1
|
Van Heuverswyn J, Hallmaier-Wacker LK, Beauté J, Gomes Dias J, Haussig JM, Busch K, Kerlik J, Markowicz M, Mäkelä H, Nygren TM, Orlíková H, Socan M, Zbrzeźniak J, Žygutiene M, Gossner CM. Spatiotemporal spread of tick-borne encephalitis in the EU/EEA, 2012 to 2020. Euro Surveill 2023; 28:2200543. [PMID: 36927718 PMCID: PMC10021474 DOI: 10.2807/1560-7917.es.2023.28.11.2200543] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BackgroundTick-borne encephalitis (TBE) is a vaccine-preventable disease involving the central nervous system. TBE became a notifiable disease on the EU/EEA level in 2012.AimWe aimed to provide an updated epidemiological assessment of TBE in the EU/EEA, focusing on spatiotemporal changes.MethodsWe performed a descriptive analysis of case characteristics, time and location using data of human TBE cases reported by EU/EEA countries to the European Centre for Disease Prevention and Control with disease onset in 2012-2020. We analysed data at EU/EEA, national, and subnational levels and calculated notification rates using Eurostat population data. Regression models were used for temporal analysis.ResultsFrom 2012 to 2020, 19 countries reported 29,974 TBE cases, of which 24,629 (98.6%) were autochthonous. Czechia, Germany and Lithuania reported 52.9% of all cases. The highest notification rates were recorded in Lithuania, Latvia, and Estonia (16.2, 9.5 and 7.5 cases/100,000 population, respectively). Fifty regions from 10 countries, had a notification rate ≥ 5/100,000. There was an increasing trend in number of cases during the study period with an estimated 0.053 additional TBE cases every week. In 2020, 11.5% more TBE cases were reported than predicted based on data from 2016 to 2019. A geographical spread of cases was observed, particularly in regions situated north-west of known endemic regions.ConclusionA close monitoring of ongoing changes to the TBE epidemiological situation in Europe can support the timely adaption of vaccination recommendations. Further analyses to identify populations and geographical areas where vaccination programmes can be of benefit are needed.
Collapse
Affiliation(s)
| | | | - Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana Gomes Dias
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Jana Kerlik
- Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia
| | | | - Henna Mäkelä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Hana Orlíková
- National Institute of Public Health, Prague, Czechia
| | - Maja Socan
- National Institute of Public Health, Ljubljana, Slovenia
| | - Jakub Zbrzeźniak
- National Institute of Public Health - NIH - National Research Institute, Warsaw, Poland
| | - Milda Žygutiene
- National Public Health Center under the Ministry of Health, Vilnius, Lithuania
| | - Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| |
Collapse
|
2
|
Vaccination against Tick-Borne Encephalitis (TBE) in Italy: Still a Long Way to Go. Microorganisms 2022; 10:microorganisms10020464. [PMID: 35208918 PMCID: PMC8880353 DOI: 10.3390/microorganisms10020464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Tick-borne encephalitis (TBE) is endemic in several European countries, and its incidence has recently increased. Various factors may explain this phenomenon: social factors (changes in human behavior, duration and type of leisure activities and increased tourism in European high-risk areas), ecological factors (e.g., effects of climate change on the tick population and reservoir animals), and technological factors (improved diagnostics, increased medical awareness). Furthermore, the real burden of TBE is not completely known, as the performance of surveillance systems is suboptimal and cases of disease are under-reported in several areas. Given the potentially severe clinical course of the disease, the absence of any antiviral therapy, and the impossibility of interrupting the transmission of the virus in nature, vaccination is the mainstay of prevention and control. TBE vaccines are effective (protective effect of approximately 95% after completion of the basic vaccination—three doses) and well tolerated. However, their uptake in endemic areas is suboptimal. In the main endemic countries where vaccination is included in the national/regional immunization program (with reimbursed vaccination programs), this decision was driven by a cost-effectiveness assessment (CEA), which is a helpful tool in the decision-making process. All CEA studies conducted have demonstrated the cost-effectiveness of TBE vaccination. Unfortunately, CEA is still lacking in many endemic countries, including Italy. In the future, it will be necessary to fill this gap in order to introduce an effective vaccination strategy in endemic areas. Finally, raising awareness of TBE, its consequences and the benefit of vaccination is critical in order to increase vaccination coverage and reduce the burden of the disease.
