Optimizing Vaccine Allocation at Different Points in Time during an Epidemic 英文参考文献.docVIP

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Optimizing Vaccine Allocation at Different Points in Time during an Epidemic 英文参考文献.doc

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Optimizing Vaccine Allocation at Different Points in Time during an Epidemic 英文参考文献

OptimizingVaccineAllocationatDifferentPointsinTime duringanEpidemic LauraMatrajt1,IraM.Longini Jr.2,3* 1Department of Applied Mathematics, University of Washington, Seattle, Washington, United States of America, 2Center for Statistics and Quantitative Infectious Diseases,VaccineandInfectiousDiseaseDivision,FredHutchinsonCancerResearchCenter,Seattle,Washington,UnitedStatesofAmerica,3DepartmentofBiostatistics, SchoolofPublicHealth,UniversityofWashington,Seattle,Washington,UnitedStatesofAmerica Abstract Background:PandemicinfluenzaA(H1N1)2009beganspreadingaroundtheglobeinAprilof2009andvaccinationstarted in October of 2009. In most countries, by the time vaccination started, the second wave of pandemic H1N1 2009 was alreadyunderway.Withlimitedsuppliesofvaccine,wearelefttoquestionwhetheritmaybeagoodstrategytovaccinate thehigh-transmissiongroupsearlierintheepidemic,butitmightbeabetteruseofresourcestoprotectinsteadthehigh- riskgroupslaterintheepidemic.Toanswerthisquestion,wedevelopadeterministicepidemicmodelwithtwoage-groups (childrenandadults)andfurthersubdivideeachagegroupinlowandhighrisk. Methods and Findings: We compare optimal vaccination strategies started at various points in time in two different settings:apopulationinadevelopedcountrywherechildrenaccountfor24%ofthepopulation,andapopulationinaless developed country where children make up the majority of the population, 55%. For each of these populations, we minimizemortalityorhospitalizationsandwefindanoptimalvaccinationstrategythatgivesthebestvaccineallocation givenastartingvaccinationtimeandvaccinecoveragelevel.Wefindthatpopulationstructureisanimportantfactorin determiningtheoptimalvaccinedistribution.Moreover,theoptimalpolicyisdynamicasthereisaswitchintheoptimal vaccinationstrategyatsometimepointjustbeforethepeakoftheepidemic.Forinstance,with25%vaccinecoverage,itis bettertoprotectthehigh-transmissiongroupsbeforethispoint,butitisoptimaltoprotectthemostvulnerablegroups afterward. Conclusions:Choosingtheoptimal