Estimating Waning of Vaccine Effectiveness: A Simulation Study

• Published in: Clinical infectious diseases Vol. 76; no. 3; pp. 479 - 486
• Main Authors: Nikas, Ariel, Ahmed, Hasan, Zarnitsyna, Veronika I
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 08.02.2023
• Subjects: Computer Simulation; Humans; Influenza Vaccines; Major; Proportional Hazards Models; Vaccination - methods; scaled Schoenfeld residuals; multiscale modeling; vaccine efficacy; estimating waning of vaccine effectiveness; Cox proportional hazards model
• DOI: 10.1093/cid/ciac725
• ISSN: 1058-4838; 1537-6591

Abstract Background Developing accurate and reliable methods to estimate vaccine protection is a key goal in immunology and public health. While several statistical methods have been proposed, their potential inaccuracy in capturing fast intraseasonal waning of vaccine-induced protection needs to be rigorously investigated. Methods To compare statistical methods for estimating vaccine effectiveness (VE), we generated simulated data using a multiscale, agent-based model of an epidemic with an acute viral infection and differing extents of VE waning. We apply a previously proposed framework for VE measures based on the observational data richness to assess changes of vaccine-induced protection over time. Results While VE measures based on hard-to-collect information (eg, the exact timing of exposures) were accurate, usually VE studies rely on time-to-infection data and the Cox proportional hazards model. We found that its extension using scaled Schoenfeld residuals, previously proposed for capturing VE waning, was unreliable in capturing both the degree of waning and its functional form and identified the mathematical factors contributing to this unreliability. We showed that partitioning time and including a time-vaccine interaction term in the Cox model significantly improved estimation of VE waning, even in the case of dramatic, rapid waning. We also proposed how to optimize the partitioning scheme. Conclusions While appropriate for rejecting the null hypothesis of no waning, scaled Schoenfeld residuals are unreliable for estimating the degree of waning. We propose a Cox-model–based method with a time-vaccine interaction term and further optimization of partitioning time. These findings may guide future analysis of VE waning data. Using simulated data, we compared different measures of vaccine effectiveness for capturing the intraseasonal waning of vaccine-induced protection. We propose an extension of the Cox model based on including a time-vaccine interaction term with further optimization of partitioning time.