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Pietrzak M, Pokorska-Śpiewak M. Impact of COVID-19 Pandemic on the Clinical Course and Complications of Varicella-A Retrospective Cohort Study. Pediatr Rep 2024; 16:451-460. [PMID: 38921704 PMCID: PMC11206722 DOI: 10.3390/pediatric16020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 06/27/2024] Open
Abstract
In this study, we aimed to characterize a cohort of children hospitalized due to varicella before and after the outbreak of the COVID-19 pandemic. Medical charts of all children hospitalized in the Regional Hospital of Infectious Diseases in Warsaw due to varicella in the years 2019 and 2022 were retrospectively analyzed and compared. In total, 221 children were included in the analysis; 59 of them were hospitalized in 2019, whereas 162 were hospitalized in 2022. Children hospitalized in 2022 were older than those reported in 2019 (median 4.0 vs. 3.0 years, p = 0.02). None of the hospitalized children received complete varicella vaccination. The most common complication in both years was bacterial superinfection of skin lesions, found in 156/221 (70.6%) of patients. This complication rate was higher in 2022 (50.8% in 2019 vs. 77.8% in 2022, p = 0.0001), OR = 3.38, 95% CI: 1.80-6.35. Moreover, skin infections in 2022 more often manifested with cellulitis (in 2022 13.6% vs. 3.4% in 2019, p = 0.03), OR = 4.40, 95% CI: 1.00-19.33. Sepsis as a complication of varicella was almost five-fold more prevalent in 2022 than in 2019 (p = 0.009), OR = 5.70, 95% CI: 1.31-24.77. Antibiotic use increased between 2019 and 2022 (71.2% vs. 85.2%, p = 0.01). Furthermore, patients were treated more frequently with the combination of two different antibiotics simultaneously (only 3.4% of patients in 2019 compared to 15.4% in 2022, p = 0.01). Primary infections with varicella zoster virus in 2022 led to a more severe course of the disease.
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Affiliation(s)
- Maja Pietrzak
- Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland;
| | - Maria Pokorska-Śpiewak
- Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland;
- Department of Children’s Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
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Ahern S, Browne J, Murphy A, Teljeur C, Ryan M. An economic evaluation and incremental analysis of the cost effectiveness of three universal childhood varicella vaccination strategies for Ireland. Vaccine 2024; 42:3321-3332. [PMID: 38609807 DOI: 10.1016/j.vaccine.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The cost effectiveness of childhood varicella vaccination is uncertain, as evidenced by variation in national health policies. Within the European Economic Area (EEA), only 10 of 30 countries offer universally funded childhood varicella vaccination. This study estimates the cost effectiveness of universal childhood varicella vaccination for one EEA country (Ireland), highlighting the difference in cost effectiveness between alternative vaccination strategies. METHODS An age-structured dynamic transmission model, simulating varicella zoster virus transmission, was developed to analyse the impact of three vaccination strategies; one-dose at 12 months old, two-dose at 12 and 15 months old (short-interval), and two-dose at 12 months and five years old (long-interval). The analysis adopted an 80-year time horizon and considered payer and societal perspectives. Clinical effectiveness was based on cases of varicella and subsequently herpes zoster and post-herpetic neuralgia avoided, and outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented in 2022 Irish Euro and cost effectiveness was interpreted with reference to a willingness-to-pay threshold of €20,000 per QALY gained. RESULTS From the payer perspective, the incremental cost-effectiveness ratio (ICER) for a one-dose strategy, compared with no vaccination, was estimated at €8,712 per QALY gained. The ICER for the next least expensive strategy, two-dose long-interval, compared with one-dose, was estimated at €45,090 per QALY gained. From a societal perspective, all three strategies were cost-saving compared with no vaccination; the two-dose short-interval strategy dominated, yielding the largest cost savings and health benefits. Results were stable across a range of sensitivity and scenario analyses. CONCLUSION A one-dose strategy was highly cost effective from the payer perspective, driven by a reduction in hospitalisations. Two-dose strategies were cost saving from the societal perspective. These results should be considered alongside other factors such as acceptability of a new vaccine within the overall childhood immunisation schedule, programme objectives and budget impact.
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Affiliation(s)
- Susan Ahern
- School of Public Health, College of Medicine and Health, University College Cork, College Road, Cork, Ireland; Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.
| | - John Browne
- School of Public Health, College of Medicine and Health, University College Cork, College Road, Cork, Ireland.
