Design principles for TB vaccines’ clinical trials based on spreading dynamics

Abstract

Tuberculosis (TB) is one of the most complex diseases from the perspective of mathematical epidemiology. Individuals recently infected with the bacillus Mycobacterium tuberculosis can either develop TB directly in a matter of several weeks, or enter into an asymptomatic latent TB infection state (LTBI) that only occasionally derives into active disease, sometimes even decades after the infection event. The possible interruptions that a vaccine might provoke on these two mechanisms are indistinguishable in phase II clinical trials. In this work, we present a new methodology that allows differentiating vaccines that slow down the progression to disease from vaccines that prevent it. By introducing a stochastic framework for simulating synthetic clinical trials based on transmission models, we show how the method proposed here contributes both to reduce uncertainty in vaccine characterization and impact forecasts as well as to assist the design of clinical trials, improving their probabilities of success.