Decision Analysis Modeling Favors Optimal Influenza Vaccination in Late November or Early December
- 1Baylor College of Medicine
Abstract
BackgroundWaning vaccine protection and variable epidemic timing create a tradeoff between vaccinating before influenza circulation and preserving protection when disease burden is greatest. Existing guidance does not quantify the week that best balances this tradeoff.
ObjectiveTo estimate the optimal week for influenza vaccination while accounting for uncertainty in epidemic timing and vaccine protection.
DesignSimulation-based probabilistic decision analysis.
SettingUnited States outpatient influenza surveillance from the 50 states and District of Columbia during the 2010/11 through 2018/19 and 2023/24 through 2025/26 seasons.
ParticipantsPeople in the United States who would receive 1 influenza vaccine dose.
InterventionsVaccination during Morbidity and Mortality Weekly Report (MMWR) weeks 36 through 12.
MeasurementsWe combined influenza-like illness (ILI) syndromic surveillance and influenza-specific data with uncertainty in epidemic timing, initial vaccine effectiveness, waning, and immune-response lag. For each candidate week, the model estimated direct protection against outpatient surveillance burden.
ResultsThe primary model identified the optimal time to vaccinate as week 47, with weeks 47-48 being of similar utility. Our influenza-weighted outpatient analysis (ILI+) selected week 48. Compared with week 44, near the end of the current September-October guidance window, week 48 reduced modeled influenza-weighted outpatient burden by 50 visit equivalents per 10,000 weekly encounters.
LimitationsThe model assumed vaccination would occur, used outpatient surveillance burden rather than severe outcomes, and did not incorporate transmission effects.
ConclusionUnder the primary waning model, these findings favor vaccinating during weeks 47-48, approximately late November through early December, for most one-dose recipients.
Primary Funding SourceNone.
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BibTeX
@misc{meyer2026decision,
title = {{Decision Analysis Modeling Favors Optimal Influenza Vaccination in Late November or Early December}},
author = {A. G. Meyer and B. N. Rosales and S. Yang and M. Santillana},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.11.26362843},
url = {https://www.medrxiv.org/content/10.64898/2026.09.11.26362843v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Decision Analysis Modeling Favors Optimal Influenza Vaccination in Late November or Early December
AU - A. G. Meyer
AU - B. N. Rosales
AU - S. Yang
AU - M. Santillana
PY - 2026
DA - 2026/09/11
PB - medRxiv
DO - 10.64898/2026.09.11.26362843
UR - https://www.medrxiv.org/content/10.64898/2026.09.11.26362843v1
AB - BackgroundWaning vaccine protection and variable epidemic timing create a tradeoff between vaccinating before influenza circulation and preserving protection when disease burden is greatest. Existing guidance does not quantify the week that best balances this tradeoff. ObjectiveTo estimate the optimal week for influenza vaccination while accounting for uncertainty in epidemic timing and vaccine protection. DesignSimulation-based probabilistic decision analysis. SettingUnited States outpatient influenza surveillance from the 50 states and District of Columbia during the 2010/11 through 2018/19 and 2023/24 through 2025/26 seasons. ParticipantsPeople in the United States who would receive 1 influenza vaccine dose. InterventionsVaccination during Morbidity and Mortality Weekly Report (MMWR) weeks 36 through 12. MeasurementsWe combined influenza-like illness (ILI) syndromic surveillance and influenza-specific data with uncertainty in epidemic timing, initial vaccine effectiveness, waning, and immune-response lag. For each candidate week, the model estimated direct protection against outpatient surveillance burden. ResultsThe primary model identified the optimal time to vaccinate as week 47, with weeks 47-48 being of similar utility. Our influenza-weighted outpatient analysis (ILI+) selected week 48. Compared with week 44, near the end of the current September-October guidance window, week 48 reduced modeled influenza-weighted outpatient burden by 50 visit equivalents per 10,000 weekly encounters. LimitationsThe model assumed vaccination would occur, used outpatient surveillance burden rather than severe outcomes, and did not incorporate transmission effects. ConclusionUnder the primary waning model, these findings favor vaccinating during weeks 47-48, approximately late November through early December, for most one-dose recipients. Primary Funding SourceNone.
ER -