{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T17:07:54Z","timestamp":1778951274942,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,14]]},"group-title":"Public and Global Health","reference-count":26,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    Tuberculosis (TB) incidence in the United States has remained elevated above pre-pandemic levels since 2021, with over 85% of cases resulting from reactivation of\n                    <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                    (\n                    <jats:italic>Mtb<\/jats:italic>\n                    ) infection. New vaccines that would prevent TB in adults are under development, but the potential health impact of a program prioritizing non-U.S.-born persons and persons with medical comorbidities, including persons living with HIV (PLWH), has not been evaluated.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We developed a deterministic compartmental transmission model that simulates\n                    <jats:italic>Mtb<\/jats:italic>\n                    infection, transmission, and progression to TB in the U.S., both in the general population and in key high-risk groups. We calibrated the model to 2024 U.S. TB surveillance data and estimated annual cases prevented, percent reduction in annual TB cases, and number needed to vaccinate (NNV, a measure of vaccine program efficiency) at equilibrium conditions for targeted vaccination strategies under optimistic and plausible scenarios, varying assumptions of vaccine efficacy, duration of protection, and achieved vaccination coverage in high-risk groups.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Under an optimistic scenario, vaccinating PLWH, non-U.S.-born persons, and persons with medical comorbidities (all high-risk groups) prevented 5,385 cases per year (51\u00b78% reduction, NNV = 366). Under a more conservative plausible scenario, the same strategy prevented 1,348 cases per year (13\u00b70% reduction, NNV = 510). The efficiency and impact of targeting strategies we considered were preserved across all sensitivity and uncertainty analyses.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>\n                    Targeted vaccination of persons with\n                    <jats:italic>Mtb<\/jats:italic>\n                    infection in population subgroups recognized to be at high-risk for TB can reduce incidence substantially. Strategies that include non- U.S.-born persons and PLWH are most efficient and impactful.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>American Lung Association, U.S. National Institutes of Health, and the Ferguson Fellowship.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.11.26352914","type":"posted-content","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:20:26Z","timestamp":1778764826000},"source":"Crossref","is-referenced-by-count":0,"title":["Targeted Tuberculosis (TB) Vaccination Strategies in the United States: A Modeling Study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9961-1092","authenticated-orcid":false,"given":"Jessica E.","family":"Rothman","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth G.","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin A.","family":"Lopman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neel R.","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin N.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026051609400785000_2026.05.11.26352914v1.1","unstructured":"Centers for Disease Control and Prevention. Reported tuberculosis in the United States, 2024: National tuberculosis surveillance system. Technical report, U.S. Department of Health and Human Services, CDC, Atlanta, GA, 2024. 10,388 reported TB cases; calibration target."},{"key":"2026051609400785000_2026.05.11.26352914v1.2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv121"},{"key":"2026051609400785000_2026.05.11.26352914v1.3","unstructured":"Daniel E. Jonas , Sheila Riley , Leila Lee , et al. Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (US), 2023. URL http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK591768\/. Accessed July 3, 2024."},{"key":"2026051609400785000_2026.05.11.26352914v1.4","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001707"},{"key":"2026051609400785000_2026.05.11.26352914v1.5","doi-asserted-by":"publisher","DOI":"10.14745\/ccdr.v43i34a01"},{"issue":"8","key":"2026051609400785000_2026.05.11.26352914v1.6","first-page":"73","article-title":"Bcg vaccines: WHO position paper \u2013 February 2018","volume":"93","author":"World Health Organization","year":"2018","journal-title":"Weekly Epidemiological Record"},{"key":"2026051609400785000_2026.05.11.26352914v1.7","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.03154"},{"key":"2026051609400785000_2026.05.11.26352914v1.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1909953"},{"issue":"1","key":"2026051609400785000_2026.05.11.26352914v1.9","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12916-021-01932-7","article-title":"The epidemiologic impact and cost-effectiveness of new tuberculosis vaccines on multidrug-resistant tuberculosis in India and China","volume":"19","year":"2021","journal-title":"BMC Medicine"},{"key":"2026051609400785000_2026.05.11.26352914v1.10","unstructured":"World Health Organization. The end TB strategy: Global strategy and targets for tuberculosis prevention, care and control after 2015. Technical report, World Health Organization, Geneva, 2014. URL https:\/\/www.who.int\/publications\/i\/item\/WHO-HTM-TB-2015.19."},{"key":"2026051609400785000_2026.05.11.26352914v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00045-1"},{"key":"2026051609400785000_2026.05.11.26352914v1.12","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1404386111"},{"key":"2026051609400785000_2026.05.11.26352914v1.13","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aax4607"},{"key":"2026051609400785000_2026.05.11.26352914v1.14","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(24)00150-6"},{"key":"2026051609400785000_2026.05.11.26352914v1.15","first-page":"48","article-title":"Predicting the impact of novel tuberculosis vaccines in the United States and South Africa using a mathematical model","volume":"469","year":"2019","journal-title":"Journal of Theoretical Biology"},{"key":"2026051609400785000_2026.05.11.26352914v1.16","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268897007917"},{"key":"2026051609400785000_2026.05.11.26352914v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30134-8"},{"key":"2026051609400785000_2026.05.11.26352914v1.18","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir951"},{"key":"2026051609400785000_2026.05.11.26352914v1.19","unstructured":"U.S. Department of Homeland Security. 2023 yearbook of immigration statistics. Technical report, Office of Immigration Statistics, 2023. Emigration rate \u03b9 = 0.023\/yr for NUSB stratum."},{"key":"2026051609400785000_2026.05.11.26352914v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2017.05.005"},{"key":"2026051609400785000_2026.05.11.26352914v1.21","unstructured":"Centers for Disease Control and Prevention. Updated guidelines for testing for latent tuberculosis infection. Technical report, U.S. Department of Health and Human Services, 2020. Recommends LTBI screening for PLWH and other immunocompromised populations."},{"key":"2026051609400785000_2026.05.11.26352914v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtbi.2008.04.011"},{"key":"2026051609400785000_2026.05.11.26352914v1.23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153728"},{"key":"2026051609400785000_2026.05.11.26352914v1.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2003.11.052"},{"issue":"10","key":"2026051609400785000_2026.05.11.26352914v1.25","first-page":"1498","article-title":"Effectiveness of 13-valent pneumococcal conjugate vaccine against hospitalization for community-acquired pneumonia in older US adults","volume":"67","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2026051609400785000_2026.05.11.26352914v1.26","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30452-2"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.05.11.26352914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T16:40:13Z","timestamp":1778949613000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.05.11.26352914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":26,"URL":"https:\/\/doi.org\/10.64898\/2026.05.11.26352914","relation":{},"subject":[],"published":{"date-parts":[[2026,5,14]]},"subtype":"preprint"}}