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Coulter J, Whichello C, Heidenreich S, Hauber B, Michaels-Igbokwe C, Cappelleri JC, Peyrani P, Vespa Presa J, Venkatraman M, Schley K. From Qualitative Research to Quantitative Preference Elicitation: An Example in Invasive Meningococcal Disease. THE PATIENT 2024; 17:319-333. [PMID: 38388957 PMCID: PMC11039532 DOI: 10.1007/s40271-024-00677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Qualitative research is fundamental for designing discrete choice experiments (DCEs) but is often underreported in the preference literature. We developed a DCE to elicit preferences for vaccination against invasive meningococcal disease (IMD) among adolescents and young people (AYP) and parents and legal guardians (PLG) in the United States. This article reports the targeted literature review and qualitative interviews that informed the DCE design and demonstrates how to apply the recent reporting guidelines for qualitative developmental work in preference studies. METHODS This study included two parts: a targeted literature review and qualitative interviews. The Medline and Embase databases were searched for quantitative and qualitative studies on IMD and immunization. The results of the targeted literature review informed a qualitative interview guide. Sixty-minute, online, semi-structured interviews with AYP and PLG were used to identify themes related to willingness to be vaccinated against IMD. Participants were recruited through a third-party recruiter's database and commercial online panels. Interviews included vignettes about IMD and vaccinations and three thresholding exercises examining the effect of incidence rate, disability rate, and fatality rate on vaccination preferences. Participant responses related to the themes were counted. RESULTS The targeted literature review identified 31 concepts that were synthesized into six topics for the qualitative interviews. Twenty AYP aged 16-23 years and 20 PLG of adolescents aged 11-17 years were interviewed. Four themes related to willingness to be vaccinated emerged: attitudes towards vaccination, knowledge and information, perception of IMD, and vaccine attributes. Most participants were concerned about IMD (AYP 60%; PLG 85%) and had positive views of vaccination (AYP 80%; PLG 60%). Ninety percent of AYP and 75% of PLG always chose vaccination over no vaccination, independent of IMD incidence rate, disability rate, or fatality rate. CONCLUSION Willingness to be vaccinated against IMD was affected by vaccine attributes but largely insensitive to IMD incidence and severity. This article provides an example of how to apply the recent reporting guidelines for qualitative developmental work in preference studies, with 21 out of 22 items in the guidelines being considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Katharina Schley
- Pfizer Pharma GmbH, Friedrichstrasse 110, 10117, Berlin, Germany.
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Pérez Martín JJ, Zornoza Moreno M, Tornel Miñarro FI, Gómez Moreno MC, Valcárcel Gómez MDC, Pérez Martínez M. Influenza Vaccination in Children Younger than 5 Years in the Region of Murcia (Spain), a Comparative Analysis among Vaccinating and Non-Vaccinating Parents: Data from the FLUTETRA Study. Vaccines (Basel) 2024; 12:192. [PMID: 38400175 PMCID: PMC10892024 DOI: 10.3390/vaccines12020192] [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: 01/17/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The high burden of influenza in children has driven numerous countries towards universal vaccination of healthy children from 6 to 59 months of age. The Region of Murcia was one of the pioneer Spanish regions to conduct a universal vaccination campaign and to use live-attenuated intranasal vaccine (LAIV) if age appropriate. This study aims to evaluate the parents' likeliness to vaccinate their children and to compare the profile of vaccinating/non-vaccinating parents. This study was designed as a prospective, real-world, survey-based data collection in the 2022-2023 season campaign. This study's sample was selected from those children whose information was available in the local Public Health System databases PERSAN and VACUSAN. Children received LAIV or intramuscular vaccine (IIV) depending on their age as per standard practice. The parent self-vaccination/intention to vaccinate themselves in this campaign (OR = 4.75), the compliance with the official vaccination schedule (OR = 3.41), and the prescription of antibiotics more than twice in the previous year (OR = 2.24) were strongly associated with children's vaccination. Overall, vaccinating parents were very satisfied with the vaccine (IIV: 67.5% vs. LAIV: 68.8%, p = 0.320), and most parents would rather have their children vaccinated with LAIV for the next campaign (43.0%). The main reasons for vaccinating were to protect the child (LAIV: 85.9% vs. IIV: 89.4%), and the predominant reasons for not vaccinating were a lack of healthcare professional recommendation (30.9%), and lack of information about the vaccination campaign (21.5%) and the vaccine itself (21.0%). The clinical context of parents and children was determinant in decision making, which was also influenced by the presence or absence of recommendation by healthcare professionals. Parents were generally very satisfied with the vaccine and showed their preference towards LAIV for future campaigns.
