---
title: "Targeted tuberculosis vaccination strategies in the United States: modeling impact on adult TB cas"
id: "pubmed-42771941"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42771941"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42771941/"
doi: "10.1016/j.vaccine.2026.129174"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Targeted tuberculosis vaccination strategies in the United States: modeling impact on adult TB cas
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42771941
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42771941/)
- **DOI:** [10.1016/j.vaccine.2026.129174](https://doi.org/10.1016%2Fj.vaccine.2026.129174)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Investigators developed a deterministic compartmental transmission model simulating **Mycobacterium tuberculosis (Mtb)** infection, transmission, and progression to tuberculosis (TB) in the United States. - The model stratified the population into four risk groups; the source did not detail those group definitions beyond naming high-risk sets. - Calibration used 2024 U.S. TB surveillance data, according to the article abstract. - Outcomes estimated included annual cases prevented, percent reduction in TB cases, and number needed to vaccinate (NNV). - Two principal scenarios were evaluated: an optimistic scenario and a conservative scenario; the abstract reports varying vaccine efficacy, duration of protection, and coverage but does not specify exact parameter values. - Under the optimistic scenario, vaccinating all high-risk adults (persons living with HIV, non-U.S.-born persons, and persons with medical comorbidities) prevented 5,385 cases per year, a 51.8% reduction (95% UI: 35.2–66.8), with an NNV of 366. - Under the conservative scenario, the same strategy prevented 1,348 cases per year, a 13.0% reduction (95% UI: 6.4–19.8), with an NNV of 510. - The study team reported that strategy rankings were preserved across sensitivity and uncertainty analyses. - Authors concluded that targeted adult vaccination can substantially reduce U.S. TB incidence and that strategies including **non-U.S.-born persons** and **PLWH** were both most efficient and most impactful. - The abstract did not provide specific vaccine product names, dosing regimens, age cutoffs, exact model equations, or numeric coverage assumptions; those methodological specifics were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 22. # Targeted tuberculosis vaccination strategies in the United States: A modeling study [Jessica E Rothman](https://pubmed.ncbi.nlm.nih.gov/?term=Rothman+JE&cauthor_id=42771941)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#full-view-affiliation-1 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. Electronic address: jessica.e.rothman@gmail.com."), [Kenneth G Castro](https://pubmed.ncbi.nlm.nih.gov/?term=Castro+KG&cauthor_id=42771941)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#full-view-affiliation-2 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA."), [Benjamin A Lopman](https://pubmed.ncbi.nlm.nih.gov/?term=Lopman+BA&cauthor_id=42771941)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#full-view-affiliation-2 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA."), [Neel R Gandhi](https://pubmed.ncbi.nlm.nih.gov/?term=Gandhi+NR&cauthor_id=42771941)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#full-view-affiliation-2 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA."), [Kristin N Nelson](https://pubmed.ncbi.nlm.nih.gov/?term=Nelson+KN&cauthor_id=42771941)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#full-view-affiliation-3 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.") Affiliations Expand ### Affiliations * 1 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. Electronic address: jessica.e.rothman@gmail.com. * 2 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. * 3 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. * PMID: **42771941** * DOI: [ 10.1016/j.vaccine.2026.129174 ](https://doi.org/10.1016/j.vaccine.2026.129174) Item in Clipboard # Targeted tuberculosis vaccination strategies in the United States: A modeling study Jessica E Rothman et al. Vaccine. 2026. Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) . 2026 Oct 24:92:129174. doi: 10.1016/j.vaccine.2026.129174. Epub 2026 Sep 22. ### Authors [Jessica E Rothman](https://pubmed.ncbi.nlm.nih.gov/?term=Rothman+JE&cauthor_id=42771941)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#short-view-affiliation-1 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. Electronic address: jessica.e.rothman@gmail.com."), [Kenneth G Castro](https://pubmed.ncbi.nlm.nih.gov/?term=Castro+KG&cauthor_id=42771941)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#short-view-affiliation-2 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA."), [Benjamin A Lopman](https://pubmed.ncbi.nlm.nih.gov/?term=Lopman+BA&cauthor_id=42771941)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#short-view-affiliation-2 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA."), [Neel R Gandhi](https://pubmed.ncbi.nlm.nih.gov/?term=Gandhi+NR&cauthor_id=42771941)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#short-view-affiliation-2 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA."), [Kristin N Nelson](https://pubmed.ncbi.nlm.nih.gov/?term=Nelson+KN&cauthor_id=42771941)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42771941/#short-view-affiliation-3 "Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.") ### Affiliations * 1 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. Electronic address: jessica.e.rothman@gmail.com. * 