Modeling the potential impact of vaccination on the epidemiology of congenital cytomegalovirus infection.
BACKGROUND
Understanding the potential for vaccination to change cytomegalovirus (CMV) epidemiology is important for developing CMV vaccines and designing clinical trials.


METHODS
We constructed a deterministic, age-specific and time-dependent mathematical model of pathogen transmission, parameterized using CMV seroprevalence from the United States and Brazil, to predict the impact of vaccination on congenital CMV infection.


RESULTS
Concurrent vaccination of young children and adolescents would result in the greatest reductions in congenital CMV infections in populations with moderate and high baseline maternal seroprevalence. Such a vaccination strategy, assuming 70% vaccine efficacy, 90% coverage and 5-year duration of protection, could ultimately prevent 30-50% of congenital CMV infections. At equilibrium, this strategy could result in a 30% reduction in congenital CMV infections due to primary maternal infection in the United States but a 3% increase in Brazil. The potential for an increase in congenital CMV infections due to primary maternal infections in Brazil was not predicted with use of a vaccine that confers protection for greater than 5 years.


CONCLUSIONS
Modeling suggests that vaccination strategies that include young children will result in greater declines in congenital CMV infection than those restricted to adolescents or women of reproductive age. Our study highlights the critical need for better understanding of the relative contribution of type of maternal infection to congenital CMV infection and disease, the main focus of vaccine prevention.
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: tmlanzieri@cdc.gov.
Tatiana M
TM
Lanzieri
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Stephanie R
SR
Bialek
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ismael R
IR
Ortega-Sanchez
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; MRC Centre for Outbreak Analysis and Modelling, Imperial College London, UK; Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Manoj
M
Gambhir
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000453:epidemiology / Q000517:prevention & control*; D022482:Cytomegalovirus Vaccines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008962:Models, Theoretical; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000379:methods*; D055815:Young Adult
D022482:Cytomegalovirus Vaccines
Congenital infection; Cytomegalovirus; Mathematical model; Vaccination impact