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Affiliation(s)
| | - Matilde Zornoza Moreno
- Affiliation Vaccination Program, Prevention and Health Protection Service, Public Health and Addictions Directorate General, Region of Murcia Ministry of Health, 30008 Murcia, Spain; (J.J.P.M.); (F.I.T.M.); (M.C.G.M.); (M.d.C.V.G.); (M.P.M.)
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Chan PSF, Fang Y, Kawuki J, Chen S, Liang X, Mo PKH, Wang Z. Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6-59 Months: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1360. [PMID: 37631928 PMCID: PMC10459009 DOI: 10.3390/vaccines11081360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
This systematic review and meta-analysis summarises the literature on parental acceptance, parental hesitancy, uptake, and the associated factors of seasonal influenza vaccination (SIV) among children aged 6-59 months. Studies were sourced from the following platforms: PubMed, Web of Science, MEDLINE, and EMBASE databases. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of parental acceptance, parental hesitancy, and SIV uptake in the last flu season and lifetime among children. A total of 36 studies were included for analysis. The overall prevalence was 64% for parental acceptance (95% CI: 51-75%), 34% for parental hesitancy (95% CI: 22-48%), 41% for SIV uptake in the last flu season (95% CI: 33-50%), and 46% for SIV uptake in a lifetime (95% CI: 20-74%). Associated factors of parental acceptance/hesitancy and uptake included the age of the children or parents, parental education level, household income level, ethnicity, and other modifiable factors, including perceived benefits, perceived barriers, perceived severity, perceived susceptibility, and cues to action related to SIV. Meta-regression analyses revealed regional differences in parental acceptance (Americas: 79% vs. Asia: 60%). The results provided implications informing us of the development of intervention programs targeting parents to improve SIV coverage among young children.
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Affiliation(s)
- Paul Shing-fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China;
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Xue Liang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Phoenix Kit-han Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
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Ballalai I, Dawson R, Horn M, Smith V, Bekkat-Berkani R, Soumahoro L, Vicic N. Understanding barriers to vaccination against invasive meningococcal disease: a survey of the knowledge gap and potential solutions. Expert Rev Vaccines 2023; 22:457-467. [PMID: 37144283 DOI: 10.1080/14760584.2023.2211163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a leading cause of life-threatening bacterial meningitis and septicemia. Evidence points to a knowledge gap among parents, teenagers, and healthcare providers (HCPs) regarding IMD and available vaccines, including those against the highly prevalent serogroup B. AREAS COVERED An online survey was conducted between March 27 and April 12, 2019, to gather insights into the knowledge that parents/guardians have about IMD vaccines. The children were aged 2 months-10 years in Australia, Brazil, Germany, Greece, Italy, and Spain, 5-20 years in the UK, and 16-23 years in the US. The findings were discussed in the context of the available literature and solutions were proposed to minimize the knowledge gap and the barriers to vaccination against IMD. EXPERT OPINION The survey demonstrated that parents have a good understanding of IMD but a limited understanding of the different serogroups and vaccines. The available literature highlighted multiple barriers to IMD vaccine uptake; these may be reduced through education of HCPs, clear recommendations to parents by HCPs, the use of technology, and disease-awareness initiatives that engage parents through physical and digital channels. Further studies are warranted to assess the impact of the COVID-19 pandemic on IMD vaccination.
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Affiliation(s)
| | - Rob Dawson
- Meningitis Research Foundation, Bristol, UK
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Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019). Vaccines (Basel) 2023; 11:vaccines11030508. [PMID: 36992092 DOI: 10.3390/vaccines11030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Despite its effectiveness in preventing invasive meningococcal disease (IMD), pediatric uptake of recombinant meningococcal vaccination for serogroup B meningitis (MenB) is low in Italy. This study aimed to investigate knowledge, attitudes, and practice (KAP) about IMD and the vaccine uptake for MenB from July to December 2019, in a sample collected from a series of local Facebook discussion groups from the provinces of Parma and Reggio Emilia (North-Eastern Italy; 337,104 registered users). A self-administered anonymous web-based questionnaire was used to collect demographics, knowledge status, perceived risk for contracting meningitis, attitude towards the utility of meningococcal vaccine, and willingness to receive/perform MenB vaccine in their offspring. In total, 541 parents returned a fully completed questionnaire (response rate of 1.6% of potential recipients), with a mean age of 39.2 years ± 6.3 (78.1% females). Meningococcal infection was identified as severe or highly severe by most participants (88.9%), while it was recognized as being frequent/highly frequent in the general population by 18.6% of respondents. The overall knowledge status was unsatisfactory (57.6% ± 33.6 of correct answers to the knowledge test). Even though 63.4% of participants were somewhat favorable to MenB/MenC vaccines, offspring’s vaccination towards MenB was reported by only 38.7% of participants. In a binary logistic regression model, the male gender of respondents (adjusted odds ratio [aOR] 3.184, 95% confidence interval [95%CI] 1.772 to 5.721), living in a municipality >15,000 inhabitants (aOR 1.675, 95%CI 1.051 to 2.668), reporting a favorable attitude on meningococcus B vaccine (aOR 12.472, 95%CI 3.030 to 51.338), having been vaccinated against serogroup B (aOR 5.624, 95%CI 1.936 to 16.337) and/or serogroup C (aOR 2.652, 95%CI 1.442 to 4.872), and having previously vaccinated their offspring against serogroup C meningococcus (aOR 6.585, 95%CI 3.648 to 11.888) were characterized as positive effectors of offspring’s vaccination. On the contrary, having a higher risk perception on vaccines was identified as the only negative effector (aOR 0.429, 95%CI 0.241 to 0.765). Our results hint towards extensive knowledge gaps on IMD and preventive interventions in the general population, suggesting that a positive attitude towards vaccines and vaccinations could be identified as the main effector also for MenB acceptance. Interventions in the general population aimed at improving confidence, compliance, and acknowledgment of the collective responsibility, as well as preventing actual constraints and the sharing of false beliefs on infectious diseases and their preventive measures, could therefore increase vaccination acceptance in both targeted individuals and their offspring.
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Shahani R, Chu J, Rufai OH, Zawar A, Muhideen S, Dilawar S, Amosun TS. Understanding the Role of Psychosocial Factors in Pakistani Parents' Hesitancy to Vaccinate Their Kids: The Mediating Role of Knowledge and Mistrust of Science about the COVID-19 Vaccine. Vaccines (Basel) 2022; 10:1260. [PMID: 36016148 PMCID: PMC9413987 DOI: 10.3390/vaccines10081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccination is a vital component in the battle against outbreaks of infectious diseases. Recognizing parents' reluctance to vaccinate their children is even more critical now, given the ongoing threat of a COVID-19 pandemic. Conspiracy theories, vaccination safety concerns, parental efficacy and risk perception, and a lack of confidence in science all influence intention. To investigate how these variables interact with vaccination behavior against COVID-19, we developed a model with psychosocial factors serving as the predictor and mistrust in science and vaccine knowledge serving as the mediator. In order to validate the model, the parents' intentions regarding their children's vaccination with COVID-19 were used. The study included 454 Pakistani parents who completed an online questionnaire assessing their intention to vaccinate their children. We analyzed the data using structural equation modeling (SEM). A significant level of vaccine hesitation is due to belief in vaccine conspiracy theories, and vaccine safety concerns were investigated. A surprising correlation exists between risk perception and vaccination intentions, followed by parental self-efficacy. It is significant to note that vaccine knowledge mediated conspiracy beliefs, risk perceptions, and intentions fully but partially mediated parental self-efficacy. Conspiracy theories were mediated by a mistrust in science, while perceptions of risk and vaccine safety were partially mediated. The findings of this research were used to develop sensible policy reforms and public health campaigns to encourage vaccination against both common infections such as measles, human papillomaviruses, or pertussis, and novel diseases such as COVID-19.
