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Fisman D, Giglio N, Levin MJ, Nguyen VH, Pelton SI, Postma M, Ruiz-Aragón J, Urueña A, Mould-Quevedo JF. The economic rationale for cell-based influenza vaccines in children and adults: A review of cost-effectiveness analyses. Hum Vaccin Immunother 2024; 20:2351675. [PMID: 38835218 PMCID: PMC11155702 DOI: 10.1080/21645515.2024.2351675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Seasonal influenza significantly affects both health and economic costs in children and adults. This narrative review summarizes published cost-effectiveness analyses (CEAs) of cell-based influenza vaccines in children and adults <65 years of age, critically assesses the assumptions and approaches used in these analyses, and considers the role of cell-based influenza vaccines for children and adults. CEAs from multiple countries demonstrated the cost-effectiveness of cell-based quadrivalent influenza vaccines (QIVc) compared with egg-based trivalent/quadrivalent influenza vaccines (TIVe/QIVe). CEA findings were consistent across models relying on different relative vaccine effectiveness (rVE) estimate inputs, with the rVE of QIVc versus QIVe ranging from 8.1% to 36.2% in favor of QIVc. Across multiple scenarios and types of analyses, QIVc was consistently cost-effective compared with QIVe, including in children and adults across different regions of the world.
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Affiliation(s)
- David Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Norberto Giglio
- Servicio de Consultorios Externos de Pediatría. Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Myron J. Levin
- Departments of Pedatrics and Medicine, University of Colorado School of Medicine, Denver, Colorado, United States
| | | | - Stephen I. Pelton
- Department of Health Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Maarten Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Analia Urueña
- Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles, Universidad Isalud, Buenos Aires, Argentina
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Kommandantvold SA, Chang SC, Surinach A, Yau V, Best JH, Zaraket H, Zhou H, Frimpter J, Blanchet Zumofen MH. Cost-Effectiveness of Baloxavir Marboxil Versus Oseltamivir or no Treatment for the Management of Influenza in the United States. Infect Dis Ther 2024; 13:2071-2087. [PMID: 39150658 PMCID: PMC11343959 DOI: 10.1007/s40121-024-01027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION This study sought to evaluate the cost-effectiveness of baloxavir marboxil compared with oseltamivir or no antiviral treatment from a US payer perspective using data from a real-world US administrative claims study. Given baloxavir's ability to rapidly stop viral shedding, the potential health economic implications of a baloxavir-induced population-level reduction in viral transmission was also explored. METHODS A decision tree cost-effectiveness model was developed for seasonal influenza (2018-2020) using a lifetime time horizon with 3.0% discounting for costs and quality-adjusted life-years (QALYs). Patients aged ≥ 12 years could receive baloxavir, oseltamivir or no antiviral treatment. Patient characteristics, complications, and costs were derived from the Merative™ MarketScan® Research Databases including US commercial claims and Medicare and Medicaid Supplemental databases. A scenario analysis explored the impact of reduced viral transmission with baloxavir. RESULTS In the base case analysis, baloxavir was cost-effective within a willingness-to-pay threshold of US$100,000/QALY compared with oseltamivir [incremental cost-effectiveness ratio (ICER), $6813/QALY gained] or no antiviral treatment (ICER, $669/QALY gained). The net monetary benefit (NMB) of baloxavir was $1180 and $6208 compared with oseltamivir and no treatment, respectively. The NMB of baloxavir increased linearly with reductions in viral transmission, where a 5% transmission reduction yielded an NMB of $2592 versus oseltamivir and $7621 versus no treatment. Baloxavir became dominant (more effective and less costly, with ICERs < 0) starting with a 12.0% reduction in viral transmission versus oseltamivir and 6.0% versus no antiviral treatment. CONCLUSION Baloxavir was cost-effective compared with oseltamivir or no antiviral treatment. The potential of baloxavir to reduce viral transmission offers a substantial economic benefit from a US payer perspective.
