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. 2008 Aug 1;198(3):305-11.
doi: 10.1086/589716.

Prioritization of influenza pandemic vaccination to minimize years of life lost

Mark A Miller  1 , Cecile Viboud, Donald R Olson, Rebecca F Grais, Maia A Rabaa, Lone Simonsen
Affiliations

Prioritization of influenza pandemic vaccination to minimize years of life lost

Mark A Miller et al. J Infect Dis. .

Abstract

Background: How to allocate limited vaccine supplies in the event of an influenza pandemic is currently under debate. Conventional vaccination strategies focus on those at highest risk for severe outcomes, including seniors, but do not consider (1) the signature pandemic pattern in which mortality risk is shifted to younger ages, (2) likely reduced vaccine response in seniors, and (3) differences in remaining years of life with age.

Methods: We integrated these factors to project the age-specific years of life lost (YLL) and saved in a future pandemic, on the basis of mortality patterns from 3 historical pandemics, age-specific vaccine efficacy, and the 2000 US population structure.

Results: For a 1918-like scenario, the absolute mortality risk is highest in people <45 years old; in contrast, seniors (those >or=65 years old) have the highest mortality risk in the 1957 and 1968 scenarios. The greatest YLL savings would be achieved by targeting different age groups in each scenario; people <45 years old in the 1918 scenario, people 45-64 years old in the 1968 scenario, and people >45 years old in the 1957 scenario.

Conclusions: Our findings shift the focus of pandemic vaccination strategies onto younger populations and illustrate the need for real-time surveillance of mortality patterns in a future pandemic. Flexible setting of vaccination priority is essential to minimize mortality.

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Conflict of interest statement

Potential conflicts of interest: none reported.

Figures

Figure 1
Figure 1
Comparison of projected rates of influenza-related deaths and years of life lost (YLL) for 3 pandemic scenarios. Solid lines show YLL, and dashed lines show deaths (both per 100,000 population). Estimates are based on historical age-specific influenza-related mortality rates from the 1918 pandemic (A), the 1957 pandemic (B), and the 1968 pandemic (C), projected onto the 2000 US population structure and life expectancies. The age groups studied vary between the pandemics due to the availability of historical data [11, 23, 25].
Figure 2
Figure 2
Comparison of projected nos. of influenza-related deaths and years of life lost (YLL) for 3 pandemic scenarios.
See this image and copyright information in PMC

References

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