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Kartasasmita CB, Rezeki Hadinegoro S, Kurniati N, Triasih R, Halim C, Gamil A. Epidemiology, Nasopharyngeal Carriage, Serotype Prevalence, and Antibiotic Resistance of Streptococcus pneumoniae in Indonesia. Infect Dis Ther 2020; 9:723-736. [PMID: 32864725 PMCID: PMC7680475 DOI: 10.1007/s40121-020-00330-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Indexed: 11/28/2022] Open
Abstract
In Indonesia, pneumococcal disease represents a considerable public health concern; however, published data on the epidemiology, nasopharyngeal carriage, serotype prevalence, and antibiotic resistance of Streptococcus pneumoniae in this region are limited. Therefore, this article reviews the available data from a variety of sources and also summarizes pneumococcal conjugate vaccine implementation and recommendations in Indonesia and subsequent impact on pneumococcal disease. Regional pneumococcal vaccination recommendations in Asia were also reviewed. Studies showed that pneumococcal nasopharyngeal carriage prevalence in Indonesia was approximately 43% to 55% in healthy children aged less than 5 years, which varied by age group, region, and year. Serotype analysis of pneumococcal nasopharyngeal carriage isolates in Indonesia revealed that 38% to 60% of isolates would be covered by the 13-valent pneumococcal conjugate vaccine (PCV13). The antimicrobial resistance of pneumococcal disease has increased over time; between 1997 and 2012, resistance to penicillin and sulfamethoxazole increased from 0% to 28% and 9% to 62%, respectively. Inclusion of pneumococcal conjugate vaccines into immunization programs is being implemented gradually. In 2017, Indonesia implemented a regional PCV13 immunization program in Lombok with a 2 + 1 vaccination schedule that was expanded in 2018-2019 to West Nusa Tenggara and Bangka Belitung Provinces; this expansion is predicted to substantially reduce the burden of pneumococcal disease in Indonesia. Overall, the limited data available regarding pneumococcal disease in Indonesia highlight the unmet need for comprehensive disease surveillance studies in this region that can help direct vaccination strategies.
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Affiliation(s)
- Cissy B Kartasasmita
- Department of Child Health, Universitas Padjadjaran/Hasan Sadikin General Hospital, West Java, Indonesia
| | - Sri Rezeki Hadinegoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nia Kurniati
- Department of Child Health, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rina Triasih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Amgad Gamil
- Pfizer Inc, Emerging Markets, Medical and Scientific Affairs, Dubai, UAE.
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Islam MT, Im J, Ahmmed F, Kim DR, Khan AI, Zaman K, Ali M, Marks F, Qadri F, Kim JH, Clemens JD. Use of Typhoid Vi-Polysaccharide Vaccine as a Vaccine Probe to Delineate Clinical Criteria for Typhoid Fever. Am J Trop Med Hyg 2020; 103:665-671. [PMID: 32588803 PMCID: PMC7410438 DOI: 10.4269/ajtmh.19-0968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Blood cultures (BCs) detect an estimated 50% of typhoid fever cases. There is need for validated clinical criteria to define cases that are BC negative, both to help direct empiric antibiotic treatment and to better evaluate the magnitude of protection conferred by typhoid vaccines. To derive and validate a clinical rule for defining BC-negative typhoid fever, we assessed, in a cluster-randomized effectiveness trial of Vi-polysaccharide (ViPS) typhoid vaccine in Kolkata, India, 14,797 episodes of fever lasting at least 3 days during 4 years of comprehensive, BC-based surveillance of 70,865 persons. A recursive partitioning algorithm was used to develop a decision rule to predict BC-proven typhoid cases with a diagnostic specificity of 97–98%. To validate this rule as a definition for BC-negative typhoid fever, we assessed whether the rule defined culture-negative syndromes prevented by ViPS vaccine. In a training subset of individuals, we identified the following two rules: rule 1: patients aged < 15 years with prolonged fever accompanied by a measured body temperature ≥ 100°F, headache, and nausea; rule 2: patients aged ≥ 15 years with prolonged fever accompanied by nausea and palpable liver but without constipation. The adjusted protective efficacy of ViPS against clinical typhoid defined by these rules in persons aged ≥ 2 years in a separate validation subset was 33% (95% CI: 4–53%). We have defined and validated a clinical rule for predicting BC-negative typhoid fever using a novel vaccine probe approach. If validated in other settings, this rule may be useful to guide clinical care and to enhance typhoid vaccine evaluations.