Collapse
|
3
|
Zavadska D, Odzelevica Z, Karelis G, Liepina L, Litauniece ZA, Bormane A, Lucenko I, Perevoscikovs J, Bridina L, Veide L, Krumina A, Storozenko J, Erber W, Htar MTT, Schmitt HJ. Tick-borne encephalitis: A 43-year summary of epidemiological and clinical data from Latvia (1973 to 2016). PLoS One 2018; 13:e0204844. [PMID: 30422984 PMCID: PMC6233910 DOI: 10.1371/journal.pone.0204844] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023] Open
Abstract
Background The incidence of tick-borne encephalitis (TBE) varies significantly over time. To better understand the annual incidence of all TBE cases in Latvia we investigated the disease burden in the country from 1973–2016 using several available sources and case definitions. Methods We identified cases of TBE from an electronic database (maintained by the Centre for Disease Prevention and Control of Latvia [CDPC]) by the use of ICD-10 diagnosis codes for TBE (A84; A84.0; A84.1; A84.8; A84.9). In addition, previously unreported TBE cases were found by review of TBE diagnoses according to ICD-10 codes in four hospital databases. Results From 1973 to 2016 a total of 15,193 TBE cases were reported to the CDPC, 2,819 of which were reported from January 2007 through December 2016, additionally for this time period, 104 cases were identified via hospital survey. From all 2,923 reported cases (2007–2016), 1,973 met TBE case definition criteria and were included in the TBE study analysis. The highest average 10 year incidence was observed from 1990–1999 (27.9 cases per 100,000; range 4.6–53.0), however, the average 10-year incidence from 2007–2016 using officially adopted TBE case definition was 9.6 cases per 100,000 (range 5.8–14.6). For this 10-year time period most cases were adults (95.1%) and male (52.2%). The most common clinical form of TBE was meningitis (90.6%). A tick bite prior to TBE onset was reported in 60.6% of TBE cases and 98.2% of cases were not vaccinated against TBE. Conclusion The data demonstrate that the incidence of TBE varies by about one third based on the case definition used. TBE occurs almost entirely in the unvaccinated population. Regular TBE awareness campaigns could encourage the population in Latvia to use protective measures to further control TBE in the country, either via vaccination or tick avoidance.
Collapse
Affiliation(s)
- Dace Zavadska
- Department of Paediatrics, Riga Stradins University, Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
- * E-mail:
| | - Zane Odzelevica
- Department of Paediatrics, Riga Stradins University, Riga, Latvia
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
| | - Guntis Karelis
- Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
- Department of Neurology, Riga East Clinical University Hospital, Riga, Latvia
| | - Lelde Liepina
- Department of Paediatrics, Riga Stradins University, Riga, Latvia
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
| | - Zane Anna Litauniece
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
- Department of Neurology, Riga Stradins University, Riga, Latvia
| | - Antra Bormane
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Irina Lucenko
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | - Linda Bridina
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
| | - Laura Veide
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
| | - Angelika Krumina
- Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - Jelena Storozenko
- Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
- National Reference Laboratory, Riga East Clinical University Hospital, Riga, Latvia
| | - Wilhelm Erber
- Pfizer Vaccines, Medical and Scientific Affairs, Paris, France and Vienna, Austria
| | - Myint Tin Tin Htar
- Pfizer Vaccines, Medical and Scientific Affairs, Paris, France and Vienna, Austria
| | - Heinz-Josef Schmitt
- Pfizer Vaccines, Medical and Scientific Affairs, Paris, France and Vienna, Austria
| |
Collapse
|
4
|
Shedrawy J, Henriksson M, Hergens MP, Askling HH. Estimating costs and health outcomes of publicly funded tick-born encephalitis vaccination: A cost-effectiveness analysis. Vaccine 2018; 36:7659-7665. [PMID: 30385058 DOI: 10.1016/j.vaccine.2018.10.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The number of notified cases of Tick-Borne Encephalitis (TBE) in Sweden has been increasing the past years despite the increased use of TBE-vaccine not subsidized by the healthcare system. Stockholm County is a high endemic area and an earlier study has shown that low-income households have lower vaccination coverage even when they are at high risk. This paper aims to determine the cost-effectiveness of a publicly funded TBE vaccination program in Stockholm. METHODS In three different cohorts with individuals aged 3, 40 or 50 years, long-term costs and health outcomes of an out-of-pocket strategy (53% of the cohort is vaccinated on their own expenses) and a structured vaccination program (full cohort is vaccinated covered by the publicly funded health care system), were estimated using a Markov model. The Markov model predicts the costs and effects in term of Quality-adjusted Life Years (QALYs) over a lifetime horizon using a third-party healthcare payer perspective. The primary results are presented as an incremental cost effectiveness ratio (ICER) indicating the additional cost required to achieve one additional QALY with the structured vaccination program. RESULTS The results show that the structured vaccination program is associated with a gain in QALYs and increased costs compared with an out-of-pocket strategy. The calculated ICERs were 27 761, 99 527 and 160 827 SEK/QALY in cohorts of age 3, 40 and 50, respectively. The sensitivity analyses showed that the results are robust when varying different parameters. CONCLUSION Given the setting of Stockholm county, this analysis shows a cost per QALY of a free vaccinations program, especially for children of 3 years old, below generally acceptable cost-effectiveness thresholds in Sweden.
