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01-12-2020 | Vaccination | Research Article

Short- and long-term impact of vaccination against cytomegalovirus: a modeling study

Authors: Ganna Rozhnova, Mirjam E. Kretzschmar, Fiona van der Klis, Debbie van Baarle, Marjolein Korndewal, Ann C. Vossen, Michiel van Boven

Published in: BMC Medicine | Issue 1/2020

Abstract

Background

Infection with cytomegalovirus (CMV) is highly prevalent worldwide and can cause severe disease in immunocompromised persons and congenitally infected infants. The disease burden caused by congenital CMV infection is high, especially in resource-limited countries. Vaccines are currently under development for various target groups.

Methods

We evaluated the impact of vaccination strategies and hygiene intervention using transmission models. Model parameters were estimated from a cross-sectional serological population study (n=5179) and a retrospective birth cohort (n=31,484), providing information on the age- and sex-specific CMV prevalence and on the birth prevalence of congenital CMV (cCMV).

Results

The analyses show that vertical transmission and infectious reactivation are the main drivers of transmission. Vaccination strategies aimed at reducing transmission from mother to child (vaccinating pregnant women or women of reproductive age) can yield substantial reductions of cCMV in 20 years (31.7–71.4% if 70% of women are effectively vaccinated). Alternatively, hygiene intervention aimed at preventing CMV infection and re-infection of women of reproductive age from young children is expected to reduce cCMV by less than 2%. The effects of large-scale vaccination on CMV prevalence can be substantial, owing to the moderate transmissibility of CMV at the population level. However, as CMV causes lifelong infection, the timescale on which reductions in CMV prevalence are expected is in the order of several decades. Elimination of CMV infection in the long run is only feasible for a vaccine with a long duration of protection and high vaccination coverage.

Conclusions

Vaccination is an effective intervention to reduce the birth prevalence of cCMV. Population-level reductions in CMV prevalence can only be achieved on a long timescale. Our results stress the value of vaccinating pregnant women and women of childbearing age and provide support for the development of CMV vaccines and early planning of vaccination scenarios and rollouts.

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Title: Short- and long-term impact of vaccination against cytomegalovirus: a modeling study
Authors: Ganna Rozhnova
Mirjam E. Kretzschmar
Fiona van der Klis
Debbie van Baarle
Marjolein Korndewal
Ann C. Vossen
Michiel van Boven
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Vaccination
Published in: BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-020-01629-3

At a glance: The STEP trials

Springer Medicine

Short- and long-term impact of vaccination against cytomegalovirus: a modeling study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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