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Affiliation(s)
| | | | | | | | | | | | - Hao Zhou
- Genentech Inc, South San Francisco, CA, USA
| | - Jeff Frimpter
- Health Interactions, an Inizio Company, San Francisco, CA, USA
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Vaghela S, Welch VL, Sinh A, Di Fusco M. Caregiver Burden among Patients with Influenza or Influenza-like Illness (ILI): A Systematic Literature Review. Healthcare (Basel) 2024; 12:1591. [PMID: 39201150 PMCID: PMC11353737 DOI: 10.3390/healthcare12161591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/27/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Influenza and influenza-like illness (ILI) pose significant clinical and economic burdens globally each year. This systematic literature review examined quantitative studies evaluating the impact of patients' influenza/ILI on their caregivers' well-being, focusing on health-related quality of life (HRQoL), work productivity, and activity impairment. A comprehensive search across six databases, including the Cochrane Database of Systematic Reviews, Embase, MEDLINE via PubMed, Ovid, PsycNet, and Web of Science, yielded 18,689 records, of which 13,156 abstracts were screened, and 662 full-text articles were reviewed from January 2007 to April 2024. Thirty-six studies [HRQoL: 2; productivity: 33; both: 1] covering 22 countries were included. Caregivers of 47,758 influenza or ILI patients across 123 study cohorts were assessed in the review. The mean workday loss among caregivers ranged from 0.5 to 10.7 days per episode, influenced by patients' influenza status (positive or negative), disease severity (mild or moderate-to-severe), age, viral type (influenza A or B), and vaccination/treatment usage. The HRQoL of caregivers, including their physical and emotional well-being, was affected by a patient's influenza or ILI, where the severity and duration of a patient's illness were associated with worse HRQoL. This review shows that the consequences of influenza or ILI significantly affect not only patients but also their caregivers.
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Affiliation(s)
- Shailja Vaghela
- HealthEcon Consulting, Inc., Ancaster, ON L9G 4L2, Canada; (S.V.)
| | | | - Anup Sinh
- HealthEcon Consulting, Inc., Ancaster, ON L9G 4L2, Canada; (S.V.)
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Chung E, Wang Y, Chow EJ, Emanuels A, Heimonen J, Ogokeh CE, Rolfes MA, Hughes JP, Uyeki TM, Starita LM, Hoag S, Boeckh M, Englund JA, Chu HY. Absenteeism and Health Behavior Trends Associated With Acute Respiratory Illness Before and During the COVID-19 Pandemic in a Community Household Cohort, King County, Washington. AJPM FOCUS 2024; 3:100248. [PMID: 39045125 PMCID: PMC11264170 DOI: 10.1016/j.focus.2024.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Introduction Longitudinal data on how acute respiratory illness (ARI) affects behavior, namely school or work participation, and nonpharmaceutical intervention (NPI) usage before and during the COVID-19 pandemic is limited. The authors assessed how ARIs and specific symptoms affected school, work, and health-related behaviors over time. Methods From November 2019 to June 2021, participating households with children in King County, Washington, were remotely monitored for ARI symptoms weekly. Following ARIs, participants reported illness-related effects on school, work, and NPI use. Using logistic regression with generalized estimating equations, the authors examined associations between symptoms and behaviors. Results Of 1,861 participants, 581 (31%) from 293 households reported 884 ARIs and completed one-week follow-up surveys. Compared with the prepandemic period, during the period of the pandemic pre-COVID-19 vaccine, ARI-related school (56% vs 10%, p<0.001) absenteeism decreased and masking increased (3% vs 28%, p<0.001). After vaccine authorization in December 2020, more ARIs resulted in masking (3% vs 48%, p<0.001), avoiding contact with non-household members (26% vs 58%, p<0.001), and staying home (37% vs 69%, p<0.001) compared with the prepandemic period. Constitutional symptoms such as fever were associated with work disruptions (OR=1.91; 95% CI=1.06, 3.43), staying home (OR=1.55; 95% CI=1.06, 2.27), and decreased contact with non-household members (OR=1.58; 95% CI=1.05, 2.36). Conclusions This remote household study permitted uninterrupted tracking of behavioral changes in families with children before and during the COVID-19 pandemic, identifying increased use of some NPIs when ill but no additional illness-associated work or school disruptions.
