{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:28:15Z","timestamp":1762918095595,"version":"3.37.3"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T00:00:00Z","timestamp":1595980800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1180199"],"award-info":[{"award-number":["OPP1180199"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Most vaccines in the Expanded Program on Immunization are universal childhood vaccines (eg, measles and rotavirus vaccines). Other vaccines such as typhoid conjugate (TCV) and Japanese encephalitis vaccines are risk based and only used in countries where populations are at risk of these diseases. However, strategies to introduce risk-based vaccines are becoming complex due to increasing intracountry variability in disease incidence. There is a need to assess whether subnational vaccine strategies are appropriate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Criteria, challenges, and benefits<\/jats:title>\n                  <jats:p>Subnational strategies consider intracountry heterogeneous risk and prioritize vaccination only in those areas that are at risk; there is no intent to introduce the vaccine nationally. The following variables should be considered to determine appropriateness of subnational strategies: disease burden, outbreak potential, treatment availability and costs, cost-effectiveness, and availability of other preventive interventions. We propose criteria for each variable and use a hypothetical country considering TCV introduction to show how criteria are applied to determine if a subnational strategy is appropriate. Challenges include granularity of disease-burden data, political challenges of vaccinating only a portion of a population, and potentially higher costs of introduction. Benefits include targeted reduction of disease burden, increased equity for marginalized populations, and progress on development goals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the absence of perfect information at the national level, adopting a subnational vaccine strategy can provide country decision makers with an alternative to national vaccine introduction. Given the changing nature of communicable disease burden, subnational vaccination may be a tool to effectively avert mortality and morbidity while maximizing the use of available health and financial resources.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa483","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T19:52:12Z","timestamp":1588189932000},"page":"S165-S171","source":"Crossref","is-referenced-by-count":3,"title":["Risk-based Vaccines and the Need for Risk-based Subnational Vaccination Strategies for Introduction"],"prefix":"10.1093","volume":"71","author":[{"given":"Farzana B","family":"Muhib","sequence":"first","affiliation":[{"name":"Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clint J","family":"Pecenka","sequence":"additional","affiliation":[{"name":"Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony A","family":"Marfin","sequence":"additional","affiliation":[{"name":"Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"key":"2020073002272361200_CIT0001","first-page":"59","article-title":"Expanded Programme on Immunization","volume":"41","author":"Keja","year":"1988","journal-title":"World Health Stat Q"},{"key":"2020073002272361200_CIT0002","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0140-6736(07)60107-X","article-title":"Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study","volume":"369","author":"Wolfson","year":"2007","journal-title":"Lancet"},{"author":"PATH","key":"2020073002272361200_CIT0003"},{"author":"PATH","key":"2020073002272361200_CIT0004"},{"author":"Malaria Atlas Project","key":"2020073002272361200_CIT0005"},{"key":"2020073002272361200_CIT0006","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/cid\/ciy938","article-title":"The importance of heterogeneity to the epidemiology of tuberculosis","volume":"69","author":"Trauer","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2020073002272361200_CIT0007","doi-asserted-by":"crossref","first-page":"E101","DOI":"10.1016\/S2214-109X(19)30456-5","article-title":"Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting","volume":"8:","author":"Bagamian","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2020073002272361200_CIT0008","article-title":"Pakistan rolls out new typhoid vaccine to fight resistant strain","author":"Shaikh","year":"2019","journal-title":"SciDev.Net"},{"key":"2020073002272361200_CIT0009","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.3201\/eid1007.030737","article-title":"Rapid assessment tool for Haemophilus influenzae type b disease in developing countries","volume":"10","author":"Feikin","year":"2004","journal-title":"Emerg Infect Dis"},{"key":"2020073002272361200_CIT0010","article-title":"A rapid epidemiological tool to measure the burden of