The potential impact of a vaccine on Neisseria gonorrhoeae prevalence among heterosexuals living in a high prevalence setting

• Published in: Vaccine Vol. 41; no. 38; pp. 5553 - 5561
• Main Authors: Padeniya, Thilini N., Hui, Ben B., Wood, James G., Seib, Kate L., Regan, David G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 31-08-2023; Elsevier Limited
• Subjects: Age; Antimicrobial resistance; Asymptomatic; Calibration; Compartmental model; Condoms; Disease transmission; Effectiveness; Females; Gonorrhea; Gonorrhoea; Gonorrhoea vaccine; Heterosexuality; Immunization; Infections; Mathematical analysis; Mathematical model; Mathematical models; Neisseria gonorrhoeae; Sexual behavior; Sexually transmitted diseases; Sexually transmitted infection; STD; Vaccine efficacy; Vaccines; Womens health; South Africa; Sexually transmitted infection; Gonorrhoea vaccine; Compartmental model; Neisseria gonorrhoeae; Gonorrhoea; Mathematical model
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2023.07.048

Treatment of Neisseria gonorrhoeae is under threat with the emergence and spread of antimicrobial resistance. Thus, there is a growing interest in the development of a gonorrhoea vaccine. We used mathematical modelling to assess the impact of a hypothetical vaccine in controlling gonorrhoea among heterosexuals living in a setting of relatively high N. gonorrhoeae prevalence (∼3 %).
We developed a mathematical model of N. gonorrhoeae transmission among 15–49-year-old heterosexuals, stratified by age and sex, and calibrated to prevalence and sexual behaviour data from South Africa as an example of a high prevalence setting for which we have data available. Using this model, we assessed the potential impact of a vaccine on N. gonorrhoeae prevalence in the entire population. We considered gonorrhoea vaccines having differing impacts on N. gonorrhoeae infection and transmission and offered to different age-groups.
The model predicts that N. gonorrhoeae prevalence can be reduced by ∼50 % in 10 years following introduction of a vaccine if annual vaccination uptake is 10 %, vaccine efficacy against acquisition of infection is 25 % and duration of protection is 5 years, with vaccination available to the entire population of 15–49-year-olds. If only 15–24-year-olds are vaccinated, the predicted reduction in prevalence in the entire population is 25 % with equivalent vaccine characteristics and uptake. Although predicted reductions in prevalence for vaccination programmes targeting only high-activity individuals and the entire population are similar over the same period, vaccinating only high-activity individuals is more efficient as the cumulative number of vaccinations needed to reduce prevalence in the entire population by 50 % is ∼3 times lower for this programme.
Provision of a gonorrhoea vaccine could lead to substantial reductions in N. gonorrhoeae prevalence in a high prevalence heterosexual setting, even with moderate annual vaccination uptake of a vaccine with partial efficacy.