The role of a hepatitis C virus vaccine: modelling the benefits alongside direct-acting antiviral treatments

• DOI: 10.1186/s12916-015-0440-2
• Publication Date: 2015-08-18T11:51:21Z
• Authors: Nick Scott; Emma McBryde; Peter Vickerman; Natasha K. Martin; Jack Stone; Heidi Drummer; Margaret Hellard
• Keywords: 0301 basic medicine; Biomedical and clinical sciences; Hepacivirus; Medical and Health Sciences; Hepatitis; Substance Misuse; Theoretical; Models; Prevalence; Chronic; Non-U.S. Gov't; Substance Abuse, Intravenous; 360; Medicine(all); Liver Disease; Research Support, Non-U.S. Gov't; Vaccination; Substance Abuse; Health Care Costs; Hepatitis C; 3. Good health; Infectious Diseases; 3.4 Vaccines; Medical Microbiology; 6.1 Pharmaceuticals; Infection; Intravenous; Biotechnology; Research Article; Viral Hepatitis Vaccines; Chronic Liver Disease and Cirrhosis; 610; Research Support; Antiviral Agents; N.I.H.; Vaccine Related; 03 medical and health sciences; Hepatitis - C; Research Support, N.I.H., Extramural; General & Internal Medicine; 616; Journal Article; Humans; Biomedical and Clinical Sciences; Prevention; Extramural; Health sciences; Hepatitis C, Chronic; Models, Theoretical; Emerging Infectious Diseases; Good Health and Well Being; Immunization; Digestive Diseases; Drug Abuse (NIDA only)

Hepatitis C virus (HCV) elimination is being seriously considered globally. Current elimination models require a combination of highly effective HCV treatment and harm reduction, but high treatment costs make such strategies prohibitively expensive. Vaccines should play a key role in elimination but their best use alongside treatments is unclear. For three vaccines with different efficacies we used a mathematical model to estimate the additional reduction in HCV prevalence when vaccinating after treatment; and to identify in which settings vaccines could most effectively reduce the number of treatments required to achieve fixed reductions in HCV prevalence among people who inject drugs (PWID).A deterministic model of HCV transmission among PWID was calibrated for settings with 25, 50 and 75% chronic HCV prevalence among PWID, stratified by high-risk or low-risk PWID. For vaccines with 30, 60 or 90% efficacies, different rates of treatment and vaccination were introduced. We compared prevalence reductions achieved by vaccinating after treatment to prevent reinfection and vaccinating independently of treatment history in the community; and by allocating treatments and vaccinations to specific risk groups and proportionally across risk groups.Vaccinating after treatment was minimally different to vaccinating independently of treatment history, and allocating treatments and vaccinations to specific risk groups was minimally different to allocating them proportionally across risk groups. Vaccines with 30 or 60% efficacy provided greater additional prevalence reduction per vaccination in a setting with 75% chronic HCV prevalence among PWID than a 90% efficacious vaccine in settings with 25 or 50% chronic HCV prevalence among PWID.Vaccinating after treatment is an effective and practical method of administration. In settings with high chronic HCV prevalence among PWID, even modest coverage with a low-efficacy vaccine could provide significant additional prevalence reduction beyond treatment alone, and would likely reduce the cost of achieving prevalence reduction targets.