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Affiliation(s)
- Erin Chung
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Yongzhe Wang
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Eric J. Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
- Public Health - Seattle & King County, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Anne Emanuels
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Jessica Heimonen
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Constance E. Ogokeh
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Military and Health Research Foundation, Laurel, Maryland
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lea M. Starita
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
- Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Samara Hoag
- Student Health Services, Seattle Public Schools, Seattle, Washington
| | - Michael Boeckh
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Janet A. Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Seattle Flu Study Investigators
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
- Public Health - Seattle & King County, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Military and Health Research Foundation, Laurel, Maryland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
- Department of Genome Sciences, University of Washington, Seattle, Washington
- Student Health Services, Seattle Public Schools, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Alshiban NM, Aleyiydi MS, Nassar MS, Alhumaid NK, Almangour TA, Tawfik YM, Damiati LA, Almutairi AS, Tawfik EA. Epidemiologic and clinical updates on viral infections in Saudi Arabia. Saudi Pharm J 2024; 32:102126. [PMID: 38966679 PMCID: PMC11223122 DOI: 10.1016/j.jsps.2024.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
In the past two decades, the world has witnessed devastating pandemics affecting the global healthcare infrastructure and disrupting society and the economy worldwide. Among all pathogens, viruses play a critical role that is associated with outbreaks due to their wide range of species, involvement of animal hosts, easily transmitted to humans, and increased rates of infectivity. Viral disease outbreaks threaten public health globally due to the challenges associated with controlling and eradicating them. Implementing effective viral disease control programs starts with ongoing surveillance data collection and analyses to detect infectious disease trends and patterns, which is critical for maintaining public health. Viral disease control strategies include improved hygiene and sanitation facilities, eliminating arthropod vectors, vaccinations, and quarantine. The Saudi Ministry of Health (MOH) and the Public Health Authority (also known as Weqayah) in Saudi Arabia are responsible for public health surveillance to control and prevent infectious diseases. The notifiable viral diseases based on the Saudi MOH include hepatitis diseases, viral hemorrhagic fevers, respiratory viral diseases, exanthematous viral diseases, neurological viral diseases, and conjunctivitis. Monitoring trends and detecting changes in these viral diseases is essential to provide proper interventions, evaluate the established prevention programs, and develop better prevention strategies. Therefore, this review aims to highlight the epidemiological updates of the recently reported viral infections in Saudi Arabia and to provide insights into the recent clinical treatment and prevention strategies.
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Affiliation(s)
- Noura M. Alshiban
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Munirah S. Aleyiydi
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Majed S. Nassar
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Nada K. Alhumaid
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Thamer A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Yahya M.K. Tawfik
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Laila A. Damiati
- Department of Biological Sciences, College of Science, University of Jeddah, Jeddah 23218, Saudi Arabia
| | | | - Essam A. Tawfik
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
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Wu W, Alexander JS, Booth JL, Miller CA, Metcalf JP, Drevets DA. Influenza virus infection exacerbates gene expression related to neurocognitive dysfunction in brains of old mice. Immun Ageing 2024; 21:39. [PMID: 38907247 PMCID: PMC11191167 DOI: 10.1186/s12979-024-00447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Age > 65 years is a key risk factor for poor outcomes after human influenza infection. Specifically, in addition to respiratory disease, non-neurotropic influenza A virus (IAV) causes neuro-cognitive complications, e.g. new onset depression and increases the risk of dementia after hospitalization. This study aimed to identify potential mechanisms of these effects by determining differences between young and old mice in brain gene expression in a mouse model of non-neurotropic IAV infection. METHODS Young (12 weeks) and old (70 weeks) C57Bl/6J mice were inoculated intranasally with 200 PFU H1N1 A/PR/34/8 (PR8) or sterile PBS (mock). Gene expression in lung and brain was measured by qRT-PCR and normalized to β-actin. Findings were confirmed using the nCounter Mouse Neuroinflammation Array (NanoString) and analyzed with nSolver 4.0 and Ingenuity Pathway Analysis (IPA, Qiagen). RESULTS IAV PR8 did not invade the central nervous system. Young and old mice differed significantly in brain gene expression at baseline and during non-neurotropic IAV infection. Expression of brain Ifnl, Irf7, and Tnf mRNAs was upregulated over baseline control at 3 days post-infection (p.i.) only in young mice, but old mice expressed more Ifnl than young mice 7 days p.i. Gene arrays showed down-regulation of the Epigenetic Regulation, Insulin Signaling, and Neurons and Neurotransmission pathways in old mice 3 days p.i. while young mice demonstrated no change or induction of these pathways at the same time point. IPA revealed marked baseline differences between old and young mice. Gene expression related to Cognitive Impairment, Memory Deficits and Learning worsened in old mice relative to young mice during IAV infection. Aged mice demonstrate more severe changes in gene expression related to memory loss and cognitive dysfunction by IPA. CONCLUSIONS These data suggest the genes and pathways related to learning and cognitive performance that were worse at baseline in old mice were further worsened by IAV infection, similar to old patients. Early events in the brain triggered by IAV infection portend downstream neurocognitive pathology in old adults.
