Abstract
For most pathogens, vaccination reduces the spread of the infection and total number of cases; thus, public policy usually advocates maximizing vaccination coverage. We use simple mathematical models to explore how this may be different for pathogens, such as influenza, which exhibit strain variation. Our models predict that the total number of seasonal influenza infections is minimized at an intermediate (rather than maximal) level of vaccination, and, somewhat counter-intuitively, further increasing the level of the vaccination coverage may lead to higher number of influenza infections and be detrimental to the public interest. This arises due to the combined effects of: competition between multiple co-circulating strains; limited breadth of protection afforded by the vaccine; and short-term strain-transcending immunity following natural infection. The study highlights the need for better quantification of the components of vaccine efficacy and longevity of strain-transcending cross-immunity in order to generate nuanced recommendations for influenza vaccine coverage levels.
Highlights
Influenza A remains a widespread disease that continues to circulate worldwide with more than 200,000 people in the US hospitalized annually for illnesses associated with seasonal influenza virus infections [1]
The prevalence of a given strain was defined as a fraction of the total population that is infected with that strain and is shown by the dashed and solid lines for the first and second strains, respectively
We considered the dynamics of two co-circulating influenza strains, and how it is changed by vaccination
Summary
Influenza A remains a widespread disease that continues to circulate worldwide with more than 200,000 people in the US hospitalized annually for illnesses associated with seasonal influenza virus infections [1]. Vaccination is considered to be a chief preventive tool against influenza, and the Centers for Disease Control and Prevention encourages maximal vaccination coverage by recommending that all individuals 6 months and older receive an influenza vaccine annually [2]. The influenza vaccine in general use is an inactivated virus vaccine that targets the strains of influenza A and B predicted to circulate in the population during the current season. Many studies have measured the efficacy of the vaccine
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