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Affiliation(s)
- Md Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,International Vaccine Institute, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D Clemens
- Korea University College of Medicine, Seoul, South Korea.,UCLA Fielding School of Public Health, Los Angeles, California.,International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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Oropharyngeal Colonization of Haemophilus influenzae Type b and Serologic Response After Administration of Third Dose of Pentavalent Vaccine to 12-Month-Old Children in Karaj, Iran, 2016. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2019. [DOI: 10.5812/apid.82238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Oropharyngeal Colonization of Haemophilus influenzae Type b and Serologic Response After Administration of Third Dose of Pentavalent Vaccine to 12-Month-Old Children in Karaj, Iran, 2016. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2019. [DOI: 10.5812/pedinfect.82238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Riumallo-Herl C, Chang AY, Clark S, Constenla D, Clark A, Brenzel L, Verguet S. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: a modelling study. BMJ Glob Health 2018; 3:e000613. [PMID: 29662691 PMCID: PMC5898318 DOI: 10.1136/bmjgh-2017-000613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/19/2018] [Accepted: 02/24/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Beyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups. Methods We build a financial risk protection model to evaluate the impact of immunisation against measles, severe pneumococcal disease and severe rotavirus for birth cohorts vaccinated over 2016-2030 for three scenarios in 41 Gavi-eligible countries: no immunisation, current immunisation coverage forecasts and the current immunisation coverage enhanced with funding support. We distribute modelled disease cases per socioeconomic group and derive the number of cases of: (1) catastrophic health costs (CHCs) and (2) medical impoverishment. Results In the absence of any vaccine coverage, the number of CHC cases attributable to measles, severe pneumococcal disease and severe rotavirus would be approximately 18.9 million, 6.6 million and 2.2 million, respectively. Expanding vaccine coverage would reduce this number by up to 90%, 30% and 40% in each case. More importantly, we find a higher share of CHC incidence among the poorest quintiles who consequently benefit more from vaccine expansion. Conclusion Our findings contribute to the understanding of how vaccines can have a broad economic impact. In particular, we find that immunisation programmes can reduce the proportion of households facing catastrophic payments from out-of-pocket health expenses, mainly in lower socioeconomic groups. Thus, vaccines could have an important role in poverty reduction.
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Affiliation(s)
- Carlos Riumallo-Herl
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Applied Economics, Erasmus School of Economics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Angela Y Chang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Clark
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Logan Brenzel
- Bill and Melinda Gates Foundation, Washington DC, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Kotirum S, Muangchana C, Techathawat S, Dilokthornsakul P, Wu DBC, Chaiyakunapruk N. Economic Evaluation and Budget Impact Analysis of Vaccination against Haemophilus influenzae Type b Infection in Thailand. Front Public Health 2017; 5:289. [PMID: 29209602 PMCID: PMC5701919 DOI: 10.3389/fpubh.2017.00289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/19/2017] [Indexed: 12/04/2022] Open
Abstract
Current study aimed to estimate clinical and economic outcomes of providing the Haemophilus influenzae type b (Hib) vaccination as a national vaccine immunization program in Thailand. A decision tree combined with Markov model was developed to simulate relevant costs and health outcomes covering lifetime horizon in societal and health care payer perspectives. This analysis considered children aged under 5 years old whom preventive vaccine of Hib infection are indicated. Two combined Hib vaccination schedules were considered: three-dose series (3 + 0) and three-dose series plus a booster does (3 + 1) compared with no vaccination. Budget impact analysis was also performed under Thai government perspective. The outcomes were reported as Hib-infected cases averted and incremental cost-effectiveness ratios (ICERs) in 2014 Thai baht (THB) ($) per quality-adjusted life year (QALY) gained. In base-case scenario, the model estimates that 3,960 infected cases, 59 disability cases, and 97 deaths can be prevented by national Hib vaccination program. The ICER for 3 + 0 schedule was THB 1,099 ($34) per QALY gained under societal perspective. The model was sensitive to pneumonia incidence among aged under 5 years old and direct non-medical care cost per episode of Hib pneumonia. Hib vaccination is very cost-effective in the Thai context. The budget impact analysis showed that Thai government needed to invest an additional budget of 110 ($3.4) million to implement Hib vaccination program. Policy makers should consider our findings for adopting this vaccine into national immunization program.
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Affiliation(s)
- Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Faculty of Pharmacy, Social and Administrative Pharmacy Department, Rangsit University, Muang Pathum Thani, Thailand
| | - Charung Muangchana
- National Vaccine Institute (Public Organization), Ministry of Public Health, Nonthaburi, Thailand
| | - Sirirat Techathawat
- National Vaccine Institute (Public Organization), Ministry of Public Health, Nonthaburi, Thailand
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand
| | - David Bin-Chia Wu
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, University of Wisconsin, Madison, WI, United States.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Malaysia
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Chongmelaxme B, Hammanee M, Phooaphirak W, Kotirum S, Hutubessy R, Chaiyakunapruk N. Economic evaluations of Haemophilus influenzae type b (Hib) vaccine: a systematic review. J Med Econ 2017; 20:1094-1106. [PMID: 28737468 DOI: 10.1080/13696998.2017.1359181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS The World Health Organization (WHO) recommends the use of Haemophilus influenzae type b (Hib) conjugate vaccines, but China and Thailand have not used Hib vaccination in their national immunization programs. This systematic review aimed to update published economic evaluations of Hib vaccinations and to determine factors that potentially affected their cost-effectiveness. METHODS Searches were performed from the inception until December 2015 using 13 databases: CAB direct; CEA registry; EconLit; EMBASE; E-library; NHSEED; PAHO; POPLINE; PubMed; Redalyc project; RePEc; SciELO; and WHOLIS. Reference lists of relevant studies and grey literature were also searched. Full economic evaluations of Hib vaccination with results of costs and outcomes were included. The WHO checklist was used to evaluate the quality of the included studies. Data from eligible studies were extracted using a standardized data collection form. RESULTS Out of 830 articles, 27 were included. Almost half of the studies (12/27) were conducted in high-income countries. Twelve studies (12/27) investigated the Hib vaccine as an addition to the existing vaccination program. Most studies (17/27) examined a 3-dose schedule of Hib vaccine. Nineteen studies (19/27) reported the model used, where all were decision tree models. Most of the studies (23/27) demonstrated an economic value of Hib vaccination programs, key influential parameters being incidence rates of Hib disease and vaccine price. CONCLUSIONS Hib vaccination programs are mostly found to be cost-effective across geographic regions and country income levels, and Hib vaccination is recommended for inclusion into all national immunization programs. The findings are expected to support policy-makers for making decisions on allocating limited resources of the Hib vaccination program effectively.
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Affiliation(s)
- Bunchai Chongmelaxme
- a Center of Pharmaceutical Outcomes Research (CPOR) , Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
| | - Maythika Hammanee
- b Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat-Yai, Songkla , Thailand
| | - Wariya Phooaphirak
- b Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat-Yai, Songkla , Thailand
| | - Surachai Kotirum
- c School of Pharmacy , Monash University Malaysia , Selangor , Malaysia
- d Social and Administrative Pharmacy Department, Faculty of Pharmacy , Rangsit University , Muang, Pathumthani , Thailand
| | - Raymond Hutubessy
- e World Health Organization , Initiative for Vaccine Research , Geneva , Switzerland
| | - Nathorn Chaiyakunapruk
- a Center of Pharmaceutical Outcomes Research (CPOR) , Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
- c School of Pharmacy , Monash University Malaysia , Selangor , Malaysia
- f School of Pharmacy , University of Wisconsin , Madison , WI , USA
- g Asian Centre for Evidence Synthesis in Population , Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway, Selangor , Malaysia
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Le P, Nghiem VT, Swint JM. Post-GAVI sustainability of the Haemophilus influenzae type b vaccine program: The potential role of economic evaluation. Hum Vaccin Immunother 2016; 12:2403-5. [PMID: 27135964 PMCID: PMC5027728 DOI: 10.1080/21645515.2016.1175695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Haemophilus influenzae type b (Hib) can cause severe invasive diseases which are, however, preventable by vaccination. To increase access to Hib vaccine, GAVI – the Vaccine Alliance – has provided financial support for 73 lower income countries worldwide. At the same time, GAVI has been implementing its co-financing policy, requiring recipient countries to pay a portion of vaccine costs and to increase this amount over time. Starting in 2016, 5 countries will stop receiving GAVI funding and procure the vaccine themselves. Although the graduating countries have access to the UNICEF/GAVI tendered vaccine price for 5 more years, the uncertainty in market vaccine price may hamper the post-GAVI program sustainability. A possible increase in vaccine price would cause a significant burden on governmental budgets, discouraging countries to continue the program. As a special tool, economic evaluation (EE) can assist decision makers by identifying the maximum affordable vaccine price for countries to pay. Given that only 6 GAVI-eligible countries have such analyses published, more EEs are necessary to strengthen countries' commitment during this transition period. The information will also be useful for manufacturers to determine their pricing policy.
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Affiliation(s)
- Phuc Le
- a Center for Value-based Care Research , Medicine Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Van T Nghiem
- b Department of Management , Policy and Community Health, The University of Texas School of Public Health , Houston , TX , USA
| | - J Michael Swint
- b Department of Management , Policy and Community Health, The University of Texas School of Public Health , Houston , TX , USA.,c Center for Clinical Research and Evidence-Based Medicine , The University of Texas School of Medicine , Houston , TX , USA
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Portnoy A, Jit M, Lauer J, Blommaert A, Ozawa S, Stack M, Murray J, Hutubessy R. Estimating costs of care for meningitis infections in low- and middle-income countries. Vaccine 2016; 33 Suppl 1:A240-7. [PMID: 25919168 DOI: 10.1016/j.vaccine.2014.11.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/22/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022]
Abstract
Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines.
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Affiliation(s)
- Allison Portnoy
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Modelling and Economics Unit, Public Health England, London NW9 5EQ, United Kingdom.
| | - Jeremy Lauer
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | - Adriaan Blommaert
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken Lokaal D.R.212, 2610 Wilrijk, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Campus Diepenbeek Agoralaan Gebouw D; BE 3590, Diepenbeek, Belgium.
| | - Sachiko Ozawa
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Meghan Stack
- Independent Consultant, 2417 Panama Street, Philadelphia, PA 19103, USA.
| | - Jillian Murray
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Raymond Hutubessy
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Rusmil K, Gunardi H, Fadlyana E, Soedjatmiko, Dhamayanti M, Sekartini R, Satari HI, Risan NA, Prasetio D, Tarigan R, Garheni R, Milanti M, Hadinegoro SR, Tanuwidjaja S, Bachtiar NS, Sari RM. The immunogenicity, safety, and consistency of an Indonesia combined DTP-HB-Hib vaccine in expanded program on immunization schedule. BMC Pediatr 2015; 15:219. [PMID: 26686508 PMCID: PMC4684926 DOI: 10.1186/s12887-015-0525-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022] Open
Abstract
Background WHO recommended incorporation of Haemophilus influenzae type b (Hib) vaccination into immunization program. Indonesia would adopt Hib as a National Immunization Program in 2013. We aimed at analyzing immunogenicity, safety, and consistency of a new combined DTP-HB-Hib (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenza B) vaccine. Methods A prospective, randomized, double blind, multicenter, phase III study of Bio Farma DTP-HB-Hib vaccine conducted in Jakarta and Bandung, August 2012 - January 2013. Subjects were divided into three groups with different batch number. Healthy infants 6–11 weeks of age at enrollment were immunized with 3 doses of DTP-HB-Hib vaccine with interval of 4 weeks, after birth dose of hepatitis B vaccine. Blood samples obtained prior to vaccination and 28 days after the third dose. Safety measures recorded until 28 days after each dose. Results Of 600 subjects, 575 (96 %) completed study protocol. After 3 doses, 100.0 and 96.0 % had anti-PRP concentration ≥0.15 and ≥1.0 μg/ml. Anti-diphtheria and anti-tetanus concentration ≥0.01 IU/ml detected in 99.7 and 100.0 %; while concentration ≥0.1 IU/ml achieved in 84.0 and 97.4 %. Protective anti-HBs found in 99.3 %. The pertussis vaccine response rate was 84.9 %. None Serious Adverse events (SAEs) considered related to study vaccine or procedure. Conclusions The 3-dose of DTP-HB-Hib was immunogenic, well tolerated and suitable for replacement of licensed-equivalent vaccines based on immunologic and safety profiles. Trial registration NCT01986335 – October 30th 2013.
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Affiliation(s)
- Kusnandi Rusmil
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
| | - Hartono Gunardi
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Eddy Fadlyana
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Soedjatmiko
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Meita Dhamayanti
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rini Sekartini
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hindra Irawan Satari
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nelly Amalia Risan
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Dwi Prasetio
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rodman Tarigan
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Reni Garheni
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Mia Milanti
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Sri Rezeki Hadinegoro
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Suganda Tanuwidjaja
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Merritt MW, Katz J, Mojtabai R, West KP. Referral of Research Participants for Ancillary Care in Community-Based Public Health Intervention Research: A Guiding Framework. Public Health Ethics 2015. [DOI: 10.1093/phe/phv021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Le P, Griffiths UK, Anh DD, Franzini L, Chan W, Swint JM. Cost-effectiveness of Haemophilus influenzae type b vaccine in Vietnam. Vaccine 2015; 33:4639-46. [PMID: 26044493 PMCID: PMC4547866 DOI: 10.1016/j.vaccine.2015.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND With GAVI support, Vietnam introduced Haemophilus influenzae type b (Hib) vaccine in 2010 without evidence on cost-effectiveness. We aimed to analyze the cost-effectiveness of Hib vaccine from societal and governmental perspectives. METHOD We constructed a decision-tree cohort model to estimate the costs and effectiveness of Hib vaccine versus no Hib vaccine for the 2011 birth cohort. The disease burden was estimated from local epidemiologic data and literature. Vaccine delivery costs were calculated from governmental reports and 2013 vaccine prices. A prospective cost-of-illness study was conducted to estimate treatment costs. The human capital approach was employed to estimate productivity loss. The incremental costs of Hib vaccine were divided by cases, deaths, and disability-adjusted life years (DALY) averted. We used the WHO recommended cost-effectiveness thresholds of an intervention being highly cost-effective if incremental costs per DALY were below GDP per capita. RESULT From the societal perspective, incremental costs per discounted case, death and DALY averted were US$ 6252, US$ 26,476 and US$ 1231, respectively; the break-even vaccine price was US$ 0.69/dose. From the governmental perspective, the results were US$ 6954, US$ 29,449, and US$ 1373, respectively; the break-even vaccine price was US$ 0.48/dose. Vietnam's GDP per capita was US$ 1911 in 2013. In deterministic sensitivity analysis, morbidity and mortality parameters were among the most influential factors. In probabilistic sensitivity analysis, Hib vaccine had an 84% and 78% probability to be highly cost-effective from the societal and governmental perspectives, respectively. CONCLUSION Hib vaccine was highly cost-effective from both societal and governmental perspectives. However, with GAVI support ending in 2016, the government will face a six-fold increase in its vaccine budget at the 2013 vaccine price. The variability of vaccine market prices adds an element of uncertainty. Increased government commitment and improved resource allocation decision making will be necessary to retain Hib vaccine.
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Affiliation(s)
- Phuc Le
- University of Texas School of Public Health, United States.
| | | | - Dang Duc Anh
- Vietnam National Institute of Hygiene and Epidemiology, Viet Nam
| | - Luisa Franzini
- University of Texas School of Public Health, United States
| | - Wenyaw Chan
- University of Texas School of Public Health, United States
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Malik A. Pentavalent vaccine and adverse events following immunization-untangling the misinterpretations. Indian J Pediatr 2014; 81:1353-7. [PMID: 24500059 DOI: 10.1007/s12098-013-1322-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
In April 2008, the National Technical Group on Immunization (NTAGI) Sub-committee on H. influenza type b (Hib) vaccine recommended that Hib containing pentavalent vaccine should be introduced in the country. Subsequently liquid pentavalent vaccine (LPV) was launched in the Kerala and Tamil Nadu on a pilot basis in December 2011. The introduction of LPV in these two states was followed by reported deaths in infants who had received LPV. An exhaustive summary of media reports and previous literature has since been made available at various fora which have been supplemented with estimations of the damage the LPV may cause. It has thus been concluded that the LPV is bound to cause more number of infant deaths than it will save from Hib meningitis and pneumonia. The current paper aims to clear some of the misinterpretations and miscalculations so that lives of 72,000 infants can be saved.
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Affiliation(s)
- Akash Malik
- Ministry of Health and Family Welfare, Government of India, New Delhi, India,
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Verma R, Khanna P, Chawla S, Bairwa M, Prinja S, Rajput M. Hemophilus influenzaetypeb(Hib) vaccine: An effective control strategy in India. HUMAN VACCINES 2014; 7:1158-60. [DOI: 10.4161/hv.7.11.17683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Abstract
Vaccine probe studies have emerged in the past 15 years as a useful way to characterise disease. By contrast, traditional studies of vaccines focus on defining the vaccine effectiveness or efficacy. The underlying basis for the vaccine probe approach is that the difference in disease burden between vaccinated and unvaccinated individuals can be ascribed to the vaccine-specific pathogen. Vaccine probe studies can increase understanding of a vaccine's public health value. For instance, even when a vaccine has a seemingly low efficacy, a high baseline disease incidence can lead to a large vaccine-preventable disease burden and thus that population-based vaccine introduction would be justified. So far, vaccines have been used as probes to characterise disease syndromes caused by Haemophilus influenzae type b, pneumococcus, rotavirus, and early infant influenza. However, vaccine probe studies have enormous potential and could be used more widely in epidemiology, for example, to define the vaccine-preventable burden of malaria, typhoid, paediatric influenza, and dengue, and to identify causal interactions between different pathogens.
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Affiliation(s)
- Daniel R Feikin
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene and Tropical Medicine, London, UK
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16
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Griffiths UK, Miners A. Economic evaluations ofHaemophilus influenzaetype b vaccine: systematic review of the literature. Expert Rev Pharmacoecon Outcomes Res 2014; 9:333-46. [DOI: 10.1586/erp.09.38] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Gessner BD. Haemophilus influenzaetype b vaccine impact in resource-poor settings in Asia and Africa. Expert Rev Vaccines 2014; 8:91-102. [DOI: 10.1586/14760584.8.1.91] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Schoeps A, Ouédraogo N, Kagoné M, Sié A, Müller O, Becher H. Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso. Vaccine 2013; 32:96-102. [PMID: 24183978 DOI: 10.1016/j.vaccine.2013.10.063] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/16/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. METHODS This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. RESULTS Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. CONCLUSIONS Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time.
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Affiliation(s)
- A Schoeps
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
| | - N Ouédraogo
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - M Kagoné
- Centre de Recherche en Santé de Nouna (CRSN), BP 02 Nouna, Burkina Faso
| | - A Sié
- Centre de Recherche en Santé de Nouna (CRSN), BP 02 Nouna, Burkina Faso
| | - O Müller
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - H Becher
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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19
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Systematic review of economic evaluation analyses of available vaccines in Spain from 1990 to 2012. Vaccine 2013; 31:3473-84. [DOI: 10.1016/j.vaccine.2013.05.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/16/2013] [Accepted: 05/24/2013] [Indexed: 12/22/2022]
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Griffiths UK, Clark A, Hajjeh R. Cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in low- and middle-income countries: regional analysis and assessment of major determinants. J Pediatr 2013; 163:S50-S59.e9. [PMID: 23773595 PMCID: PMC5749634 DOI: 10.1016/j.jpeds.2013.03.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low- and middle-income countries and identify the model variables, which are most important for the result. STUDY DESIGN A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. RESULTS From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%-53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. CONCLUSIONS Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae.
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Affiliation(s)
- Ulla Kou Griffiths
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine London, United Kingdom.
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Verma R, Khanna P, Chawla S. Pentavalent DTP vaccine: need to be incorporated in the vaccination program of India. Hum Vaccin Immunother 2013; 9:1497-9. [PMID: 23571225 DOI: 10.4161/hv.24382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis among infants and young children and the second leading cause of bacterial pneumonia deaths among children under 5 y. The overall case-fatality rate for Hib meningitis is 20-29%, and nearly 30% of surviving children suffer from major disabilities, while all invasive Hib disease (including meningitis) has a case fatality rate of 16% in India. Using the estimates from the Hib study, ~215,000 new cases of Hib pneumonia occur yearly in Indian children under the age of 5 y and result in over 61,000 deaths. This level of mortality is because of poor access to health services and poor health-seeking behavior by population, lack of laboratory infrastructure, and difficulty to diagnosis Hib disease among affected children. Disease burden is difficult to calculate. Even for those affected children who do reach healthcare facilities, the lack of quality health services and increasing prevalence of antibiotic-resistance makes treatment difficult for these children. Even in countries that have poor immunization coverage, indirect benefits of the Hib vaccine have been reported due to the herd effect. The Hib vaccine thus should be effective in India where Universal Immunization Programme (UIP) coverage is poor. Following the World Health Organization (WHO) recommendation that Hib-containing Pentavalent DTP vaccine (a combination vaccine that protects against five killer diseases: diphtheria, pertussis, tetanus, hepatitis B [hepB] and Hib) should be administered to every child in the world, the Government of India asked the National Technical Advisory Group on Immunization (NTAGI) to study the need for HepB and Hib vaccines in the Indian population. The India Ministry of Health and Family Welfare introduced Pentavalent DTP vaccines in the UIP with the aim of reducing the burden of Hib-related morbidity and mortality.
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Affiliation(s)
- Ramesh Verma
- Department of Community Medicine; Pt. B.D. Sharma PGIMS; Rohtak, Haryana India
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22
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Ozawa S, Mirelman A, Stack ML, Walker DG, Levine OS. Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: a systematic review. Vaccine 2012; 31:96-108. [PMID: 23142307 DOI: 10.1016/j.vaccine.2012.10.103] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 10/19/2012] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions. METHODS To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit). RESULTS Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination. CONCLUSIONS This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
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Development and introduction of a ready-to-use pediatric pentavalent vaccine to meet and sustain the needs of developing countries – Quinvaxem®: The first 5 years. Vaccine 2012; 30:6241-8. [DOI: 10.1016/j.vaccine.2012.07.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/25/2012] [Accepted: 07/31/2012] [Indexed: 11/23/2022]
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Sinha A, Kim S, Ginsberg G, Franklin H, Kohberger R, Strutton D, Madhi SA, Griffiths UK, Klugman KP. Economic burden of acute lower respiratory tract infection in South African children. Paediatr Int Child Health 2012; 32:65-73. [PMID: 22595212 DOI: 10.1179/2046905512y.0000000010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Acute lower respiratory tract infections (ALRTI) are a leading cause of childhood mortality, but there are few data on disease costs in developing countries. OBJECTIVES This study's purpose was to analyse ALRTI's costs-of-illness and economic burden in urban South African children. METHODS ALRTI costs-of-illness (expressed in US$ 2010) at a tertiary hospital were measured using a micro-costing approach nested within a clinical trial. Demographic, epidemiological and data on use of health resources were integrated with costs-of-illness to estimate the economic burden of ALRTI in urban South African children aged <5 years. RESULTS 745 children experiencing 858 ALRTI episodes were studied. 338 (39.4%), 513 (59.8%) and 7 (0.8%) episodes were managed in short-stay, paediatric ward and intensive care settings, respectively. Mean lengths of stay in short-stay, paediatric ward and intensive care (ICU) were 1.4, 8.1 and 14.4 days, respectively. The societal costs-of-illness per ALRTI episode managed in short-stay and paediatric ward settings, respectively, were US$266 (95% CI 245-286) and 1287 (95% CI 1174-1401) in HIV-infected patients, and US$257 (95% CI 247-267) and 1032 (95% CI 931-1133) in HIV-uninfected patients. Family costs were not collected in ICUs. ICU direct medical costs were US$5968 (95% CI 4025-8056) in HIV-uninfected patients and US$7849 in one HIV-infected patient. Under-5 children experienced an estimated 424,220 episodes annually of ALRTI. ALRTI treatment cost the public health system an estimated US$28,975,000 while an additional US$539,000 of costs were borne by families. CONCLUSION ALRTIs in children <5 years impose a heavy economic burden on families and the South African public health-care system.
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Affiliation(s)
- Anushua Sinha
- Department of Preventive Medicine and Community Health, New Jersey Medical School, Newark, USA.
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Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a major cause of morbidity in industrialized countries and morbidity/mortality in developing countries. In China, comprehensive studies of the etiology of CAP in children aged between 2 months and 14 years who are serious enough to require hospitalization are lacking. Previous studies have been limited in child age range, focused on fatal cases, and/or limited in etiologies sought. An understanding of the etiologies is needed for development of best prevention and management practices. OBJECTIVE The aim of this study was to prospectively determine during a 12-month period the etiology of CAP in hospitalized children in a center in Northwest China. DESIGN/METHODS A prospective 12-month study (2004-2005) of CAP cases in children who were 2 months to 14 years of age admitted to the Second Hospital of Lanzhou University, China. Testing included admission and 1-month postdischarge serum for viral and bacterial serologic analyses (respiratory syncytial virus, influenza A and B, paraflu 1-3, adenovirus; Streptococcus pneumoniae, Haemophilus influenza B, Mycoplasma, and Moraxella. catarrhalis), blood culture, a nasopharyngeal aspirate for viral antigen testing, and a chest radiograph on admission and 1 month postdischarge. The study was funded by Lanzhou University. The study was performed in compliance with the guidelines of the institutional review board of the Second Hospital of Lanzhou University. RESULTS CAP was the admitting diagnosis for 29% of all admissions during the 12-month study. Of the 884 CAP cases, 821 (93%) were enrolled and completed the study. The age range was 2 months to 14 years; mean age was 2.3 years; 40% were <1 year. The average length of stay was 9.2 days (range, 6-20) but varied by age and etiology. Fourteen percent had received antibiotics before admission and 14% had underlying illnesses; 12% required intensive care unit treatment and 5 died. A microbial etiology for CAP was identified in 547 (67%); viral 535 (43%), bacterial 228 (27%), mixed viral bacterial 107 (13%), mixed viral in 1%, and mixed bacterial in 1%. The etiology varied by age; respiratory syncytial virus was most common in <1 year, S. pneumoniae and Hib 1-3 years, and Mycoplasma 5 years. Three potentially vaccine preventable etiologies accounted for 35% of the cases: influenza 9%, Hib 12%, and S. pneumonia 14%. CONCLUSIONS CAP is a major cause of childhood admission in China. Given the etiologic findings in this study, potentially 25% to 35% of cases could be prevented if seasonal influenza vaccine and conjugated H. influenza b and conjugated pneumococcal vaccines were introduced into routine practice.