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Affiliation(s)
- Wenxin Wu
- Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Oklahoma Health Sciences Center, Room 425, RP1 800 N. Research Pkwy, Oklahoma City, OK, 73104, USA
| | - Jeremy S Alexander
- Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Oklahoma Health Sciences Center, Room 425, RP1 800 N. Research Pkwy, Oklahoma City, OK, 73104, USA
| | - J Leland Booth
- Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Oklahoma Health Sciences Center, Room 425, RP1 800 N. Research Pkwy, Oklahoma City, OK, 73104, USA
| | - Craig A Miller
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Oklahoma State University, Stillwater, OK, USA
| | - Jordan P Metcalf
- Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Oklahoma Health Sciences Center, Room 425, RP1 800 N. Research Pkwy, Oklahoma City, OK, 73104, USA.
- Veterans Affairs Medical Center, Oklahoma City, OK, USA.
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Douglas A Drevets
- Infectious Diseases, Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young, Suite 7300, Oklahoma City, OK, 73104, USA.
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Kommandantvold SA, Lemenuel-Diot A, Skedgel C, Pitman R, Rouse P, Zaraket H, Zhou H, Blanchet Zumofen MH. A cost-effectiveness analysis of reduced viral transmission with baloxavir marboxil versus oseltamivir or no treatment for seasonal and pandemic influenza management in the United Kingdom. Expert Rev Pharmacoecon Outcomes Res 2024:1-14. [PMID: 38850520 DOI: 10.1080/14737167.2024.2365421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/14/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Baloxavir marboxil is an oral, single-dose, cap-dependent endonuclease inhibitor that reduces the duration of influenza symptoms and rapidly stops viral shedding. We developed a susceptible, exposed, infected, recovered (SEIR) model to inform a cost-effectiveness model (CEM) of baloxavir versus oseltamivir or no antiviral treatment in the UK. RESEARCH DESIGN AND METHODS The SEIR model estimated the attack rates among otherwise healthy and high-risk individuals in seasonal and pandemic settings. The CEM assumed that a proportion of infected patients would receive antiviral treatment. Results were reported at the population level (per 10,000 at risk of infection). RESULTS The SEIR model estimated greater reductions in infections with baloxavir. In a seasonal setting, baloxavir provided incremental cost-effectiveness ratios (ICERs) of £1884 per quality-adjusted life-year (QALY) gained versus oseltamivir and a dominant cost-effectiveness position versus no antiviral treatment in the total population; ICERs of £2574/QALY versus oseltamivir and £128/QALY versus no antiviral treatment were seen in the high-risk population. Baloxavir was also cost-effective versus oseltamivir or no antiviral treatment and reduced population-level health system occupancy concerns during a pandemic. CONCLUSION Baloxavir treatment resulted in the fewest influenza cases and was cost-effective versus oseltamivir or no antiviral treatment from a UK National Health Service perspective.
