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.
Below: The prevalence of gonorrhea
in the absence of a vaccine, and with (A) vaccines of differing efficacies and
20 years duration of protection, or (B) vaccines with 100% efficacy and of
differing durations of protection. Vaccine coverage is 100% of 13-year-olds.
Below: The prevalence of gonorrhea
in the absence of a vaccine, and with different rates and types of vaccine
coverage. (A) Vaccines have 100% efficacy and 20 years duration. (B) Vaccines
have 50% efficacy and 20 years duration.
By: Andrew P. Craig,a Richard T. Gray,a Jennifer L. Edwards,b Michael A. Apicella,c Michael P. Jennings,d David P. Wilson,#a and Kate L. Seib#d,*
aThe Kirby
Institute, UNSW Australia, Sydney 2052, NSW, Australia
bCenter for
Microbial Pathogenesis, The Research Institute at Nationwide Children's
Hospital, and The Ohio State University Department of Pediatrics, Columbus, OH,
USA
cDepartment
of Microbiology, University of Iowa, Iowa City, IA, USA
dInstitute
for Glycomics, Griffith University, Southport, QLD, Australia
#Contributed equally.
* Corresponding
author. Tel.: +61 755527453; fax: +61 7 5552 8098. Email: ua.ude.htiffirg@bies.k (K.L. Seib).
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