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Affiliation(s)
- Riffat Shahani
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Jianxun Chu
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Olayemi Hafeez Rufai
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Asma Zawar
- School of Public Affairs, University of Science and Technology of China, Hefei 230052, China
| | - Sayibu Muhideen
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Sana Dilawar
- School of Public Affairs, University of Science and Technology of China, Hefei 230052, China
| | - Tunde Simeon Amosun
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
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Arnheim-Dahlström L, Zarabi N, Hagen K, Bencina G. Parental acceptance and knowledge of varicella vaccination in relation to socioeconomics in Sweden: A cross-sectional study. PLoS One 2021; 16:e0256642. [PMID: 34673809 PMCID: PMC8530319 DOI: 10.1371/journal.pone.0256642] [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: 02/12/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
Varicella infection is a highly contagious disease which, whilst mild in most cases, can cause severe complications. Varicella vaccination is available privately in Sweden and is currently being reviewed for inclusion in the Swedish Public Health Agency's national immunisation program (NIP). A cross-sectional study of parents of Swedish children aged 1-8 years (n = 2212) was conducted to understand parental acceptance, beliefs and knowledge around varicella infection and vaccination. Respondents generally viewed varicella infection as a mild disease, with only a small proportion aware of potential severe complications. While 65% of respondents were aware of the vaccine, only 15% had started the course of vaccination as of February 2019. Further, 43% of parents did not intend to vaccinate, most commonly due to lack of inclusion in the NIP, but also due to perception of mild disease. Nevertheless, if offered within the NIP, 85% of parents would be highly likely to vaccinate their child. A number of statistically significant differences in awareness and behaviours were observed between sociodemographic subgroups. In general, women were more aware of vaccination (72%) compared to men (58%). Among unemployed or respondents with elementary school education, awareness was below 43%, and among respondents with high income the awareness was above 75%. Similarly, among unemployed or respondents with a low income the vaccination rate was as low as 30% compared with at least 57% among respondents with a high income. Respondents from metropolitan areas, those with university degrees and respondents with a higher income were more likely to be aware of the varicella vaccine and to have vaccinated their child. Whilst inclusion in the NIP is clearly the main driver for uptake, these identified knowledge gaps should inform educational efforts to ensure that all parents are informed of the availability and benefits of the varicella vaccine independent of socioeconomic status.
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Caso D, Capasso M, Fabbricatore R, Conner M. Understanding the psychosocial determinants of Italian parents' intentions not to vaccinate their children: an extended theory of planned behaviour model. Psychol Health 2021; 37:1111-1131. [PMID: 34180333 DOI: 10.1080/08870446.2021.1936522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to identify the psychosocial factors involved in Italian parents' intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children. DESIGN Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality. RESULTS Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children. CONCLUSION These findings provide support for the validity of the proposed extended TPB model in explaining parents' intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.
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Affiliation(s)
- Daniela Caso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Miriam Capasso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Rosa Fabbricatore
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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Szmuda T, Talha SM, Singh A, Ali S, Słoniewski P. YouTube as a source of patient information for meningitis: A content-quality and audience engagement analysis. Clin Neurol Neurosurg 2021; 202:106483. [PMID: 33497948 DOI: 10.1016/j.clineuro.2021.106483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Now that the internet is more accessible to an increasing number of populations worldwide, many rely on the internet for their information about their daily lives. This includes people concerned about their health to students to sometimes also doctors. Since YouTube is the second most visited website, our aim was to evaluate the content-quality of YouTube videos relating to meningitis. METHODS We chose the first 30 videos for four different search phrases: meningitis, bacterial meningitis, viral meningitis, fungal meningitis and meningitis signs. The validated DISCERN scoring criteria was used to assess the videos by two raters independently. Qualitative data, quantitative data and the source of upload of each video were analyzed for video quality and audience engagement. RESULTS Out of 150 videos, 84 videos met the inclusion criteria. The mean DISCERN score was 34.6 ± 9.76 (out of a total 75), which indicates that the quality of YouTube videos on meningitis is poor. There is an excellent reliability between the two raters. Videos had a higher audience engagement via a greater number of daily views and comments when they included the definition, symptoms, prognosis, animation, diagrams, and an anatomical explanation of the meninges (P < 0.0001 for all). CONCLUSION The quality of YouTube videos on meningitis is poor, however, we have listed the videos which may be most effective for patient education for reference. Our quality and engagement analysis may help content creators make better health content on meningitis.
