Short- and Long-term Impact of Vaccination against Cytomegalovirus: a Modeling Study
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.
Authors
Ganna Rozhnova: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; BioISI – Biosystems &Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal.
Mirjam E. Kretzschmar: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Fiona van der Klis: Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Debbie van Baarle: Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Marjolein J. Korndewal Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Ann C. Vossen: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
Michiel van Boven: Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Published: BMC Medicine, July 2nd, 2020
Keywords: Cytomegalovirus, CMV, Congenital CMV infection, Transmission model, Vaccination strategies, Hygiene intervention, CMV elimination, CMV disease burden