Collapse
Affiliation(s)
- Jad Shedrawy
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Henriksson
- Department of Medical and Health Sciences/Division of Health Care Analysis, Linköping University, Sweden
| | - Maria-Pia Hergens
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Medicine/Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Communicable Disease Control and Prevention, Stockholm County, Sweden
| | - H Helena Askling
- Department of Medicine/Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Communicable Disease Control and Prevention, Sörmland County, Sweden
| |
Collapse
|
5
|
Mihajlović J, Hovius JWR, Sprong H, Bogovič P, Postma MJ, Strle F. Cost-effectiveness of a potential anti-tick vaccine with combined protection against Lyme borreliosis and tick-borne encephalitis in Slovenia. Ticks Tick Borne Dis 2018; 10:63-71. [PMID: 30197268 DOI: 10.1016/j.ttbdis.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 12/30/2022]
Abstract
This study assessed cost-effectiveness of a potential anti-tick vaccine that would protect against both Lyme borreliosis (LB) and tick-borne encephalitis (TBE) in a highly endemic setting of Slovenia. A Markov model was developed to estimate cost-effectiveness of a vaccine with potential combined protection against LB and TBE from the societal perspective. The model expressed time in annual cycles, followed a target population through their lifetime, and applied an annual discounting of 3%. A target population entered the model in a susceptible state, with time dependent probabilities to acquire LB/TBE. Disease manifestations were either resolved within one cycle, or a patient developed LB/TBE sequelae. The vaccination consisted of initial immunization and one revaccination. Estimates of LB/TBE direct and indirect costs, and data on natural course of LB/TBE were obtained from Slovenian databases. Effectiveness of the vaccine with potential combined protection against LB/TBE was derived from studies on existing TBE and LB vaccines, while utility estimates were collected from various literature sources. A vaccine with potential combined protection against LB/TBE was predicted to have an incremental cost of €771,300 per 10,000 vaccinated persons, an incremental utility of 17QALYs and a base-case incremental cost-effectiveness ratio (ICER) of 46,061€/QALY. Vaccine cost, effectiveness and discount rates were identified as the most influential model parameters. A wholesale price for a vaccine shot of €9.13 would lead to cost savings followed by health gains for the vaccination strategy. The base-case ICER was below commonly accepted thresholds of cost-effectiveness, indicating that a combined LB/TBE vaccine might be a cost-effective option in Slovenia. With early Health Technology Assessment becoming increasingly important, this analysis still represents a rare example of cost-effectiveness assessment prior to market authorisation. Although obviously in such a situation some key parameters are unknown, our model sets up a tool to analyse pharmacoeconomic criteria that can help development of a cost-effective health technology, in this case a combined tick-borne diseases vaccine.
