveness that can be used by stakeholders and government advisory committees to inform and update recommendations for the use of novel RSV vaccines and monoclonal antibodies.