2 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. * 3 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. * PMID: **42771941** * DOI: [ 10.1016/j.vaccine.2026.129174 ](https://doi.org/10.1016/j.vaccine.2026.129174) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** 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 Mycobacterium tuberculosis (Mtb) 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. **Methods:** We developed a deterministic compartmental transmission model that simulates Mtb infection, transmission, and progression to TB in the U.S., stratified into four risk groups. We calibrated the model to 2024 U.S. TB surveillance data and estimated annual cases prevented, percent reduction in TB cases, and number needed to vaccinate (NNV) for targeted vaccination strategies under optimistic and conservative scenarios, varying vaccine efficacy, duration of protection, and vaccination coverage. **Results:** Under an optimistic scenario, vaccinating all high-risk groups (PLWH, non-U.S.-born persons, and persons with medical comorbidities) prevented 5385 cases per year (51.8% reduction, 95% UI: 35.2-66.8, NNV = 366). Under a conservative scenario, the same strategy prevented 1348 cases per year (13.0% reduction, 95% UI: 6.4-19.8, NNV = 510). Strategy rankings were preserved across all sensitivity and uncertainty analyses. **Conclusions:** Targeted vaccination of adults at high risk of progression from Mtb infection to TB disease can reduce U.S. TB incidence substantially. Strategies that include non-U.S.-born persons and PLWH are most efficient and impactful. Copyright © 2026 Elsevier Ltd. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Update of * [ Targeted Tuberculosis (TB) Vaccination Strategies in the United States: A Modeling Study. ](https://pubmed.ncbi.nlm.nih.gov/42180358/) Rothman JE, Castro KG, Lopman BA, Gandhi NR, Nelson KN. Rothman JE, et al. medRxiv [Preprint]. 2026 May 14:2026.05.11.26352914. doi: 10.64898/2026.05.11.26352914. medRxiv. 2026. Update in: [Vaccine. 2026 Oct 24;92:129174. doi: 10.1016/j.vaccine.2026.129174.](https://pubmed.ncbi.nlm.nih.gov/42771941/) PMID: 42180358 Free PMC article. Updated. Preprint. ## Similar articles * [ Age-targeted tuberculosis vaccination in China and implications for vaccine development: a modelling study. ](https://pubmed.ncbi.nlm.nih.gov/30630775/) Harris RC, Sumner T, Knight GM, Evans T, Cardenas V, Chen C, White RG.Harris RC, et al.Lancet Glob Health. 2019 Feb;7(2):e209-e218. doi: 10.1016/S2214-109X(18)30452-2. Epub 2019 Jan 7.Lancet Glob Health. 2019.PMID: 30630775 * [ Tuberculosis. ](https://pubmed.ncbi.nlm.nih.gov/30212088/) Bloom BR, Atun R, Cohen T, Dye C, Fraser H, Gomez GB, Knight G, Murray M, Nardell E, Rubin E, Salomon J, Vassall A, Volchenkov G, White R, Wilson D, Yadav P.Bloom BR, et al.In: Holmes KK, Bertozzi S, Bloom BR, Jha P, editors. Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 11.In: Holmes KK, Bertozzi S, Bloom BR, Jha P, editors. Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 11.PMID: 30212088Free Books & Documents.Review. * [ CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors--United States, 2005-2013. ](https://pubmed.ncbi.nlm.nih.gov/25356673/) Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA; Centers for Disease Control and Prevention (CDC).Johnson NB, et al.MMWR Suppl. 2014 Oct 31;63(4):3-27.MMWR Suppl. 2014.PMID: 25356673 * [ Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance - National Tuberculosis Indicators Project, 2016-2022. ](https://pubmed.ncbi.nlm.nih.gov/38833409/) Woodruff R, Pratt R, Kolasa M.Woodruff R, et al.MMWR Surveill Summ. 2024 Jun 6;73(4):1-18. doi: 10.15585/mmwr.ss7304a1.MMWR Surveill Summ. 2024.PMID: 38833409Free PMC article. * [ The role of BCG vaccine in the prevention and control of tuberculosis in the United States. A joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices. ](https://pubmed.ncbi.nlm.nih.gov/8602127/) [No authors listed][No authors listed]MMWR Recomm Rep. 1996 Apr 26;45(RR-4):1-18.MMWR Recomm Rep. 1996.PMID: 8602127 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42771941) ## MeSH terms * Adult Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adult%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adult) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * HIV Infections / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22HIV+Infections%2Fcomplications%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=HIV+Infections) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * Incidence Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Incidence%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Incidence) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * Mycobacterium tuberculosis / immunology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Mycobacterium+tuberculosis%2Fimmunology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Mycobacterium+tuberculosis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * Tuberculosis Vaccines* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tuberculosis+Vaccines%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Tuberculosis+Vaccines) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * Tuberculosis Vaccines* / immunology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tuberculosis+Vaccines%2Fimmunology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Tuberculosis+Vaccines) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42771941/) * Tuberculosis* / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tuberculosis%2Fepi
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