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, College Road, Cork, Ireland.
| | - Conor Teljeur
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.
| | - Máirín Ryan
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland; Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, James Street, Dublin 8, Ireland.
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Kujawski SA, Casey CS, Haas H, Patel A, Diomatari C, Holbrook T, Pawaskar M. Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France. Pediatr Infect Dis J 2024; 43:393-399. [PMID: 38456715 PMCID: PMC10919277 DOI: 10.1097/inf.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. METHODS A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. RESULTS Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. CONCLUSION This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.
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Affiliation(s)
- Stephanie A. Kujawski
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Hervé Haas
- Department of Pediatrics and Neonatalogy, Centre Hospitalier Princesse Grace, Monaco
| | | | | | | | - Manjiri Pawaskar
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
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4
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Shah HA, Meiwald A, Perera C, Casabona G, Richmond P, Jamet N. Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis. Infect Dis Ther 2024; 13:79-103. [PMID: 38117427 PMCID: PMC10828225 DOI: 10.1007/s40121-023-00899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Varicella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella symptoms are usually self-limiting; however, different complications with widespread and systemic manifestations can occur. This systematic literature review aims to explore and quantify varicella-associated complication rates. METHODS Two databases (Embase and MEDLINE), congress abstracts, and reference lists of systematic reviews were screened to identify evidence on varicella complications. Complications were identified and grouped into 14 clinically relevant categories. Proportional meta-analyses were conducted using a random-effects model and tests for heterogeneity and publication bias were performed. Subgroup, sensitivity, and meta-regression analyses were also conducted. A total of 78 studies, spanning 30 countries, were included in the meta-analysis. RESULTS Pooled prevalence was highest in severe varicella (22.42%; 95% confidence interval [CI] 10.13-37.77), skin-related complications (20.12%; 95% CI 15.48-25.20), and infection-related complications (10.03%; 95% CI 7.47-12.90). Cardiovascular (0.55%; 95% CI 0.08-1.33), genitourinary (1.17%; 95% CI 0.55-1.99), and musculoskeletal (1.54%; 95% CI 1.06-2.11) complications had the lowest pooled prevalence. The remaining complication categories ranged between 1% and 10%. Subgroup analysis showed that complications were more prevalent in children versus adults and in hospitalized patients versus outpatients. Meta-regression analysis found that no ecological level covariates were accurate predictors for the overall prevalence of varicella-associated complications. There was substantial heterogeneity and publication bias across all meta-analyses. CONCLUSION Results suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease.
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Affiliation(s)
| | | | | | | | - Peter Richmond
- University of Western Australia School of Medicine, Telethon Kids Institute and Perth Children's Hospital, Nedlands, Australia
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Williame I, George M, Shah HA, Homer N, Alderson D, Jamet N. Healthcare resource use and costs of varicella and its complications: A systematic literature review. Hum Vaccin Immunother 2023; 19:2266225. [PMID: 37885425 PMCID: PMC10760364 DOI: 10.1080/21645515.2023.2266225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Varicella is a highly contagious disease caused by the varicella zoster virus (VZV). While the disease is usually mild, severe complications can occur requiring costly hospitalization. A thorough understanding of the healthcare resource use (HCRU) and costs of varicella is needed to inform health-economic models of preventive strategies. A systematic literature review was carried out to retrieve relevant publications between 1999 and 2021, reporting HCRU and cost outcomes for varicella and its complications. Data were extracted and stratified according to pre-specified age groups and complication categories. Costs were re-based to a $US2020 footing using both purchasing power parity and the medical component of consumer price indexes. Data were summarized descriptively due to high heterogeneity in study design and outcome reporting. Forty-four publications fulfilled the inclusion and exclusion criteria of which 28 were conducted in Europe, 6 in Middle East and Asia, 5 in South America, 3 in North America, and 2 in multiple regions. Primary healthcare visits accounted for 30% to 85% of total direct costs. Hospitalization costs varied between $1,308 and $38,268 per episode depending on country, complication type, and length of stay, contributing between 2% and 60% to total direct costs. Indirect costs, mostly driven by workdays lost, accounted for approximately two-thirds of total costs due to varicella. The management of varicella and related complications can lead to substantial HCRU and costs for patients and the healthcare system. Additional research is needed to further characterize the varicella-associated economic burden and its broader impact from a societal standpoint.
