The potential impact of vaccination on the prevalence of gonorrhea

• Published in: Vaccine Vol. 33; no. 36; pp. 4520 - 4525
• Main Authors: Craig, Andrew P, Gray, Richard T, Edwards, Jennifer L, Apicella, Michael A, Jennings, Michael P, Wilson, David P, Seib, Kate L
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 26.08.2015; Elsevier Limited
• Subjects: Adolescent; Adult; Allergy and Immunology; Antibiotics; Antimicrobial resistance; Bacterial Vaccines - administration & dosage; Bacterial Vaccines - immunology; Behavior; Computer Simulation; Disease Transmission, Infectious - prevention & control; Epidemiological simulation model; Female; Gonorrhea; Gonorrhea - epidemiology; Gonorrhea - prevention & control; Gonorrhea - transmission; HIV; Human immunodeficiency virus; Humans; Infections; Infertility; Male; Mathematical models; Mens health; Middle Aged; Neisseria gonorrhoeae; Neisseria gonorrhoeae - immunology; Prevalence; Public health; Sexually transmitted diseases; STD; Studies; Vaccine; Vaccines; Viral infections; Womens health; Young Adult; Vaccine; Neisseria gonorrhoeae; Epidemiological simulation model; Gonorrhea; Antimicrobial resistance
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2015.07.015

Abstract Gonorrhea, one of the most common sexually transmitted infections worldwide, can lead to serious sequelae, including infertility and increased HIV transmission. Recently, untreatable, multidrug-resistant Neisseria gonorrhoeae strains have been reported. In the absence of new antibiotics, and given the speed with which resistance has emerged to all previously used antibiotics, development of a vaccine would be the ideal solution to this public health emergency. Understanding the desired characteristics, target population, and expected impact of an anti-gonococcal vaccine is essential to facilitate vaccine design, assessment and implementation. The modeling presented herein aims to fill these conceptual gaps, and inform future gonococcal vaccine development. Using an individual-based, epidemiological simulation model, gonococcal prevalence was simulated in a heterosexual population of 100,000 individuals after the introduction of vaccines with varied efficacy (10–100%) and duration of protection (2.5–20 years). Model simulations predict that gonococcal prevalence could be reduced by at least 90% after 20 years, if all 13-year-olds were given a non-waning vaccine with 50% efficacy, or a vaccine with 100% efficacy that wanes after 7.5 years. A 40% reduction in prevalence is achievable with a non-waning vaccine of only 20% efficacy. We conclude that a vaccine of moderate efficacy and duration could have a substantive impact on gonococcal prevalence, and disease sequelae, if coverage is high and protection lasts over the highest risk period ( i.e. , most sexual partner change) among young people.