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Cao KH, Damien P, Woo CK, Zarnikau J. A Bayes Decision Rule to Assist Policymakers during a Pandemic. Healthcare (Basel) 2021; 9:healthcare9081023. [PMID: 34442160 PMCID: PMC8391194 DOI: 10.3390/healthcare9081023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
A new decision rule based on net benefit per capita is proposed and exemplified with the aim of assisting policymakers in deciding whether to lockdown or reopen an economy-fully or partially-amidst a pandemic. Bayesian econometric models using Markov chain Monte Carlo algorithms are used to quantify this rule, which is illustrated via several sensitivity analyses. While we use COVID-19 data from the United States to demonstrate the ideas, our approach is invariant to the choice of pandemic and/or country. The actions suggested by our decision rule are consistent with the closing and reopening of the economies made by policymakers in Florida, Texas, and New York; these states were selected to exemplify the methodology since they capture the broad spectrum of COVID-19 outcomes in the U.S.
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Affiliation(s)
- Kang-Hua Cao
- Department of Economics, Hong Kong Baptist University, Hong Kong, China;
| | - Paul Damien
- Department of Information, Risk and Operations Management, McCombs School of Business, University of Texas in Austin, Austin, TX 78712, USA
- Correspondence:
| | - Chi-Keung Woo
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong, China;
| | - Jay Zarnikau
- Department of Economics, University of Texas in Austin, Austin, TX 78712, USA;
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2
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Fongwen N, Delrieu I, Ham LH, Gubler DJ, Durbin A, Ooi EE, Peeling RW, Flasche S, Hartigan-Go K, Clifford S, Martinez CT, de Lamballerie X, Barnighausen T, Wilder-Smith A. Implementation strategies for the first licensed dengue vaccine: A meeting report. Vaccine 2021; 39:4759-4765. [PMID: 34253416 DOI: 10.1016/j.vaccine.2021.06.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 01/18/2023]
Abstract
Dengue vaccination would enhance the control of dengue, one of the most frequent vector-borne viral diseases globally. CYD-TDV is the first dengue vaccine to be licensed, but global uptake has been hampered due to its use being limited to seropositive persons aged 9 years and above, and the need for a 3-dose schedule. The Partnership for Dengue Control (PDC) organized a meeting with key opinion leaders and stakeholders to deliberate on implementation strategies for the use of CYD-TDV. New data have emerged that support the shortening of the primary schedule from a 3 to 2 dose schedule, extending the age range below 9 to 6 years of age, and expanding the indication from endemic populations to also include travelers to endemic areas. Cost-effectiveness may improve with the modified 2-dose regimen and with multiple testing. Strategies to implement a dengue vaccination program have been developed, in particular school-based strategies. A range of delivery scenarios can then be considered, using various settings for each step of the intervention. However, several challenges remain, including communication about limiting the use of this vaccine to seropositive individuals only. Affordability will vary from country to country, as will government commitment and community acceptance. Well-tailored communication strategies that target key stakeholders are expected to make up a significant part of any future dengue vaccination program.
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Affiliation(s)
- Noah Fongwen
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | | | - Duane J Gubler
- Partnership for Dengue Control, Fondation Merieux, France
| | | | | | - Rosanna W Peeling
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Sam Clifford
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Carlos Torres Martinez
- Director of Cafettor Medical, Professor of Pediatric Infectious Diseases, Universidad del Bosque, in Bogotá, Colombia
| | - Xavier de Lamballerie
- UMR IRD 190, Inserm 1207 "Unité des Virus Émergents", Aix-Marseille Université - Institut de Recherche pour le Développement - Institut National de la Santé et de la Recherche Médicale - Institut de Recherche Biomédicale des Armées - Établissement Français du Sang, France
| | - Till Barnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | - Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Germany; Institute for Social and Preventive Medicine, University of Bern, Switzerland.
