Can self- or caregiver-administered nasal spray influenza vaccination improve outcomes? An agent-based model using the Framework for Reconstructing Epidemiological Dynamics (FRED)

Abstract Newly licensed self- or caregiver-administered nasal spray live attenuated influenza vaccine (LAIV), available to order for home delivery, may improve vaccine coverage (VC) among adults aged 18–49 overall, as well those in this age group who live in households with school-aged children. Using the agent-based Framework for Reproducing Epidemiological Dynamics (FRED), which simulates influenza transmission in U.S. census-based populations with defined household structures, we modeled the impact of: 1) 5-15% increases VC among those ages 18-49 through self-administration and 2) household-based strategies for ages 5–17 and 18–49 that may occur from home LAIV orders. Household strategies included: vaccinating children aged 5–17 followed by their 18–49-year-old HH (Kids+HH), and vaccinating children aged 5–17 and all household adults aged 18–49 (Kids+Adults). A 5%-15% VC increase in adults aged 18–49 reduced symptomatic cases in all adults by up to 10%. Among household strategies, Kids+Adults yielded a higher VC increase (9.2%) and greater reduction in symptomatic cases (5.7%) among adults ≥18 than the Kids +HH strategy. The convenience of self-administration and household-based LAIV strategies in homes with school-age children may enhance adult VC and reduce influenza burden.