Collapse
Affiliation(s)
- J Mihajlović
- Mihajlović Health Analytics, Serbia; University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.
| | - J W R Hovius
- ANti-tick Vaccines to Prevent TIck-borne Diseases in Europe (ANTIDotE) Consortium, The Netherlands; Academic Medical Center, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
| | - H Sprong
- ANti-tick Vaccines to Prevent TIck-borne Diseases in Europe (ANTIDotE) Consortium, The Netherlands; The Netherlands Institute of Public Health and the Environment, The Netherlands
| | - P Bogovič
- Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia
| | - M J Postma
- University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands; Department of Health Sciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands; Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
| | - F Strle
- Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia
| |
Collapse
|
6
|
Slunge D, Boman A. Learning to live with ticks? The role of exposure and risk perceptions in protective behaviour against tick-borne diseases. PLoS One 2018; 13:e0198286. [PMID: 29924806 PMCID: PMC6010238 DOI: 10.1371/journal.pone.0198286] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/14/2018] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study is to analyse the role of risk perceptions and exposure for protective behaviour against tick bites and the related diseases Lyme borreliosis (LB) and tick-borne encephalitis (TBE), both of which are growing health concerns. We use data from a national survey in Sweden with respondents in geographical areas with substantial differences in both abundance of ticks and incidence of LB and TBE. We find that the share of respondents who frequently use protective clothing (64%), perform tick checks (63%) or avoid tall grass while in areas with ticks (48%) is relatively high. However, the use of protective measures is uneven and a considerably lower share tuck their trousers into their socks (18%), use repellent against ticks (16%) or use a combination of protective measures. Thirty-one per cent of the respondents report one or more tick bites in the last year and 68% report one or more lifetime tick bites, indicating that it is difficult to protect oneself from tick bites. There is a strong positive association between exposure and checking the skin for ticks, but exposure is only weakly associated with other protective measures. Tick bites are perceived as a serious health risk by as many as 43% of the respondents. The perception that a single tick bite is serious is negatively associated with actual exposure to ticks, while the opposite is true for the perception that tick bites constitute a serious lifetime health risk. This indicates a learning effect in relation to risk perceptions and the performance of tick checks, but not in relation to other protective measures. Recommendations include informing people of the risks associated with tick bites, the efficacy of various protective measures and the importance of combining multiple types of protection. Given the high exposure to tick bites, the growing incidence of TBE and LB, and the difficulties in preventing tick bites, other preventive measures should be further discussed, including vaccination programmes.
Collapse
Affiliation(s)
- Daniel Slunge
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
- Gothenburg Centre for Sustainable Development, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Anders Boman
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
7
|
Abstract
BACKGROUND Arthropod-borne virus (Arbovirus) infections are considered an emerging threat for Europe, with an increase in cases in recent decades. The increase in global travel and trade has contributed to the introduction of vectors and viruses into new geographical areas. Tropical arboviruses such as dengue and chikungunya have re-emerged causing local, sporadic outbreaks ignited by travel-imported cases. The recent Zika virus outbreak in the Americas highlighted a need to strengthen preparedness for (re-)emerging arbovirus infections globally. AIMS To strengthen preparedness for the early identification of (re-)emerging arbovirus outbreaks in Europe and highlight areas for research. SOURCES An evidence review of published and grey literature together with consultations with European arbovirus experts. CONTENT This paper presents an overview of endemic and travel-imported arboviruses of clinical significance in Europe. The overview includes syndromic presentation, risk factors for infection and risk of transmission as well as an update on treatments and vaccinations and surveillance notifications and reporting. The paper also presents predictive modelled risks of further geographical expansion of vectors and viruses. IMPLICATIONS There are a range of arboviruses of clinical significance to Europe. There has been an increase in notifications of endemic and travel-imported arbovirus cases in recent years and an increased geographical range of vectors and viruses. The heterogeneity in surveillance reporting indicates a risk for the early identification of (re-)emerging outbreaks. The data presented show a need to strengthen preparedness for (re-)emerging arbovirus infections and a need for research into neglected arboviruses, risks of non-vector transmission and effective therapeutics and vaccinations.
