Fractional dose vaccination

From Wikipedia, the free encyclopedia

Fractional dose vaccination[1][2] is a strategy to reduce the dose of a vaccine to achieve a vaccination policy goal that is more difficult to achieve with conventional vaccination approaches, including deploying a vaccine faster in a pandemic,[3] reaching more individuals in the setting of limited healthcare budgets, or minimizing side effects due to the vaccine.

Fractional dose vaccination exploits the nonlinear dose-response characteristics of a vaccine: If two persons can be vaccinated instead of one, but each one gets 2/3 of the protective efficacy, there is a net benefit at society scale for reducing the number of infections. If the healthcare budget is limited or only a limited amount of vaccine is available during the early phase of a pandemic, this can make a difference for the total number of infections.

Fractional dose vaccination uses a fraction of the standard dose of a regular vaccine that is administered by the same, or an alternative route (often subcutaneously or intradermally).[4]

Fractional dose vaccination is used or proposed in a number of relevant infectious poverty diseases including yellow fever,[2] poliomyelitis,[5] COVID-19.[6]

Use[]

In the context of limited healthcare budgets[]

In yellow fever, fractional dose vaccination with 1/5 of the standard vaccine dose, administered intradermally, conferred protection for 10 years, as documented by a randomized clinical trial.[7]

In Poliomyelitis, fractional dose vaccination has been shown to be effective while reducing overal cost,[8] rendering polio vaccination available to more individuals.

In the Covid-19 pandemic[]

In a pandemic wave, fractional dose vaccination is considered to accelerate widespread access to vaccination when vaccine supply is limited:

In the COVID-19 pandemic, epidemiologic models predict a major benefit of personalized fractional dose vaccination strategies with certain vaccines in terms of case load, deaths, and shortening of the pandemic.[3][9]

To reduce side effects[]

In some segments of the population, disease risk is lower but specific vaccine side effect risks may be increased.[10] In such subpopulations, fractional dose vaccination might optimize the benefit-risk ratio of vaccination for an individuum and optimize the cost-benefit relation for society.

References[]

  1. ^ "Modelling epidemics with fractional-dose vaccination in response to limited vaccine supply". Journal of Theoretical Biology. 486: 110085. 2020-02-07. doi:10.1016/j.jtbi.2019.110085. ISSN 0022-5193.
  2. ^ a b Vannice, Kirsten; Wilder-Smith, Annelies; Hombach, Joachim (2018-08-16). "Fractional-Dose Yellow Fever Vaccination — Advancing the Evidence Base". New England Journal of Medicine. 379 (7): 603–605. doi:10.1056/NEJMp1803433. ISSN 0028-4793. PMID 29995585.
  3. ^ a b Hunziker, Patrick (2021-07-24). "Personalized-dose Covid-19 vaccination in a wave of virus Variants of Concern: Trading individual efficacy for societal benefit". Precision Nanomedicine. doi:10.33218/001c.26101. ISSN 2639-9431.
  4. ^ "Fractional dose of intradermal compared to intramuscular and subcutaneous vaccination - A systematic review and meta-analysis". Travel Medicine and Infectious Disease. 37: 101868. 2020-09-01. doi:10.1016/j.tmaid.2020.101868. ISSN 1477-8939. PMC 7474844.
  5. ^ Resik, Sonia; Tejeda, Alina; Sutter, Roland W.; Diaz, Manuel; Sarmiento, Luis; Alemañi, Nilda; Garcia, Gloria; Fonseca, Magilé; Hung, Lai Heng; Kahn, Anna-Lea; Burton, Anthony (2013-01-31). "Priming after a Fractional Dose of Inactivated Poliovirus Vaccine". New England Journal of Medicine. 368 (5): 416–424. doi:10.1056/NEJMoa1202541. ISSN 0028-4793. PMID 23363495.
  6. ^ Hunziker, Patrick (2021-03-07). "Vaccination strategies for minimizing loss of life in Covid-19 in a Europe lacking vaccines". medRxiv: 2021.01.29.21250747. doi:10.1101/2021.01.29.21250747.
  7. ^ Roukens, Anna H.E.; van Halem, Karlijn; de Visser, Adriëtte W.; Visser, Leo G. (2018-11-27). "Long-Term Protection After Fractional-Dose Yellow Fever Vaccination". Annals of Internal Medicine. 169 (11): 761. doi:10.7326/m18-1529. ISSN 0003-4819.
  8. ^ "Intradermal fractional dose inactivated polio vaccine: A review of the literature". Vaccine. 30 (2): 121–125. 2012-01-05. doi:10.1016/j.vaccine.2011.11.018. ISSN 0264-410X.
  9. ^ Hunziker, Patrick (2021-07-24). "Personalized-dose Covid-19 vaccination in a wave of virus Variants of Concern: Trading individual efficacy for societal benefit". Precision Nanomedicine. 4 (3): 805–820. doi:10.33218/001c.26101.
  10. ^ Wallace, Megan; Oliver, Sara (2021-06-23). "COVID-19 mRNA vaccines in adolescents and young adults: Benefit-risk discussion" (PDF).{{cite web}}: CS1 maint: url-status (link)
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