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Assessing the economic impact of vaccine availability when controlling foot and mouth disease outbreaks

机译:在控制手足口病暴发时评估疫苗供应的经济影响

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Predictive models have been used extensively to assess the likely effectiveness of vaccination policies as part of control measures in the event of a foot and mouth disease (FMD) outbreak. However the availability of vaccine stocks and the impact of vaccine availability on disease control strategies represent a key uncertainty when assessing potential control strategies. Using an epidemiological, spatially explicit, simulation model in combination with a direct cost calculator, we assessed how vaccine availability constraints may affect the economic benefit of a ‘vaccination-to-live’ strategy during a FMD outbreak in Scotland, when implemented alongside culling of infected premises and dangerous contacts. We investigated the impact of vaccine stock size and restocking delays on epidemiological and economic outcomes. We also assessed delays in the initial decision to vaccinate, maximum daily vaccination capacity, and vaccine efficacy. For scenarios with conditions conducive to large outbreaks, all vaccination strategies perform better than the strategy where only culling is implemented. A stock of 200,000 doses, enough to vaccinate 12% of the Scottish cattle population, would be sufficient to maximize the relative benefits of vaccination, both epidemiologically and economically. However, this generates a wider variation in economic cost than if vaccination is not implemented, making outcomes harder to predict. The probability of direct costs exceeding GBP500 million is reduced when vaccination is used, and is steadily reduced further as the size of initial vaccine stock increases. If only a suboptimal quantity of vaccine doses is initially available (100,000 doses), restocking delays of more than two weeks rapidly increase the cost of controlling outbreaks. Impacts of low vaccine availability or restocking delays are particularly aggravated by delays in the initial decision to vaccinate, or low vaccine efficacy. Our findings confirm that implementing an emergency vaccination-to-live strategy in addition to the conventional stamping out strategy is economically beneficial in scenarios with conditions conducive to large FMD outbreaks in Scotland. However, the size of the initial vaccine stock available at the start of the outbreak, and the interplay with other factors such as vaccine efficacy and delays in restocking or implementing vaccination, should be considered in making decisions about optimal.
机译:预测模型已广泛用于评估口蹄疫(FMD)爆发时疫苗接种政策作为控制措施一部分的可能效果。但是,在评估潜在控制策略时,疫苗储备的可用性以及疫苗可用性对疾病控制策略的影响代表了一个关键的不确定性。使用流行病学,空间明确的模拟模型与直接成本计算器相结合,我们评估了疫苗的可利用性可能如何影响苏格兰口蹄疫爆发期间“以活疫苗”策略的经济效益,同时实施受感染的场所和危险的联系人。我们调查了疫苗库存量和补货延迟对流行病学和经济结果的影响。我们还评估了最初的疫苗接种决定,最大每日疫苗接种量和疫苗效力的延误。对于具有导致大规模爆发的条件的情况,所有疫苗接种策略的效果要优于仅实施淘汰策略的策略。 200,000剂疫苗的存量足以为12%的苏格兰牛群接种疫苗,足以在流行病学和经济上最大化疫苗接种的相对利益。但是,与未实施疫苗接种相比,这会产生更大的经济成本差异,从而使结果难以预测。当使用疫苗接种时,直接成本超过5亿英镑的可能性会降低,并且随着初始疫苗储备量的增加,这种可能性会逐步降低。如果最初只能获得次优数量的疫苗剂量(100,000剂),则超过两周的补货延迟会迅速增加控制疫情的成本。疫苗可得性低或补货延误的影响由于最初决定接种疫苗的延误或疫苗效力低而特别恶化。我们的研究结果证实,在常规情况下,实施紧急疫苗接种到活疫苗的策略除了在苏格兰造成大规模口蹄疫暴发的情况下,在经济上是有益的。但是,在决定最佳方案时,应考虑爆发初期可获得的初始疫苗库存的大小,以及与其他因素(如疫苗效力以及补货或实施疫苗接种的延迟)的相互作用。

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