Collapse
|
8
|
Šmit R, Postma MJ. The Burden of Tick-Borne Encephalitis in Disability-Adjusted Life Years (DALYs) for Slovenia. PLoS One 2015; 10:e0144988. [PMID: 26672751 PMCID: PMC4684505 DOI: 10.1371/journal.pone.0144988] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/25/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Tick-borne encephalitis (TBE) presents an increasing burden in many parts of Europe, Asian Russia, Siberia, Asian former USSR and Far East. Incidence can be considered as one way to express the burden. A more comprehensive measure concerns disability-adjusted life years (DALYs), better characterizing the full burden of TBE. TBE burden in DALYs has not yet been estimated, nor has it been specified by the Global Burden of Disease (GBD) studies. OBJECTIVE The purpose of the present study is to estimate the burden of TBE in Slovenia, expressed in DALYs, both from the population and individual perspectives. We discuss the impact of TBE burden on public health and potential strategies to reduce this burden in Slovenia. METHODS The burden of TBE is estimated by using the updated DALYs' methodology first introduced in the GBD project. The DALYs᾽ calculations are based on the health outcomes of the natural course of the disease being modelled. Corrections for under-reporting and under-ascertainment are applied. The impact of uncertainty in parameters in the model was assessed using sensitivity analyses. RESULTS From the population perspective, total DALYs amount to 3,450 (167.8 per 100,000 population), while from the individual perspective they amount to 3.1 per case in 2011. Notably, the consequences of TBE present a larger burden than TBE itself. CONCLUSIONS TBE presents a relatively high burden expressed in DALYs compared with estimates for other infectious diseases from the GBD 2010 study for Slovenia. Raising awareness and increasing vaccination coverage are needed to reduce TBE and its consequences.
Collapse
Affiliation(s)
- Renata Šmit
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, Netherlands
- Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Maarten J. Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, Netherlands
- Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Department of Epidemiology, UMCG, University of Groningen, Groningen, Netherlands
| |
Collapse
|
9
|
Slunge D. The Willingness to Pay for Vaccination against Tick-Borne Encephalitis and Implications for Public Health Policy: Evidence from Sweden. PLoS One 2015; 10:e0143875. [PMID: 26641491 PMCID: PMC4671589 DOI: 10.1371/journal.pone.0143875] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/10/2015] [Indexed: 12/30/2022] Open
Abstract
The increasing incidence of tick-borne encephalitis (TBE) in Sweden and several other European countries has sparked a discussion about the need for a public vaccination strategy. However, TBE vaccination coverage is incomplete and there is little knowledge about the factors influencing vaccination behavior. Based on a survey of 1,500 randomly selected respondents in Sweden, we estimate vaccination coverage in areas with different TBE risk levels and analyze the role of vaccine price and other factors influencing the demand for vaccination. First, we find that the average rate of TBE vaccination in Sweden is 33% in TBE risk areas and 18% elsewhere. Income, age and risk-related factors such as incidence of TBE in the area of residence, frequency of visits to areas with TBE risk, and experience with tick bites are positively associated with demand for TBE vaccine. Next, using contingent valuation methodology, we estimate the willingness to pay for TBE vaccination among the unvaccinated respondents and the effect of a possible subsidy. Among the unvaccinated respondents in TBE risk areas, we estimate the mean willingness to pay for the recommended three doses of TBE vaccine to be 465 SEK (approximately 46 euros or 40% of the current market price). We project that a subsidy making TBE vaccines free of charge could increase the vaccination rate in TBE risk areas to around 78%, with a larger effect on low-income households, whose current vaccination rate is only 15% in risk areas. However, price is not the only factor affecting demand. We find significant effects on vaccination behavior associated with trust in vaccine recommendations, perceptions about tick bite-related health risks and knowledge about ticks and tick-borne diseases. Hence, increasing knowledge and trust, as well as ease of access to vaccinations, can also be important measures for public health agencies that want to increase the vaccination rate.