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Affiliation(s)
| | | | | | | | | | | | - Hao Zhou
- Genentech Inc, South San Francisco, CA, USA
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Gärtner BC, Beier D, Gosch G, Wahle K, Wendt L, Förster LC, Schmidt KJ, Schwarz TF. Cell-based influenza vaccines: An effective vaccine option for under 60-year-olds. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc21. [PMID: 38766639 PMCID: PMC11099537 DOI: 10.3205/dgkh000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Aim Seasonal influenza poses a significant burden of disease, affecting not only older adults but also individuals under the age of 60. It carries a high economic burden, mainly driven by influenza-associated productivity losses in the working population. Conventional egg-based influenza vaccines may have reduced effectiveness due to antigen adaptation in eggs. In contrast, cell-based influenza vaccines are less likely to be affected by such antigen adaptation. This review aims to present real-world data (RWD) comparing the effectiveness of quadrivalent cell-based (QIVc) and egg-based (QIVe) influenza vaccines over three consecutive seasons. Methods A comprehensive review was conducted, analyzing RWD from retrospective cohort and case-control studies on the relative vaccine effectiveness (rVE) of QIVc versus QIVe during the 2017/18-2019/20 seasons. Results This study included six retrospective cohort studies and one case-control study, with a combined total of approximately 29 million participants. A cohort study involving people aged ≥4 years during the 2017/18 season showed a statistically significant rVE of QIVc compared to QIVe in preventing influenza-like illness, with a value of 36.2%. QIVc demonstrated statistically significant superiority over QIVe in preventing outpatient and inpatient medical encounters as observed in two cohort studies conducted during the 2018/19 and 2019/20 seasons. The rVE of QIVc compared to QIVe was found to be 7.6% in individuals aged ≥4 years and 9.5% in individuals aged ≥18 years. Three additional cohort studies conducted between 2017/18-2019/20 reported a statistically significant improvement in rVE (5.3-14.4%) of QIVc compared to QIVe in preventing influenza-related hospitalizations and emergency department visits due to influenza in individuals aged 4-64 years. In a case-control study across all three seasons, QIVc showed statistically significantly higher effectiveness compared to QIVe in preventing test-confirmed influenza, with rVEs of 10.0-14.8%. Conclusions RWD from the 2017/18-2019/20 seasons demonstrated that QIVc is more effective than QIVe in preventing influenza-related outcomes in individuals aged 4-64 years. Preferential use of cell-based influenza vaccines, as opposed to conventional egg-based vaccines, could reduce the burden of influenza-related symptoms on individuals and alleviate the economic impact on the German population under 60 years of age.
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Affiliation(s)
- Barbara C. Gärtner
- Institute for Medical Microbiology and Hygiene – Saarland University Hospital, Homburg/Saar, Germany
| | - Dietmar Beier
- Saxon Committee on Vaccinations (SIKO), Chemnitz, Germany
| | | | - Klaus Wahle
- Medical Faculty – University of Münster, Münster, Germany
| | | | | | | | - Tino F. Schwarz
- Institute of Laboratory Medicine and Vaccination Center – Klinikum Würzburg Mitte, Standort Juliusspital, Würzburg, Germany
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9
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Chen H, Xiao M. Seasonality of influenza-like illness and short-term forecasting model in Chongqing from 2010 to 2022. BMC Infect Dis 2024; 24:432. [PMID: 38654199 PMCID: PMC11036656 DOI: 10.1186/s12879-024-09301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Influenza-like illness (ILI) imposes a significant burden on patients, employers and society. However, there is no analysis and prediction at the hospital level in Chongqing. We aimed to characterize the seasonality of ILI, examine age heterogeneity in visits, and predict ILI peaks and assess whether they affect hospital operations. METHODS The multiplicative decomposition model was employed to decompose the trend and seasonality of ILI, and the Seasonal Auto-Regressive Integrated Moving Average with exogenous factors (SARIMAX) model was used for the trend and short-term prediction of ILI. We used Grid Search and Akaike information criterion (AIC) to calibrate and verify the optimal hyperparameters, and verified the residuals of the multiplicative decomposition and SARIMAX model, which are both white noise. RESULTS During the 12-year study period, ILI showed a continuous upward trend, peaking in winter (Dec. - Jan.) and a small spike in May-June in the 2-4-year-old high-risk group for severe disease. The mean length of stay (LOS) in ILI peaked around summer (about Aug.), and the LOS in the 0-1 and ≥ 65 years old severely high-risk group was more irregular than the others. We found some anomalies in the predictive analysis of the test set, which were basically consistent with the dynamic zero-COVID policy at the time. CONCLUSION The ILI patient visits showed a clear cyclical and seasonal pattern. ILI prevention and control activities can be conducted seasonally on an annual basis, and age heterogeneity should be considered in the health resource planning. Targeted immunization policies are essential to mitigate potential pandemic threats. The SARIMAX model has good short-term forecasting ability and accuracy. It can help explore the epidemiological characteristics of ILI and provide an early warning and decision-making basis for the allocation of medical resources related to ILI visits.