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Fongwen N, Wilder-Smith A, Gubler DJ, Ooi EE, T. Salvana EM, de Lamballerie X, Olliaro PL, Peeling RW. Target product profile for a dengue pre-vaccination screening test. PLoS Negl Trop Dis 2021; 15:e0009557. [PMID: 34324505 PMCID: PMC8320982 DOI: 10.1371/journal.pntd.0009557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
With increasing geographic spread, frequency, and magnitude of outbreaks, dengue continues to pose a major public health threat worldwide. Dengvaxia, a dengue live-attenuated tetravalent vaccine, was licensed in 2015, but post hoc analyses of long-term data showed serostatus-dependent vaccine performance with an excess risk of hospitalized and severe dengue in seronegative vaccine recipients. The World Health Organization (WHO) recommended that only persons with evidence of past dengue infection should receive the vaccine. A test for pre-vaccination screening for dengue serostatus is needed. To develop the target product profile (TPP) for a dengue pre-vaccination screening test, face-to-face consultative meetings were organized with follow-up regional consultations. A technical working group was formed to develop consensus on a reference test against which candidate pre-vaccination screening tests could be compared. The group also reviewed current diagnostic landscape and the need to accelerate the evaluation, regulatory approval, and policy development of tests that can identify seropositive individuals and maximize public health impact of vaccination while avoiding the risk of hospitalization in dengue-naive individuals. Pre-vaccination screening strategies will benefit from rapid diagnostic tests (RDTs) that are affordable, sensitive, and specific and can be used at the point of care (POC). The TPP described the minimum and ideal characteristics of a dengue pre-vaccination screening RDT with an emphasis on high specificity. The group also made suggestions for accelerating access to these RDTs through streamlining regulatory approval and policy development. Risk and benefit based on what can be achieved with RDTs meeting minimal and optimal characteristics in the TPP across a range of seroprevalences were defined. The final choice of RDTs in each country will depend on the performance of the RDT, dengue seroprevalence in the target population, tolerance of risk, and cost-effectiveness. This paper describes the consensus on the minimum and ideal performance and operational characteristics of rapid tests that would be used for dengue pre-vaccination screening. This profile will incentivize industry to develop better pre-vaccination screening tests. The choice of which test to use depends on the seroprevalence of the population targeted for vaccination and the optimal balance between benefit and risks. The group also made suggestions for accelerating access to these pre-vaccination screening tests through streamlining regulatory approval and policy development.
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Affiliation(s)
- Noah Fongwen
- International Diagnostics Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annelise Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Duane J. Gubler
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Eng Eong Ooi
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Edsel Maurice T. Salvana
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Xavier de Lamballerie
- Unité des Virus Emergents (UVE), Aix Marseille Université, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Piero L. Olliaro
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rosanna W. Peeling
- International Diagnostics Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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España G, Leidner AJ, Waterman SH, Perkins TA. Cost-effectiveness of dengue vaccination in Puerto Rico. PLoS Negl Trop Dis 2021; 15:e0009606. [PMID: 34310614 PMCID: PMC8341694 DOI: 10.1371/journal.pntd.0009606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/05/2021] [Accepted: 06/29/2021] [Indexed: 01/12/2023] Open
Abstract
An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue virus infection. However, in vaccinees who had no prior dengue virus infection, the vaccine had a modestly elevated risk of hospitalization and severe disease. The WHO therefore recommended a strategy of pre-vaccination screening and vaccination of seropositive persons. To estimate the cost-effectiveness and benefits of this intervention (i.e., screening and vaccination of seropositive persons) in Puerto Rico, we simulated 10 years of the intervention in 9-year-olds using an agent-based model. Across the entire population, we found that 5.5% (4.6%-6.3%) of dengue hospitalizations could be averted. However, we also found that 0.057 (0.045-0.073) additional hospitalizations could occur for every 1,000 people in Puerto Rico due to DENV-naïve children who were vaccinated following a false-positive test results for prior exposure. The ratio of the averted hospitalizations among all vaccinees to additional hospitalizations among DENV-naïve vaccinees was estimated to be 19 (13-24). At a base case cost of vaccination of 382 USD, we found an incremental cost-effectiveness ratio of 122,000 USD per QALY gained. Our estimates can provide information for considerations to introduce the CYD-TDV vaccine in Puerto Rico.
