title: Vaccine allocation in a declining epidemic.
abstract: Sizeable quantities of 2009 pandemic influenza A/H1N1 (H1N1pdm) vaccine in the USA became available at the end of 2009 when the autumn wave of the epidemic was declining. At that point, risk factors for H1N1-related mortality for some of the high-risk groups, particularly adults with underlying health conditions, could be estimated. Although those high-risk groups are natural candidates for being in the top priority tier for vaccine allocation, another candidate group is school-aged children through their role as vectors for transmission affecting the whole community. In this paper, we investigate the question of prioritization for vaccine allocation in a declining epidemic between two groups-a group with a high risk of mortality versus a 'core' group with a relatively low risk of mortality but fuelling transmission in the community. We show that epidemic data can be used, under certain assumptions on future decline, seasonality and vaccine efficacy in different population groups, to give a criterion when initial prioritization of a population group with a sufficiently high risk of epidemic-associated mortality is advisable over the policy of prioritizing the core group.
authors: Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. egoldste@hsph.harvard.edu
authors: E
authors: E
authors: Goldstein
authors: J
authors: J
authors: Wallinga
authors: M
authors: M
authors: Lipsitch
mesh_terms: D004196:Disease Outbreaks / Q000266:history / Q000517:prevention & control*; D015276:Health Care Rationing / Q000379:methods*; D049674:History, 21st Century; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000600:supply & distribution*; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control*; D008962:Models, Theoretical; D018570:Risk Assessment; D012621:Seasons; D014481:United States / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines