Impact of Targeted Tuberculosis Vaccination Among a Mining Population in South Africa: A Model-Based Study

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Abstract
Optimizing the use of new tools, such as vaccines, may play a crucial role in reaching global targets for tuberculosis (TB) control. Some of the most promising candidate vaccines target adults, although high-coverage mass vaccinations may be logistically more challenging among this population than among children. Vaccine-delivery strategies that target high-risk groups or settings might yield proportionally greater impact than do those that target the general population. We developed an individual-based TB transmission model representing a hypothetical population consisting of people who worked in South African gold mines or lived in associated labor-sending communities. We simulated the implementation of a postinfection adult vaccine with 60% efficacy and a mean effect duration of 10 years. We then compared the impact of a mine-targeted vaccination strategy, in which miners were vaccinated while in the mines, with that of a community-targeted strategy, in which random individuals within the labor-sending communities were vaccinated. Mine-targeted vaccination averted an estimated 0.37 TB cases per vaccine dose compared with 0.25 for community-targeted vaccination, for a relative efficacy of 1.46 (95% range, 1.13–1.91). The added benefit of mine-targeted vaccination primarily reflected the disproportionate demographic burden of TB among the population of adult males as a whole. As novel vaccines for TB are developed, venue-based vaccine delivery that targets high-risk demographic groups may improve both vaccine feasibility and the impact on transmission.
Funding Information
  • Aeras Foundation
  • United Kingdom Medical Research Council (MRC)
  • United Kingdom Department for International Development (DFID)
  • European Union (MR/P002404/1)
  • Bill and Melinda Gates Foundation (OPP1084276, OPP1135288, OPP1110334, OPP1137034, OPP1160830)
  • Unitaid (4214-LSHTM-Sept15, PO 8477-0-600)

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