Collapse
Affiliation(s)
- Daniel Slunge
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
10
|
Šmit R, Postma MJ. Vaccines for tick-borne diseases and cost-effectiveness of vaccination: a public health challenge to reduce the diseases’ burden. Expert Rev Vaccines 2015; 15:5-7. [DOI: 10.1586/14760584.2016.1111142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Askling HH, Insulander M, Hergens MP, Leval A. Tick borne encephalitis (TBE)-vaccination coverage and analysis of variables associated with vaccination, Sweden. Vaccine 2015. [PMID: 26207593 DOI: 10.1016/j.vaccine.2015.07.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To estimate the tick borne encephalitis (TBE)-vaccination coverage in the greater Stockholm region, we sent a questionnaire to a randomized sample of 8000 individuals in 2013. Fifty-three percent of all respondents (n=4307) reported being vaccinated against TBE at least once. Reasons for not vaccinating included: no perceived risk (28.6%), too expensive (25.6%), did not have the time or opportunity (23%) and worried about vaccine side-effects (20.5%). Multiple logistic regression revealed that the probability of being vaccinated was higher among those who reported ≥2 weeks outdoor exposure in a known high risk area (OR 4.13 95% CI 3.54-4.81) and in individuals ≥60 years of age compared to all other age groups (OR 0.67 95% CI 0.55-0.81). A high net household income was associated with a higher probability of being vaccinated (OR 2.10 95% CI 1.6-2.73). Being born outside Europe was negatively correlated (OR 0.57 95% CI 0.39-0.83). Based on our findings the estimated TBE-incidence in the unvaccinated regional population was 8.5-12/100,000 which is comparable with high endemic areas as the Baltic region and Central Europe. We suggest targeted vaccination and reimbursement strategies in high-endemic areas of Sweden. Our results indicate a need for improved public information about TBE.
Collapse
Affiliation(s)
- Helena Hervius Askling
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| | - Mona Insulander
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| | - Maria-Pia Hergens
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| | - Amy Leval
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| |
Collapse
|
12
|
Kos M, Locatelli I. Reply to response to Limitations of the study “Cost-effectiveness of tick-borne encephalitis vaccination in Slovenian adults”. Vaccine 2015; 33:17. [DOI: 10.1016/j.vaccine.2013.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/17/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022]
|
13
|
Šmit R, Postma MJ. Review of tick-borne encephalitis and vaccines: clinical and economical aspects. Expert Rev Vaccines 2014; 14:737-47. [DOI: 10.1586/14760584.2015.985661] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
14
|
Smit R. Explanation of "cost-effectiveness of tick-borne encephalitis vaccination in Slovenian adults". Vaccine 2014; 32:1227-8. [PMID: 24412299 DOI: 10.1016/j.vaccine.2013.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/14/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
|
15
|
Šmit R. Response to “Limitations of the study ‘Cost-effectiveness of tick-borne encephalitis vaccination in Slovenian adults”’. Vaccine 2013; 31:2602. [DOI: 10.1016/j.vaccine.2013.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/27/2013] [Accepted: 03/11/2013] [Indexed: 11/16/2022]
|
16
|
Kos M, Locatelli I. Limitations of the study “Cost-effectiveness of tick-borne encephalitis vaccination in Slovenian adults”. Vaccine 2013; 31:2601. [DOI: 10.1016/j.vaccine.2012.12.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
|
17
|
Amicizia D, Domnich A, Panatto D, Lai PL, Cristina ML, Avio U, Gasparini R. Epidemiology of tick-borne encephalitis (TBE) in Europe and its prevention by available vaccines. Hum Vaccin Immunother 2013; 9:1163-71. [PMID: 23377671 PMCID: PMC3899155 DOI: 10.4161/hv.23802] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/21/2013] [Accepted: 01/28/2013] [Indexed: 12/30/2022] Open
Abstract
Tick-borne Encephalitis (TBE), which is caused by a Flavivirus, is the most common tick-transmitted disease in Central and Eastern Europe and Russia. Today, TBE is endemic in 27 European countries, and has become an international public health problem. The epidemiology of TBE is changing owing to various factors, such as improvements in diagnosis and case reporting, increased recreational activities in areas populated by ticks, and changes in climatic conditions affecting tick habitats. Vaccination remains the most effective protective measure against TBE for people living in risk zones, occupationally exposed subjects and travelers to endemic areas. The vaccines currently in use are FSME-Immun(®), Encepur(®), EnceVir(®) and TBE vaccine Moscow(®). The numerous studies performed on the efficacy and safety of these vaccines have shown a high level of immunogenicity and an excellent safety profile. Several studies have also shown a high level of cross-protection among strains belonging to different subtypes. In the present paper we attempted to describe the continuously changing epidemiology of TBE in European States and to overview clinical development of available vaccines paying particular attention on cross-protection elicited by the vaccines.