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Affiliation(s)
- Guido España
- University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
| | - Andrew J. Leidner
- Immunization Services Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Stephen H. Waterman
- Dengue Branch, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - T. Alex Perkins
- University of Notre Dame, Notre Dame, Indiana, United States of America
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Falconi-Agapito F, Kerkhof K, Merino X, Michiels J, Van Esbroeck M, Bartholomeeusen K, Talledo M, Ariën KK. Dynamics of the Magnitude, Breadth and Depth of the Antibody Response at Epitope Level Following Dengue Infection. Front Immunol 2021; 12:686691. [PMID: 34290707 PMCID: PMC8289389 DOI: 10.3389/fimmu.2021.686691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
Dengue is a major public health problem in tropical and sub-tropical regions worldwide. Since the Zika epidemic and the increased co-circulation of other arboviruses, the serology-based diagnosis of dengue has become more problematic due to the high antigenic resemblance, especially among the flavivirus family. Therefore, a more comprehensive understanding of the diversity, specificity and temporal evolution of the antibody response following dengue infection is needed. In order to close this knowledge gap, we used a high-density peptide microarray of 9,072 linear peptides covering the entire proteome diversity of dengue, Zika, yellow fever and chikungunya viruses. The IgM and IgG antibody responses were measured against the designed microarray in symptomatic dengue infected individuals from an arbovirus endemic area in Peru and in overseas travelers returning to Belgium, as representatives of multiple-exposed and primary infections, respectively. Serum samples were collected longitudinally across four time points over the period of six months in Peru and over two time points in travelers. We show that epitopes eliciting the strongest flavivirus cross-reactive antibodies, in both primary and secondary infections were concentrated in the capsid, E, NS1, NS3 and NS5 proteins. The IgG antibody responses against NS1 and NS3 followed a rise-and-fall pattern, with peak titers between two to four weeks after onset of illness. The response to the E and NS5 proteins increased rapidly in the acute phase and was maintained at stable levels until at least 6 months after illness. A more scattered IgM antibody reactivity across the viral proteome was observed in the acute phase of the disease and that persisted through the 6-month window. The magnitude, breadth (i.e. number of unique epitopes targeted) and depth (i.e. number of epitope variants recognized) of the IgG response was higher in secondary infections compared to primary infections. For IgM antibodies, the magnitude of the response was higher in primary infected individuals whereas the breadth and depth of the response was lower in this group compared with the endemic subjects. Finally, through this arboviral proteome-wide epitope mapping, we were able to identify IgM and IgG dengue-specific epitopes which can be useful serological markers for dengue diagnosis and serostatus determination.
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Affiliation(s)
- Francesca Falconi-Agapito
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karen Kerkhof
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Xiomara Merino
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Johan Michiels
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, National Reference Center for Arboviruses, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Bartholomeeusen
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael Talledo
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kevin K. Ariën
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Abellana DP. Modelling the interdependent relationships among epidemic antecedents using fuzzy multiple attribute decision making (F-MADM) approaches. OPEN COMPUTER SCIENCE 2021. [DOI: 10.1515/comp-2020-0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
With the high incidence of the dengue epidemic in developing countries, it is crucial to understand its dynamics from a holistic perspective. This paper analyzes different types of antecedents from a cybernetics perspective using a structural modelling approach. The novelty of this paper is twofold. First, it analyzes antecedents that may be social, institutional, environmental, or economic in nature. Since this type of study has not been done in the context of the dengue epidemic modelling, this paper offers a fresh perspective on this topic. Second, the paper pioneers the use of fuzzy multiple attribute decision making (F-MADM) approaches for the modelling of epidemic antecedents. As such, the paper has provided an avenue for the cross-fertilization of knowledge between scholars working in soft computing and epidemiological modelling domains.