norovirus infection and disease in resource-limited settings","volume":"4:ofx049","author":"Olson","year":"2017","journal-title":"Open Forum Infect Dis"},{"author":"Institute for Health Metrics and Evaluation","key":"2020073002272361200_CIT0011"},{"author":"World Health Organization","key":"2020073002272361200_CIT0012"},{"key":"2020073002272361200_CIT0013","doi-asserted-by":"crossref","first-page":"11","DOI":"10.15585\/mmwr.mm6801a3","article-title":"Emergence of extensively drug-resistant Salmonella typhi infections among travelers to or from Pakistan\u2014United States, 2016\u20132018","volume":"68","author":"Chatham-Stephens","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"author":"Sabin Vaccine Institute","key":"2020073002272361200_CIT0014"},{"key":"2020073002272361200_CIT0015","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.envres.2018.08.030","article-title":"Association between floods and typhoid fever in Yongzhou, China: effects and vulnerable groups","volume":"167","author":"Liu","year":"2018","journal-title":"Environ Res"},{"key":"2020073002272361200_CIT0016","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12889-016-4002-0","article-title":"A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January\u2013June 2015","volume":"17","author":"Kabwama","year":"2017","journal-title":"BMC Public Health"},{"key":"2020073002272361200_CIT0017","doi-asserted-by":"crossref","first-page":"44","DOI":"10.15585\/mmwr.mm6802a5","article-title":"Typhoid fever outbreak\u2014Harare, Zimbabwe, October 2017\u2013February 2018","volume":"68","author":"N\u2019cho","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020073002272361200_CIT0018","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.4269\/ajtmh.17-0778","article-title":"Exploring droughts and floods and their association with cholera outbreaks in sub-Saharan Africa: a register-based ecological study from 1990 to 2010","volume":"98","author":"Rieckmann","year":"2018","journal-title":"Am J Trop Med Hyg"},{"key":"2020073002272361200_CIT0019","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.trstmh.2008.04.023","article-title":"Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence","volume":"102","author":"Kiwanuka","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2020073002272361200_CIT0020","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1093\/heapol\/czr038","article-title":"Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries","volume":"27","author":"Jacobs","year":"2012","journal-title":"Health Policy Plan"},{"key":"2020073002272361200_CIT0021","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0140-6736(15)00725-4","article-title":"Public health impact and cost-effectiveness of the RTS,S\/AS01 malaria vaccine: a systematic comparison of predictions from four mathematical models","volume":"387","author":"Penny","year":"2016","journal-title":"Lancet"},{"key":"2020073002272361200_CIT0022","doi-asserted-by":"crossref","first-page":"100024","DOI":"10.1016\/j.jvacx.2019.100024","article-title":"Potential impact and cost-effectiveness of future ETEC and Shigella vaccines in 79 low- and lower middle-income countries","volume":"2","author":"Anderson","year":"2019","journal-title":"Vaccine X"},{"key":"2020073002272361200_CIT0023","doi-asserted-by":"crossref","first-page":"4425","DOI":"10.1016\/j.vaccine.2018.05.088","article-title":"Breaking the inertia in coverage: Mainstreaming under-utilized immunization strategies in the Middle East and North Africa region","volume":"36","author":"Sadr-Azodi","year":"2018","journal-title":"Vaccine"},{"key":"2020073002272361200_CIT0024","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.1093\/cid\/ciy1122","article-title":"A review of the economic evidence of typhoid fever and typhoid vaccines","volume":"68","author":"Luthra","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2020073002272361200_CIT0025","article-title":"Life-course vaccination can protect adults from infectious disease","author":"Privor-Dumm","year":"2019","journal-title":"STAT"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/71\/Supplement_2\/S165\/33546468\/ciaa483.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/71\/Supplement_2\/S165\/33546468\/ciaa483.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T06:28:01Z","timestamp":1596090481000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/71\/Supplement_2\/S165\/5877835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,9]]},"references-count":25,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2020,7,9]]},"published-print":{"date-parts":[[2020,7,29]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa483","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"type":"print","value":"1058-4838"},{"type":"electronic","value":"1537-6591"}],"subject":[],"published-other":{"date-parts":[[2020,8,15]]},"published":{"date-parts":[[2020,7,9]]}}}