Collapse
Affiliation(s)
- Daniela Amicizia
- Department of Health Sciences; University of Genoa; Genoa, Italy
| | | | | | - Piero Luigi Lai
- Department of Health Sciences; University of Genoa; Genoa, Italy
| | | | - Ulderico Avio
- Business Unit Manager Vaccines; Baxter S.p.A.; Rome, Italy
| | | |
Collapse
|
18
|
Zavadska D, Anca I, André F, Bakir M, Chlibek R, Čižman M, Ivaskeviciene I, Mangarov A, Mészner Z, Pokorn M, Prymula R, Richter D, Salman N, Šimurka P, Tamm E, Tešović G, Urbancikova I, Usonis V. Recommendations for tick-borne encephalitis vaccination from the Central European Vaccination Awareness Group (CEVAG). Hum Vaccin Immunother 2013; 9:362-74. [PMID: 23291941 PMCID: PMC3859759 DOI: 10.4161/hv.22766] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/27/2012] [Accepted: 11/03/2012] [Indexed: 12/13/2022] Open
Abstract
Tick-borne encephalitis (TBE) is a viral neurological zoonotic disease transmitted to humans by ticks or by consumption of unpasteurized dairy products from infected cows, goats, or sheep. TBE is highly endemic in areas of Central and Eastern Europe and Russia where it is a major public health concern. However, it is difficult to diagnose TBE as clinical manifestations tend to be relatively nonspecific and a standardized case definition does not exist across the region. TBE is becoming more important in Europe due to the appearance of new endemic areas. Few Central European Vaccination Awareness Group (CEVAG) member countries have implemented universal vaccination programmes against TBE and vaccination coverage is not considered sufficient to control the disease. When implemented, immunization strategies only apply to risk groups under certain conditions, with no harmonized recommendations available to date across the region. Effective vaccination programmes are essential in preventing the burden of TBE. This review examines the current situation of TBE in CEVAG countries and contains recommendations for the vaccination of children and high-risk groups. For countries at very high risk of TBE infections, CEVAG strongly recommends the introduction of universal TBE vaccination in children > 1 y of age onwards. For countries with a very low risk of TBE, recommendations should only apply to those traveling to endemic areas. Overall, it is generally accepted that each country should be free to make its own decision based on regional epidemiological data and the vaccination calendar, although recommendations should be made, especially for those living in endemic areas.
Collapse
Affiliation(s)
- Dace Zavadska
- Department of Pediatrics; Riga Stradins University; Riga, Latvia
| | - Ioana Anca
- Carol Davila University of Medicine and Pharmacy; Institute for Mother and Child Care; Bucharest, Romania
| | | | - Mustafa Bakir
- Department of Pediatrics; Division of Pediatric Infectious Diseases; Marmara University School of Medicine; Istanbul, Turkey
| | - Roman Chlibek
- Faculty of Military Health Sciences; University of Defence; Hradec Kralove, Czech Republic
| | - Milan Čižman
- Department of Infectious Diseases; University Medical Centre; Ljubljana, Slovenia
| | - Inga Ivaskeviciene
- Faculty of Medicine; Vilnius University Clinic of Children’s Diseases; Vilnius, Lithuania
| | | | | | - Marko Pokorn
- Department of Infectious Diseases; University Medical Centre; Ljubljana, Slovenia
| | - Roman Prymula
- Faculty of Military Health Sciences; University of Defence; Hradec Kralove, Czech Republic
- University Hospital; Hradec Kralove, Czech Republic
| | - Darko Richter
- Department of Pediatrics; University Hospital Center; Zagreb, Croatia
| | - Nuran Salman
- Division of Infectious Disease and Clinical Microbiology; University of Istanbul; Istanbul Turkey
| | - Pavol Šimurka
- Pediatric Clinic; Faculty Hospital; University of Trencin; Trenčín, Slovakia
| | - Eda Tamm
- Children’s Clinic of Tartu University Hospital; Tartu, Estonia
| | - Goran Tešović
- Paediatric Infectious Diseases Department; University of Zagreb School of Medicine; Zagreb, Croatia
| | - Ingrid Urbancikova
- Department of Paediatric Infectious Diseases; Children’s Faculty Hospital; Košice, Slovakia
| | - Vytautas Usonis
- Faculty of Medicine; Vilnius University Clinic of Children’s Diseases; Vilnius, Lithuania
| |
Collapse
|