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Affiliation(s)
- Huayong Chen
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, 400016, Chongqing, P. R. China
| | - Mimi Xiao
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, 400016, Chongqing, P. R. China.
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Wagner GR, Michaels D. Work Matters: Mainstreaming Worker Health and Safety Is Not Limited to Pandemic Response. Am J Public Health 2024; 114:372-376. [PMID: 38359381 PMCID: PMC10937612 DOI: 10.2105/ajph.2023.307565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Gregory R Wagner
- Gregory R. Wagner is with the Harvard T. H. Chan School of Public Health, Boston, MA. David Michaels is with the George Washington University Milken Institute School of Public Health, Washington, DC
| | - David Michaels
- Gregory R. Wagner is with the Harvard T. H. Chan School of Public Health, Boston, MA. David Michaels is with the George Washington University Milken Institute School of Public Health, Washington, DC
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Gärtner BC, Beier D, Gosch G, Wahle K, Wendt L, Förster LC, Schmidt KJ, Schwarz TF. [Cell-based influenza vaccines: an effective vaccine option for under 60-year-olds]. Wien Klin Wochenschr 2024; 136:35-42. [PMID: 38393348 PMCID: PMC10891230 DOI: 10.1007/s00508-024-02327-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/25/2024]
Abstract
The population < 60 years of age is also affected by a significant disease burden from seasonal influenza. It carries a high economic burden, mainly driven by influenza-associated productivity losses in the working population. Conventional egg-based influenza vaccines may experience reduced effectiveness due to antigen adaptation in eggs. In contrast, cell-based influenza vaccines are less likely to be affected by antigenic adaptations to the host system and showed better effectiveness in individuals 4-64 years old over several seasons compared to conventional egg-based influenza vaccines under real-world conditions. Preferential use of cell-based influenza vaccines, as opposed to conventional egg-based vaccines, could reduce the burden of influenza-related symptoms on individuals and alleviate the economic impact on the German population < 60 years of age.
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Affiliation(s)
- Barbara C Gärtner
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | | | - Gunther Gosch
- Kinderarztpraxis am Domplatz, Magdeburg, Deutschland
| | - Klaus Wahle
- Medizinische Fakultät, Universität Münster, Münster, Deutschland
| | | | | | | | - Tino F Schwarz
- Institut für Labormedizin und Impfzentrum, Klinikum Würzburg Mitte, Standort Juliusspital, Salvatorstr. 7, 97074, Würzburg, Deutschland.