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Affiliation(s)
- Dharyll Prince Abellana
- Department of Computer Science , University of the Philippines – Cebu , Cebu City , Cebu , Philippines
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Akbar NA, Assiri AM, Shabouni OI, Alwafi OM, Al-Raddadi R, H. Alzahrani M, Azhar EI, Amir A, Aljiffri AM, Althaqafi AO. The economic burden of dengue fever in the Kingdom of Saudi Arabia. PLoS Negl Trop Dis 2020; 14:e0008847. [PMID: 33253181 PMCID: PMC7728199 DOI: 10.1371/journal.pntd.0008847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/10/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022] Open
Abstract
Rapid urbanization, global trade, and the exceptionally great numbers of worldwide visitors during Hajj and Umrah have all placed the Kingdom of Saudi Arabia at a significant risk of introducing several vector-borne tropical diseases, such as dengue fever virus (DENV) infection. In this study we estimated DENV infection cost of illness (COI) in Saudi Arabia in the period 2013–2017, by processing national data including all declared cases recorded in referral centers in the western region, being the endemic region of the country. Using a statistically validated predictive model that was built on a representative sample of 717 laboratory-confirmed cases of DENV infection, direct costs, due to care-related expenditures, were estimated by applying the predictive equation to national data. However, indirect costs, which are due to productivity loss, were estimated using the human capital model based on gross domestic product adjusted for invalidity duration. Further, under-reporting was adjusted by using an expansion factor EF = 3. We observed highest estimated costs in 2016 with over US$168.5 Million total costs, including direct (US$29.0 Million) and indirect (US$139.5 Million) costs, for a total 4415 confirmed cases. The total DENV COI for the five years was estimated as US$551.0 Million for a total 15,369 patients (59.7%) out of 25,745 declared cases, resulting in an average cost of US$11 947.6 by patient. Depending on the year, productivity years loss costs accounted for 63.3% to 83.8% of the estimated total costs. Dengue has a substantial local economic burden that costs US$110.2 Million per year, stressing the urgent need for an effective national prevention strategy to perform considerable cost-savings besides reducing morbidity. The global incidence of DENV infection has evidenced a dramatic increase in the recent two decades with a great number of cases that are misclassified or underreported. These epidemiological characteristics generate high economic costs, especially in endemic regions and countries such as Saudi Arabia. This two-phase study aimed at providing economic data that helps political efficiency and resource prioritization for dengue prevention programs, by assessing the economic burden of disease over the last five years 2013–2017. A double-method used to estimate direct costs due to care expenses and indirect costs due to productivity loss, by using a predictive and an economic model, respectively. Assuming an expansion factor of 3 to correct under-reporting, the average estimated costs of dengue illness per year in the current study was US$117.87 million. Comparison of these findings with international reports emphasized the substantial disease burden of dengue fever in Saudi Arabia. Despite some limitations, this study provided the first economic data of dengue fever infection burden in Saudi Arabia.