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Burgess C, Samant S, leFevre T, Schade Larsen C, Pawaskar M. Universal varicella vaccination in Denmark: Modeling public health impact, age-shift, and cost-effectiveness. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001743. [PMID: 37018165 PMCID: PMC10075481 DOI: 10.1371/journal.pgph.0001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/01/2023] [Indexed: 04/06/2023]
Abstract
We modeled the long-term clinical and economic impact of two-dose universal varicella vaccination (UVV) strategies in Denmark using a dynamic transmission model. The cost-effectiveness of UVV was evaluated along with the impact on varicella (including age-shift) and herpes zoster burden. Six two-dose UVV strategies were compared to no vaccination, at either short (12/15 months) or medium (15/48 months) intervals. Monovalent vaccines (V-MSD or V-GSK) for the 1st dose, and either monovalent or quadrivalent vaccines (MMRV-MSD or MMRV-GSK) for the 2nd dose were considered. Compared to no vaccination, all two-dose UVV strategies reduced varicella cases by 94%-96%, hospitalizations by 93%-94%, and deaths by 91%-92% over 50 years; herpes zoster cases were also reduced by 9%. There was a decline in the total number of annual varicella cases in all age groups including adolescents and adults. All UVV strategies were cost-effective compared to no vaccination, with ICER values ranging from €18,228-€20,263/QALY (payer perspective) and €3,746-€5,937/QALY (societal perspective). The frontier analysis showed that a two-dose strategy with V-MSD (15 months) and MMRV-MSD (48 months) dominated all other strategies and was the most cost-effective. In conclusion, all modeled two-dose UVV strategies were projected to substantially reduce the clinical and economic burden of varicella disease in Denmark compared to the current no vaccination strategy, with declines in both varicella and zoster incidence for all age groups over a 50-year time horizon.
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Affiliation(s)
| | - Salome Samant
- Merck & Co., Inc., Rahway, NJ, United States of America
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Rodrigues F, Marlow R, Gouveia C, Correia P, Brett A, Silva C, Gameiro I, Rua I, Dias J, Martins M, Diogo R, Lopes T, Hipólito E, Moreira D, Costa Alves M, Prata F, Labrusco M, Gomes S, Fernandes A, Andrade A, Granjo Morais C, João Virtuoso M, Manuel Zarcos M, Teresa Raposo A, Boon A, Finn A. Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella. Vaccine 2023; 41:1182-1189. [PMID: 36522267 DOI: 10.1016/j.vaccine.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/06/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND AIMS Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection. METHODS Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs. RESULTS Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower. CONCLUSIONS The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.
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Affiliation(s)
- Fernanda Rodrigues
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
| | - Robin Marlow
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, BS2 8AE, UK
| | - Catarina Gouveia
- Hospital D. Estefânia, Centro Hospitalar Lisboa Central, Rua Jacinta Marto, 1150-191 Lisboa, Portugal
| | - Paula Correia
- Hospital Prof. Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Ana Brett
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Catarina Silva
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Inês Gameiro
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Inês Rua
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - João Dias
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Marta Martins
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Rui Diogo
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Teresa Lopes
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Elsa Hipólito
- Hospital Infante D. Pedro, Av. Dr. Artur Ravara, 3810-164 Aveiro, Portugal
| | - Diana Moreira
- Centro Hospitalar de Vila Nova de Gaia/Espinho (Unidade 2), Rua Dr. Francisco Sá Carneiro, 4400-129 Vila Nova de Gaia, Portugal
| | - Manuela Costa Alves
- Hospital de Braga, Rua das Comunidades Lusíadas 133, 4710-243 Braga, Portugal
| | - Filipa Prata
- Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Miguel Labrusco
- Hospital Beatriz Ângelo, Av. Carlos Teixeira, 2674-514 Loures, Portugal
| | - Susana Gomes
- Hospital do Espírito Santo, Largo Senhor da Pobreza, 7000-811 Évora, Portugal
| | - Alexandre Fernandes
- Centro Materno Infantil do Norte, Largo da Maternidade de Júlio Dinis, 4050-651 Porto, Portugal
| | - Alexandra Andrade
- Hospital Nélio Mendonça, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal
| | - Catarina Granjo Morais
- Centro Hospitalar e Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Maria João Virtuoso
- Hospital de Faro, Centro Hospitalar e Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Maria Manuel Zarcos
- Hospital de Santo André, Centro Hospitalar Leiria Pombal, Rua de Santo André, 2410-197 Leiria, Portugal
