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. 2020 Jul 22;38(34):5474-5479.
doi: 10.1016/j.vaccine.2020.06.034. Epub 2020 Jun 26.

Number needed to immunize to prevent RSV with extended half-life monoclonal antibody

Lyn Finelli  1 , Yoonyoung Choi  2 , Edward Goldstein  3
Affiliations

Number needed to immunize to prevent RSV with extended half-life monoclonal antibody

Lyn Finelli et al. Vaccine. .

Abstract

Background: Respiratory syncytial virus (RSV) is one of the most important respiratory pathogens in young children. Infants <6 months of age and infants and young children with extreme pre-term birth, and cardiac and pulmonary co-morbidities experience the highest incidence of severe RSV disease. There are no licensed vaccines; immunoprophylaxis is recommended for the highest risk children. Extended half-life RSV monoclonal antibodies (EHL-mAbs) are under development intended for immunization of all infants and high-risk children <2 years of age. We modeled the anticipated public health benefits of RSV EHL-mAb immunization using the number needed to immunize (NNI).

Methods: We combined RSV hospitalization, outpatient and outpatient lower respiratory tract infection (LRI) incidence estimates and a range of immunization efficacies to estimate the annual NNI. We calculated the absolute incidence rate reduction (ARR) by multiplying the incidence rates by immunization efficacy. NNI was calculated as the reciprocal of the ARR.

Results: For an RSV EHL-mAb with 70% efficacy, 6-18 infants would need to be immunized to prevent one RSV-associated outpatient visit, and 13-33 infants would need to be immunized to prevent one RSV-associated LRI outpatient visit. To prevent one RSV-associated hospitalization, 37-85 infants 0-5 months of age, and 107-280 infants 6-11 months of age would need to be immunized.

Conclusions: Public health benefits, such as disease cases averted due to immunization, are essential elements in consideration of candidate vaccines for a national immunization program. An RSV EHL-mAb of moderate efficacy could have high impact. These data provide an additional perspective for public health decision making.

Keywords: Immunization; Number needed to vaccinate; RSV monoclonal antibody; mAb.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Number Needed to Immunize to Avert One RSV-Associated Pediatric Outpatient Visit in Infants by Age Group and Immunization Efficacy.
Fig. 2.
Fig. 2.
Number Needed to Immunize to Avert One RSV-Associated Outpatient Lower Respiratory Infection in Infants by Age Group and Immunization.
Fig. 3.
Fig. 3.
Number Needed to Immunize to Avert One RSV-Associated Hospitalization in Infants by Age Group and Immunization Efficacy.
See this image and copyright information in PMC

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