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Affiliation(s)
- Naeema A. Akbar
- Preventive medicine, Public Health MOH, Jeddah, Saudi Arabia
- * E-mail:
| | | | | | - Osama M. Alwafi
- Preventive medicine department, Public Health MOH, Makkah, Saudi Arabia
| | - Rajaa Al-Raddadi
- King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
| | | | - Esam I. Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center & Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ashraf Amir
- Chief Medical Officer, International Medical center, Jeddah, Saudi Arabia
| | - Abdullah M. Aljiffri
- Infection Control Consultant, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulhakeem O. Althaqafi
- Department of medicine, King Abdulaziz Medical city- Jeddah, King Saud bin Abdulaziz university for Health Sciences, King Abdullah Medical center, Saudi Arabia
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Hladish TJ, Pearson CAB, Toh KB, Rojas DP, Manrique-Saide P, Vazquez-Prokopec GM, Halloran ME, Longini IM. Designing effective control of dengue with combined interventions. Proc Natl Acad Sci U S A 2020; 117:3319-3325. [PMID: 31974303 PMCID: PMC7022216 DOI: 10.1073/pnas.1903496117] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Viruses transmitted by Aedes mosquitoes, such as dengue, Zika, and chikungunya, have expanding ranges and seem unabated by current vector control programs. Effective control of these pathogens likely requires integrated approaches. We evaluated dengue management options in an endemic setting that combine novel vector control and vaccination using an agent-based model for Yucatán, Mexico, fit to 37 y of data. Our intervention models are informed by targeted indoor residual spraying (TIRS) experiments; trial outcomes and World Health Organization (WHO) testing guidance for the only licensed dengue vaccine, CYD-TDV; and preliminary results for in-development vaccines. We evaluated several implementation options, including varying coverage levels; staggered introductions; and a one-time, large-scale vaccination campaign. We found that CYD-TDV and TIRS interfere: while the combination outperforms either alone, performance is lower than estimated from their separate benefits. The conventional model hypothesized for in-development vaccines, however, performs synergistically with TIRS, amplifying effectiveness well beyond their independent impacts. If the preliminary performance by either of the in-development vaccines is upheld, a one-time, large-scale campaign followed by routine vaccination alongside aggressive new vector control could enable short-term elimination, with nearly all cases avoided for a decade despite continuous dengue reintroductions. If elimination is impracticable due to resource limitations, less ambitious implementations of this combination still produce amplified, longer-lasting effectiveness over single-approach interventions.
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Affiliation(s)
- Thomas J Hladish
- Department of Biology, University of Florida, Gainesville, FL 32611;
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa 7600
| | - Kok Ben Toh
- School of Natural Resources and Environment, University of Florida, Gainesville, FL 32611
| | - Diana Patricia Rojas
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
- Division of Public Health and Tropical Medicine, James Cook University, Townsville QLD 4814, Australia
| | - Pablo Manrique-Saide
- Collaborative Unit for Entomological Bioassays, Universidad Autónoma de Yucatán, Mérida, Mexico 9700
| | | | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA 98109
- Department of Biostatistics, University of Washington, Seattle, WA 98195
| | - Ira M Longini
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA 98109
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Pearson CAB, Abbas KM, Clifford S, Flasche S, Hladish TJ. Serostatus testing and dengue vaccine cost-benefit thresholds. J R Soc Interface 2019; 16:20190234. [PMID: 31431184 PMCID: PMC6731500 DOI: 10.1098/rsif.2019.0234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The World Health Organization (WHO) currently recommends pre-screening for past infection prior to administration of the only licensed dengue vaccine, CYD-TDV. Using a threshold modelling analysis, we identify settings where this guidance prohibits positive net-benefits, and are thus unfavourable. Generally, however, our model shows test-then-vaccinate strategies can improve CYD-TDV economic viability: effective testing reduces unnecessary vaccination costs while increasing health benefits. With sufficiently low testing cost, those trends outweigh additional screening costs, expanding the range of settings with positive net-benefits. This work highlights two aspects for further analysis of test-then-vaccinate strategies. We found that starting routine testing at younger ages could increase benefits; if real tests are shown to sufficiently address safety concerns, the manufacturer, regulators and WHO should revisit guidance restricting use to 9-years-and-older recipients. We also found that repeat testing could improve return-on-investment (ROI), despite increasing intervention costs. Thus, more detailed analyses should address questions on repeat testing and testing periodicity, in addition to real test sensitivity and specificity. Our results follow from a mathematical model relating ROI to epidemiology, intervention strategy, and costs for testing, vaccination and dengue infections. We applied this model to a range of strategies, costs and epidemiological settings pertinent to CYD-TDV. However, general trends may not apply locally, so we provide our model and analyses as an R package available via CRAN, denvax. To apply to their setting, decision-makers need only local estimates of age-specific seroprevalence and costs for secondary infections.
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Affiliation(s)
- Carl A. B. Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa,e-mail:
| | - Kaja M. Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel Clifford
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas J. Hladish
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
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