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12
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Tofan VC, Ermeneanu AL, Caraș I, Lenghel A, Ionescu IE, Țucureanu C, Gal C, Stăvaru CG, Onu A. Generation of a DSF-Guided Refolded Bacterially Expressed Hemagglutinin Ectodomain of Influenza Virus A/Puerto Rico/8/1934 H1N1 as a Model for Influenza Vaccine Antigens. Vaccines (Basel) 2023; 11:1520. [PMID: 37896924 PMCID: PMC10610769 DOI: 10.3390/vaccines11101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Influenza virus infections represent an ongoing public health threat as well as an economic burden. Although seasonal influenza vaccines have been available for some decades, efforts are being made to generate new efficient, flexible, and cost-effective technologies to be transferred into production. Our work describes the development of a model influenza hemagglutinin antigen that is capable of inducing protection against viral challenge in mice. High amounts of the H1 hemagglutinin ectodomain, HA18-528, were expressed in a bacterial system as insoluble inclusion bodies. Solubilization was followed by a thorough differential scanning fluorimetry (DSF)-guided optimization of refolding, which allows for fast and reliable screening of several refolding conditions, yielding tens of milligrams/L of folded protein. Structural and functional analysis revealed native-like folding as well as the presence of a mix of monomers and oligomers in solution. Mice immunized with HA18-528 were protected when exposed to influenza A virus as opposed to mice that received full-length denatured protein. Sera of mice immunized with HA18-528 showed both high titers of antigen-specific IgG1 and IgG2a isotypes as well as viral neutralization activity. These results prove the feasibility of the recombinant bacterial expression system coupled with DSF-guided refolding in providing influenza hemagglutinin for vaccine development.
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Affiliation(s)
- Vlad-Constantin Tofan
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Andreea-Laura Ermeneanu
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Iuliana Caraș
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Alina Lenghel
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Irina-Elena Ionescu
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Cătălin Țucureanu
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Claudiu Gal
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Crina-Georgeta Stăvaru
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
| | - Adrian Onu
- “Cantacuzino” Institute, 050096 Bucharest, Romania (I.C.); (I.-E.I.); (C.Ț.); (C.-G.S.); (A.O.)
- Faculty of Pharmacy, Titu Maiorescu University, 040317 Bucharest, Romania
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13
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Schütze S, Drevets DA, Tauber SC, Nau R. Septic encephalopathy in the elderly - biomarkers of potential clinical utility. Front Cell Neurosci 2023; 17:1238149. [PMID: 37744876 PMCID: PMC10512712 DOI: 10.3389/fncel.2023.1238149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Next to acute sickness behavior, septic encephalopathy is the most frequent involvement of the brain during infection. It is characterized by a cross-talk of pro-inflammatory cells across the blood-brain barrier, by microglial activation and leukocyte migration, but not by the entry of infecting organisms into the brain tissue. Septic encephalopathy is very frequent in older persons because of their limited cognitive reserve. The predominant clinical manifestation is delirium, whereas focal neurological signs and symptoms are absent. Electroencephalography is a very sensitive method to detect functional abnormalities, but these abnormalities are not specific for septic encephalopathy and of limited prognostic value. Routine cerebral imaging by computer tomography usually fails to visualize the subtle abnormalities produced by septic involvement of the brain. Magnetic resonance imaging is by far more sensitive to detect vasogenic edema, diffuse axonal injury or small ischemic lesions. Routine laboratory parameters most suitable to monitor sepsis, but not specific for septic encephalopathy, are C-reactive protein and procalcitonin. The additional measurement of interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor-α increases the accuracy to predict delirium and an unfavorable outcome. The most promising laboratory parameters to quantify neuronal and axonal injury caused by septic encephalopathy are neurofilament light chains (NfL) and S100B protein. Neuron-specific enolase (NSE) plasma concentrations are strongly influenced by hemolysis. We propose to determine NSE only in non-hemolytic plasma or serum samples for the estimation of outcome in septic encephalopathy.
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Affiliation(s)
- Sandra Schütze
- Department of Neuropathology, University Medicine Göttingen, Georg-August University Göttingen, Göttingen, Germany
- Department of Geriatrics, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
| | - Douglas A. Drevets
- Infectious Diseases, Department of Internal Medicine, University of Oklahoma HSC, Oklahoma City, OK, United States
| | - Simone C. Tauber
- Department of Neurology, University Medicine Aachen, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Roland Nau
- Department of Neuropathology, University Medicine Göttingen, Georg-August University Göttingen, Göttingen, Germany
- Department of Geriatrics Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
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