of averted COVID-19 cases and deaths attributable to reduced risk in vaccinated individuals in Japan Taishi Kayano,a Misaki Sasanami,a,1 Tetsuro Kobayashi,a,1 Yura K. Ko,b,1 Kanako Otani,b,1 Motoi Suzuki,b and Hiroshi Nishiura a* aKyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan bCenter for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo 162-8640, Japan Summary Background In Japan, vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initi- ated on 17 February 2021, mainly using messenger RNA vaccines and prioritizing health care professionals. Whereas nationwide vaccination alleviated the coronavirus disease 2019 (COVID-19)-related burden, the population impact has yet to be quantified in Japan. We aimed to estimate the numbers of COVID-19 cases and deaths pre- vented that were attributable to the reduced risk among vaccinated individuals via a statistical modeling framework. Methods We analyzed confirmed cases registered in the Health Center Real-time Information-sharing System on COVID-19 (3 March−30 November 2021) and publicly reported COVID-19-related deaths (24 March−30 November 2021). The vaccination coverage over this time course, classified by age and sex, was extracted from vaccine registra- tion systems. The total numbers of prevented cases and deaths were calculated by multiplying the daily risk differen- ces between unvaccinated and vaccinated individuals by the population size of vaccinated individuals. Findings For both cases and deaths, the averted numbers were estimated to be the highest among individuals aged 65 years and older. In total, we estimated that 564,596 (95% confidence interval: 477,020−657,525) COVID-19 cases and 18,622 (95% confidence interval: 6522−33,762) deaths associated with SARS-CoV-2 infection were prevented owing to vaccination during the analysis period (i.e., fifth epidemic wave, caused mainly by the Delta variant). Female individuals were more likely to be protected from infection following vaccination than male individuals whereas more deaths were prevented in male than in female individuals. Interpretation The vaccination program in Japan led to substantial reductions in the numbers of COVID-19 cases and deaths (33% and 67%, respectively). The preventive effect will be further amplified during future pandemic waves caused by variants with shared antigenicity. Funding This project was supported by the Japan Science and Technology Agency; the Japan Agency for Medical Research and Development; the Japan Society for the Promotion of Science; and the Ministry of Health, Labour and Welfare. Copyright Ó 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Keywords: Averted burden; COVID-19; Statistical model; Vaccination; Epidemiology; Direct effectiveness Introduction Shortly after the emergence of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), which causes coronavirus disease 2019 (COVID-19), the main interventions in 2020 were non-pharmaceutical, which are presently referred to as public health and social measures (PHSM). PHSM range from social distancing at a local level to widespread restrictions, such as lock- down policies, and have contributed to reducing virus transmission and buying time. However, these restric- tions have curbed people’s freedom and the adverse impact on social and economic activities has been sub- stantial.1−3 In this regard, vaccination has been a key player in epidemic control programs. The vaccine roll- out against COVID-19 was launched in December *Corresponding author at: School of Public Health, Kyoto Uni- versity, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. E-mail address:
[email protected] (H. Nishiura). 1 These authors contributed equally. The Lancet Regional Health - Western Pacific 2022;28: 100571 Published online 11 August 2022 https://doi.org/10.1016/j. lanwpc.2022.100571 www.thelancet.com Vol 28 November, 2022 1 Articles 感染症疫学の数理モデル計算に基づき 「新型コロナワクチンの接種により 死亡者が約18000人減少」 Kayano et al. (2022) https://doi.org/10.1016 /j.lanwpc.2022.100571 本日は主に統計的因果推論の話をベースにお話します