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Showing content from http://www.ncbi.nlm.nih.gov/pubmed/32687792 below:

Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

. 2020 Oct;8(10):e1264-e1272. doi: 10.1016/S2214-109X(20)30308-9. Epub 2020 Jul 17. Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Collaborators, Affiliations

Collaborators

LSHTM CMMID COVID-19 Working Group: Rein M G J Houben, W John Edmunds, Christian Julian Villabona-Arenas, Katherine E Atkins, Gwenan M Knight, Fiona Yueqian Sun, Megan Auzenbergs, Alicia Rosello, Petra Klepac, Joel Hellewell, Timothy W Russell, Damien C Tully, Jon C Emery, Hamish P Gibbs, James D Munday, Billy J Quilty, Charlie Diamond, Carl A B Pearson, Quentin J Leclerc, Emily S Nightingale, Yang Liu, Akira Endo, Arminder K Deol, Adam J Kucharski, Sam Abbott, Christopher I Jarvis, Kathleen O'Reilly, Thibaut Jombart, Amy Gimma, Nikos I Bosse, Kiesha Prem, Stéphane Hué, Nicholas G Davies, Rosalind M Eggo, Samuel Clifford, Graham Medley

Affiliations

¹ London School of Hygiene & Tropical Medicine, London, UK. Electronic address: kaja.abbas@lshtm.ac.uk.
² London School of Hygiene & Tropical Medicine, London, UK.
³ Gavi, the Vaccine Alliance, Geneva, Switzerland.
⁴ Bill & Melinda Gates Foundation, Seattle, WA, USA.
⁵ London School of Hygiene & Tropical Medicine, London, UK; Public Health England, London, UK; University of Hong Kong, Hong Kong Special Administrative Region, China.

PMID: 32687792
PMCID: PMC7367673
DOI: 10.1016/S2214-109X(20)30308-9

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Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Kaja Abbas et al. Lancet Glob Health. 2020 Oct.

. 2020 Oct;8(10):e1264-e1272. doi: 10.1016/S2214-109X(20)30308-9. Epub 2020 Jul 17. Collaborators

LSHTM CMMID COVID-19 Working Group: Rein M G J Houben, W John Edmunds, Christian Julian Villabona-Arenas, Katherine E Atkins, Gwenan M Knight, Fiona Yueqian Sun, Megan Auzenbergs, Alicia Rosello, Petra Klepac, Joel Hellewell, Timothy W Russell, Damien C Tully, Jon C Emery, Hamish P Gibbs, James D Munday, Billy J Quilty, Charlie Diamond, Carl A B Pearson, Quentin J Leclerc, Emily S Nightingale, Yang Liu, Akira Endo, Arminder K Deol, Adam J Kucharski, Sam Abbott, Christopher I Jarvis, Kathleen O'Reilly, Thibaut Jombart, Amy Gimma, Nikos I Bosse, Kiesha Prem, Stéphane Hué, Nicholas G Davies, Rosalind M Eggo, Samuel Clifford, Graham Medley

Affiliations

¹ London School of Hygiene & Tropical Medicine, London, UK. Electronic address: kaja.abbas@lshtm.ac.uk.
² London School of Hygiene & Tropical Medicine, London, UK.
³ Gavi, the Vaccine Alliance, Geneva, Switzerland.
⁴ Bill & Melinda Gates Foundation, Seattle, WA, USA.
⁵ London School of Hygiene & Tropical Medicine, London, UK; Public Health England, London, UK; University of Hong Kong, Hong Kong Special Administrative Region, China.

PMID: 32687792
PMCID: PMC7367673
DOI: 10.1016/S2214-109X(20)30308-9

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Erratum in

Correction to Lancet Glob Health 2020; 8: e1264-72.
[No authors listed] [No authors listed] Lancet Glob Health. 2020 Nov;8(11):e1371. doi: 10.1016/S2214-109X(20)30419-8. Epub 2020 Sep 24. Lancet Glob Health. 2020. PMID: 32979934 Free PMC article. No abstract available.

Abstract

Background: National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points.

Methods: We considered a high-impact scenario and a low-impact scenario to approximate the child deaths that could be caused by immunisation coverage reductions during COVID-19 outbreaks. In the high-impact scenario, we used previously reported country-specific child mortality impact estimates of childhood immunisation for diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Streptococcus pneumoniae, rotavirus, measles, meningitis A, rubella, and yellow fever to approximate the future deaths averted before 5 years of age by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. In the low-impact scenario, we approximated the health benefits of sustaining routine childhood immunisation on only the child deaths averted from measles outbreaks during the COVID-19 risk period. We assumed that contact-reducing interventions flattened the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children can be infected by either vaccinators or during transport, and that upon child infection the whole household will be infected. Country-specific household age structure estimates and age-dependent infection-fatality rates were applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit-risk ratios for routine childhood immunisation, with 95% uncertainty intervals (UIs) from a probabilistic sensitivity analysis.

Findings: In the high-impact scenario, for every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, 84 (95% UI 14-267) deaths in children could be prevented by sustaining routine childhood immunisation in Africa. The benefit-risk ratio for the vaccinated children is 85 000 (4900-546 000), for their siblings (<20 years) is 75 000 (4400-483 000), for their parents or adult carers (aged 20-60 years) is 769 (148-2700), and for older adults (>60 years) is 96 (14-307). In the low-impact scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit-risk ratio to the households of vaccinated children is 3 (0-10); if the risk to only the vaccinated children is considered, the benefit-risk ratio is 3000 (182-21 000).

Interpretation: The deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic.

Funding: Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation.

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Figures
Figure 1

Benefit–risk ratios for sustaining routine…

Figure 1

Benefit–risk ratios for sustaining routine childhood immunisation during the COVID-19 pandemic in Africa…

Figure 1

Benefit–risk ratios for sustaining routine childhood immunisation during the COVID-19 pandemic in Africa In this scenario, we assume that the suspension of immunisation will result in a cohort of unvaccinated children who have the same risk of disease as children in a completely unvaccinated population, and their vulnerability persists until they are 5 years old (ie, no catch-up campaigns). A benefit–risk ratio greater than 1 indicates in favour of sustaining the routine childhood immunisation programme. Countries shaded in grey had missing data.

Figure 2

Benefit–risk ratios of sustaining routine…

Figure 2

Benefit–risk ratios of sustaining routine childhood vaccination, with a minimal chance of a…

Figure 2

Benefit–risk ratios of sustaining routine childhood vaccination, with a minimal chance of a measles outbreak and no other vaccine-preventable outbreaks, during the COVID-19 pandemic in Africa In this scenario, we assumed that, in the absence of immunisation, herd immunity would protect children missing vaccination for all diseases except measles. We assumed that the chance of a measles outbreak during the 6-month suspension of immunisation was 12·5%, and no other vaccine-preventable disease outbreaks occurred. Countries shaded in grey had missing data.

Figure 3

Sensitivity analysis for uncertainty in…

Figure 3

Sensitivity analysis for uncertainty in the benefit–risk ratio estimates The tornado diagram was…

Figure 3

Sensitivity analysis for uncertainty in the benefit–risk ratio estimates The tornado diagram was constructed using a multivariate Poisson regression model fitted to the estimated posterior distribution of the benefit–risk ratio using our model input parameters as predictors, and treating total deaths averted by childhood immunisation as a single variable. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.