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Abstract
An effective vaccine to prevent invasive infections caused by Haemophilus influenzae type b (Hib) bacteria has been available for more than 20 years. Hib conjugate vaccine is safe, efficacious and easy to use, and its cost-benefit ratio is high both in industrialized as well as in developing countries. In spite of this, WHO estimates that every year approximately 8 million children contract life-threatening Haemophilus infections, especially meningitis or severe pneumonia. If we want to take seriously the Millenium Development Goal of reducing the mortality of under 5-year-old children by two-thirds before the year 2015, an effective means to contribute to this would be more efficient use of Hib vaccines.
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Affiliation(s)
- J Eskola
- National Institute for Health and Welfare, FI-00271 Helsinki, Finland.
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Vaccine preventable infections and multiple organ dysfunction syndrome in critically ill children in China. Pediatr Infect Dis J 2009; 28:182-5. [PMID: 19165134 DOI: 10.1097/inf.0b013e31818a65d2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is a major cause of mortality in PICUs in industrialized countries. As developing countries become more advanced, PICU care comes into reach. The aim of this study was to examine MODS in a PICU in China in comparison with other countries. METHODS A retrospective 5-year audit (2001-2006) of MODS cases in a 6-bed PICU in the Second Hospital of Lanzhou University, China. RESULTS Of the 332 PICU patients, 176 (53%) had MODS; the mean age was 35 months, and 60% were <1 year of age. Infectious diseases were the predominant factor underlying MODS (128/176; 73%) with 24% attributable to potentially vaccine preventable infections (14 to Haemophilus influenzae b, 13 to Streptococcus pneumoniae, and 4 to Neisseria meningitidis). The case fatality rate for MODS was 49% with no difference between infectious or noninfectious causes (48% vs. 52%; P > 0.05). The frequency of organ dysfunction in MODS was in decreasing order: respiratory (95%), cardiovascular (89%), gastrointestinal (39%), neurologic (35%), hematologic (16%), renal (14%), and hepatic (4%) systems. Mortality rose with increasing number of organs involved. Gastrointestinal system failure was more common in MODS caused by infection than noninfection (45% vs. 23%; P <0.01) and had a higher mortality (72% vs. 34%; P < 0.001). The case fatality rate for MODS in this study was comparable to rates in other developing countries but higher than in industrialized countries. CONCLUSIONS MODS is a major cause of mortality in PICU patients in China. In China, infection-related MODS PICU cases could potentially be reduced to rates closer to those in industrialized countries, if conjugated H. influenzae b and conjugated pneumococcal vaccines were introduced into routine practice.
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Griffiths UK, Korczak VS, Ayalew D, Yigzaw A. Incremental system costs of introducing combined DTwP-hepatitis B-Hib vaccine into national immunization services in Ethiopia. Vaccine 2009; 27:1426-32. [PMID: 19146901 DOI: 10.1016/j.vaccine.2008.12.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 12/12/2008] [Accepted: 12/20/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE With support from the GAVI Alliance a fully liquid combined DTwP-HepB-Hib (pentavalent) vaccine in a single dose vial was introduced into Ethiopia's routine immunization services in March 2007. This vaccine was substituted with DTwP in a 10-dose vial. We aimed to estimate the incremental system costs of pentavalent vaccine delivery. METHODS Data on cold storage expansion and increased vaccine transport frequency were collected in four regions of Ethiopia over a 2-week period, as part of a Post-Introduction Evaluation of the new vaccine. Interviews were conducted with individuals at all levels of the health system. Information on the costs of training and communication to facilitate the introduction was collected from the Ministry of Health, UNICEF and WHO in Addis Ababa. RESULTS The switch from a 10-dose DTwP to a single dose pentavalent vaccine increased refrigeration storage volume per fully vaccinated child by 106% at national and regional levels and by 71% at the three lower levels of vaccine distribution. Cold storage equipment were purchased at all levels and the frequency of vaccine collection more than doubled in many places. Incremental capital costs of cold storage equipment, training and communication amounted to US$ 4.8 million, or US$ 1.53 per child in the 2007 birth cohort. After annualizing capital costs and adding recurrent costs, system costs came to US$ 0.80 per child in the 2007 birth cohort. With a vaccination coverage rate of 78% this is equivalent to US$ 1.13 per fully vaccinated child. The most important system cost item is cold storage, amounting to US$ 0.62 per child in the birth cohort and US$ 0.03 per additional cm(3) of cold storage. CONCLUSION In Ethiopia introduction of pentavalent vaccine necessitated considerable investments in additional cold storage equipment as well as an increase in vaccine transport frequency. A GAVI Alliance introduction grant of US$ 0.30 per child in the birth cohort would cover approximately 20% of the capital investments undertaken to facilitate introduction.
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Affiliation(s)
- Ulla K Griffiths
- Hib Initiative, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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