title: The potential impact of vaccination on the prevalence of gonorrhea.
abstract: Gonorrhea, one of the most common sexually transmitted infections worldwide, can lead to serious sequelae, including infertility and increased HIV transmission. Recently, untreatable, multidrug-resistant Neisseria gonorrhoeae strains have been reported. In the absence of new antibiotics, and given the speed with which resistance has emerged to all previously used antibiotics, development of a vaccine would be the ideal solution to this public health emergency. Understanding the desired characteristics, target population, and expected impact of an anti-gonococcal vaccine is essential to facilitate vaccine design, assessment and implementation. The modeling presented herein aims to fill these conceptual gaps, and inform future gonococcal vaccine development. Using an individual-based, epidemiological simulation model, gonococcal prevalence was simulated in a heterosexual population of 100,000 individuals after the introduction of vaccines with varied efficacy (10-100%) and duration of protection (2.5-20 years). Model simulations predict that gonococcal prevalence could be reduced by at least 90% after 20 years, if all 13-year-olds were given a non-waning vaccine with 50% efficacy, or a vaccine with 100% efficacy that wanes after 7.5 years. A 40% reduction in prevalence is achievable with a non-waning vaccine of only 20% efficacy. We conclude that a vaccine of moderate efficacy and duration could have a substantive impact on gonococcal prevalence, and disease sequelae, if coverage is high and protection lasts over the highest risk period (i.e., most sexual partner change) among young people.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney 2052, NSW, Australia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Craig
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney 2052, NSW, Australia.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Gray
authors.affiliation: Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and The Ohio State University Department of Pediatrics, Columbus, OH, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Edwards
authors.affiliation: Department of Microbiology, University of Iowa, Iowa City, IA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Apicella
authors.affiliation: Institute for Glycomics, Griffith University, Southport, QLD, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jennings
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney 2052, NSW, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
authors.affiliation: Institute for Glycomics, Griffith University, Southport, QLD, Australia.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Seib
mesh_terms: D000293:Adolescent; D000328:Adult; D001428:Bacterial Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D003198:Computer Simulation; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000276:immunology*; D015995:Prevalence; D055815:Young Adult
chemical_list: D001428:Bacterial Vaccines
keywords: Antimicrobial resistance; Epidemiological simulation model; Gonorrhea; Neisseria gonorrhoeae; Vaccine