Targeted Tuberculosis (TB) Vaccination Strategies in the United States: A Modeling Study

Area of Science:

• Epidemiology
• Infectious Disease Modeling
• Public Health Interventions

Background:

• Tuberculosis (TB) incidence in the U.S. remains high, with most cases stemming from latent Mycobacterium tuberculosis (Mtb) infection reactivation.
• New TB vaccines are in development, but their impact on high-risk populations like non-U.S.-born individuals and people with HIV (PLWH) is unevaluated.

Purpose of the Study:

• To evaluate the potential health impact and efficiency of targeted TB vaccination strategies in the U.S.
• To assess the effectiveness of prioritizing vaccination in specific high-risk subgroups.

Main Methods:

• Developed a deterministic compartmental transmission model for Mtb infection, transmission, and TB progression in the U.S.
• Calibrated the model using 2024 U.S. TB surveillance data.
• Estimated cases prevented, percentage reduction, and number needed to vaccinate (NNV) for various targeted vaccination scenarios.

Main Results:

• An optimistic scenario (vaccinating PLWH, non-U.S.-born, and those with comorbidities) prevented 5,385 cases annually (51.8% reduction, NNV=366).
• A plausible scenario yielded 1,348 cases prevented annually (13.0% reduction, NNV=510).
• Targeting strategies showed consistent efficiency and impact across sensitivity analyses.

Conclusions:

• Targeted vaccination in high-risk subgroups can substantially reduce TB incidence.
• Vaccination strategies incorporating non-U.S.-born persons and PLWH are the most impactful and efficient.