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Affiliation(s)
- Tomasz Szmuda
- Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland
| | - Syed Mohammad Talha
- Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland.
| | - Akshita Singh
- Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland
| | - Shan Ali
- Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland
| | - Paweł Słoniewski
- Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland
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van Lier A, de Gier B, McDonald SA, Mangen MJJ, van Wijhe M, Sanders EAM, Kretzschmar ME, van Vliet H, de Melker HE. Disease burden of varicella versus other vaccine-preventable diseases before introduction of vaccination into the national immunisation programme in the Netherlands. ACTA ACUST UNITED AC 2020; 24. [PMID: 31064637 PMCID: PMC6505181 DOI: 10.2807/1560-7917.es.2019.24.18.1800363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction Estimating burden of disease (BoD) is an essential first step in the decision-making process on introducing new vaccines into national immunisation programmes (NIPs). For varicella, a common vaccine-preventable disease, BoD in the Netherlands was unknown. Aim To assess national varicella BoD and compare it to BoD of other vaccine-preventable diseases before their introduction in the NIP. Methods In this health estimates reporting study, BoD was expressed in disability-adjusted life years (DALYs) using methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project. As no parameters/disease model for varicella (including herpes zoster) were available in the BCoDE toolkit, incidence, disease progression model and parameters were derived from seroprevalence, healthcare registries and published data. For most other diseases, BoD was estimated with existing BCoDE-parameters, adapted to the Netherlands if needed. Results In 2017, the estimated BoD of varicella in the Netherlands was 1,800 (95% uncertainty interval (UI): 1,800–1,900) DALYs. Herpes zoster mainly contributed to this BoD (1,600 DALYs; 91%), which was generally lower than the BoD of most current NIP diseases in the year before their introduction into the NIP. However, BoD for varicella was higher than for rotavirus gastroenteritis (1,100; 95%UI: 440–2,200 DALYs) and meningococcal B disease (620; 95%UI: 490–770 DALYs), two other potential NIP candidates. Conclusions When considering the introduction of a new vaccine in the NIP, BoD is usually estimated in isolation. The current approach assesses BoD in relation to other vaccine-preventable diseases’ BoD, which may help national advisory committees on immunisation and policymakers to set vaccination priorities.
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Affiliation(s)
- Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marie-Josée J Mangen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Maarten van Wijhe
- Department of Science and Environment, Roskilde University, Roskilde, Denmark.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Elisabeth A M Sanders
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht (UMCU), Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Hans van Vliet
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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de Boer PT, Backer JA, van Hoek AJ, Wallinga J. Vaccinating children against influenza: overall cost-effective with potential for undesirable outcomes. BMC Med 2020; 18:11. [PMID: 31931789 PMCID: PMC6958762 DOI: 10.1186/s12916-019-1471-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The present study aims to assess the cost-effectiveness of an influenza vaccination program for children in the Netherlands. This requires an evaluation of the long-term impact of such a program on the burden of influenza across all age groups, using a transmission model that accounts for the seasonal variability in vaccine effectiveness and the shorter duration of protection following vaccination as compared to natural infection. METHODS We performed a cost-effectiveness analysis based on a stochastic dynamic transmission model that has been calibrated to reported GP visits with influenza-like illness in the Netherlands over 11 seasons (2003/2004 to 2014/2015). We analyzed the costs and effects of extending the current program with vaccination of children aged 2-16 years at 50% coverage over 20 consecutive seasons. We measured the effects in quality-adjusted life-years (QALYs) and we adopted a societal perspective. RESULTS The childhood vaccination program is estimated to have an average incremental cost-effectiveness ratio (ICER) of €3944 per QALY gained and is cost-effective in the general population (across 1000 simulations; conventional Dutch threshold of €20,000 per QALY gained). The childhood vaccination program is not estimated to be cost-effective for the target-group itself with an average ICER of €57,054 per QALY gained. Uncertainty analyses reveal that these ICERs hide a wide range of outcomes. Even though introduction of a childhood vaccination program decreases the number of infections, it tends to lead to larger epidemics: in 23.3% of 1000 simulations, the childhood vaccination program results in an increase in seasons with a symptomatic attack rate larger than 5%, which is expected to cause serious strain on the health care system. In 6.4% of 1000 simulations, the childhood vaccination program leads to a net loss of QALYs. These findings are robust across different targeted age groups and vaccination coverages. CONCLUSIONS Modeling indicates that childhood influenza vaccination is cost-effective in the Netherlands. However, childhood influenza vaccination is not cost-effective when only outcomes for the children themselves are considered. In approximately a quarter of the simulations, the introduction of a childhood vaccination program increases the frequency of seasons with a symptomatic attack rate larger than 5%. The possibility of an overall health loss cannot be excluded.
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Affiliation(s)
- Pieter T de Boer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
| | - Jantien A Backer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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