| | - Ana Teresa Raposo
- Hospital do Divino Espírito Santo, Av. D. Manuel I, 9500-370 Ponta Delgada, Portugal
| | - Adam Boon
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, BS2 8AE, UK
| | - Adam Finn
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, BS2 8AE, UK
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Galanis P, Vraka I, Katsiroumpa A, Siskou O, Konstantakopoulou O, Zogaki E, Kaitelidou D. Psychosocial Predictors of COVID-19 Vaccine Uptake among Pregnant Women: A Cross-Sectional Study in Greece. Vaccines (Basel) 2023; 11:269. [PMID: 36851147 PMCID: PMC9967309 DOI: 10.3390/vaccines11020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
An understanding of the factors associated with the COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against COVID-19. We estimated the vaccination rate of pregnant women against COVID-19 and evaluated psychosocial factors associated with vaccine uptake among them. We conducted a cross-sectional study with a convenience sample. In particular, we investigated socio-demographic data of pregnant women (e.g., age, marital status, and educational level), COVID-19 related variables (e.g., previous COVID-19 diagnosis and worry about the side effects of COVID-19 vaccines), and stress due to COVID-19 (e.g., danger and contamination fears, fears about economic consequences, xenophobia, compulsive checking and reassurance seeking, and traumatic stress symptoms about COVID-19) as possible predictors of COVID-19 vaccine uptake. Among pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of the COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to the fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated. An understanding of the psychosocial factors associated with increased COVID-19 vaccine uptake in pregnant women could be helpful for policy makers and healthcare professionals in their efforts to persuade women to get vaccinated against COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce vaccine hesitancy in pregnancy.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleftheria Zogaki
- Faculty of Midwifery, University of West Attica, West Attica, 12243 Aigaleo, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Pawaskar M, Fergie J, Harley C, Samant S, Veeranki P, Diaz O, Conway JH. Impact of universal varicella vaccination on the use and cost of antibiotics and antivirals for varicella management in the United States. PLoS One 2022; 17:e0269916. [PMID: 35687559 PMCID: PMC9187103 DOI: 10.1371/journal.pone.0269916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Our objective was to estimate the impact of universal varicella vaccination (UVV) on the use and costs of antibiotics and antivirals for the management of varicella among children in the United States (US).
Methods
A decision tree model of varicella vaccination, infections and treatment decisions was developed. Results were extrapolated to the 2017 population of 73.5 million US children. Model parameters were populated from published sources. Treatment decisions were derived from a survey of health care professionals’ recommendations. The base case modelled current vaccination coverage rates in the US with additional scenarios analyses conducted for 0%, 20%, and 80% coverage and did not account for herd immunity benefits.
Results
Our model estimated that 551,434 varicella cases occurred annually among children ≤ 18 years in 2017. Antivirals or antibiotics were prescribed in 23.9% of cases, with unvaccinated children receiving the majority for base case. The annual cost for varicella antiviral and antibiotic treatment was approximately $14 million ($26 per case), with cases with no complications accounting for $12 million. Compared with the no vaccination scenario, the current vaccination rates resulted in savings of $181 million (94.7%) for antivirals and $78 million (95.0%) for antibiotics annually. Scenario analyses showed that higher vaccination coverage (from 0% to 80%) resulted in reduced annual expenditures for antivirals (from $191 million to $41 million), and antibiotics ($82 million to $17 million).
Conclusions
UVV was associated with significant reductions in the use of antibiotics and antivirals and their associated costs in the US. Higher vaccination coverage was associated with lower use and costs of antibiotics and antivirals for varicella management.
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Affiliation(s)
- Manjiri Pawaskar
- Merck & Co. Inc., Rahway, New Jersey, United States of America
- * E-mail:
| | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas, United States of America
| | - Carolyn Harley
- PRECISIONheor, Los Angeles, California, United States of America
| | - Salome Samant
- Merck & Co. Inc., Rahway, New Jersey, United States of America
| | - Phani Veeranki
- PRECISIONheor, Los Angeles, California, United States of America
| | - Oliver Diaz
- PRECISIONheor, Los Angeles, California, United States of America
| | - James H. Conway
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
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