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Risk-benefit analysis of the AstraZeneca COVID-19 vaccine in Australia using a Bayesian network modelling framework
Colleen L Lau; Helen J Mayfield; Jane E Sinclair; Sam J Brown; Michael Waller; Anoop K Enjeti; Andrew Baird; Kirsty R Short; Kerrie Mengersen; John Litt.
Afiliación
  • Colleen L Lau; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Helen J Mayfield; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Jane E Sinclair; School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, Australia
  • Sam J Brown; School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, Australia
  • Michael Waller; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Anoop K Enjeti; School Of Medicine and Public Health, University of Newcastle, Callaghan, NSW; Calvary Mater Newcastle Hospital, Waratah and NSW Health Pathology John Hunter Ho
  • Andrew Baird; St Kilda Medical Group, St Kilda, Victoria, Australia
  • Kirsty R Short; School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, Australia
  • Kerrie Mengersen; School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Queensland, Australia
  • John Litt; Discipline of General Practice, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Scientific Advisory Committee, Immunisation Coa
Preprint en En | PREPRINT-MEDRXIV | ID: ppmedrxiv-21264337
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ABSTRACT
Thrombosis and Thromobocytopenia Syndrome (TTS) has been associated with the AstraZencea (AZ) COVID-19 vaccine. Australia has reported low TTS incidence of <3/100,000 after the first dose, with case fatality rate (CFR) of 5-6%. Risk-benefit analysis of vaccination has been challenging because of rapidly evolving data, changing levels of transmission, and age-specific variation in rates of TTS, COVID-19, and CFR. We aim to optimise risk-benefit analysis by developing a model that enables inputs to be updated rapidly as evidence evolves. A Bayesian network was used to integrate local and international data, government reports, published literature and expert opinion. The model estimates probabilities of outcomes under different scenarios of age, sex, low/medium/high transmission (0.05%/0.45%/5.76% of population infected over 6 months), SARS-CoV-2 variant, vaccine doses, and vaccine effectiveness. We used the model to compare estimated deaths from vaccine-associated TTS with i) COVID-19 deaths prevented under different scenarios, and ii) deaths from COVID-19 related atypical severe blood clots (cerebral venous sinus thrombosis & portal vein thrombosis). For a million people aged [≥]70 years where 70% received first dose and 35% received two doses, our model estimated <1 death from TTS, 25 deaths prevented under low transmission, and >3000 deaths prevented under high transmission. Risks versus benefits varied significantly between age groups and transmission levels. Under high transmission, deaths prevented by AZ vaccine far exceed deaths from TTS (by 8 to >4500 times depending on age). Probability of dying from COVID-related atypical severe blood clots was 58-126 times higher (depending on age and sex) than dying from TTS. To our knowledge, this is the first example of the use of Bayesian networks for risk-benefit analysis for a COVID-19 vaccine. The model can be rapidly updated to incorporate new data, adapted for other countries, extended to other outcomes (e.g., severe disease), or used for other vaccines. HIGHLIGHTSO_LIAZ vaccination risk-benefit analysis must consider age/community transmission level C_LIO_LIAZ vaccine benefits far outweigh risks in older age groups and during high transmission C_LIO_LIAZ vaccine-associated TTS lower fatality than COVID-related atypical blood clots C_LIO_LIBayesian networks utility for risk-benefit analysis of rapidly evolving situations C_LIO_LIBNs allow integrating multiple data sources when large datasets are not available C_LI
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Texto completo: 1 Colección: 09-preprints Base de datos: PREPRINT-MEDRXIV Tipo de estudio: Experimental_studies / Observational_studies / Prognostic_studies / Rct Idioma: En Año: 2021 Tipo del documento: Preprint
Texto completo: 1 Colección: 09-preprints Base de datos: PREPRINT-MEDRXIV Tipo de estudio: Experimental_studies / Observational_studies / Prognostic_studies / Rct Idioma: En Año: 2021 Tipo del documento: Preprint