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Zhang S, Akmar LZ, Bailey F, Rath BA, Alchikh M, Schweiger B, Lucero MG, Nillos LT, Kyaw MH, Kieffer A, Tong S, Campbell H, Beutels P, Nair H, Nair H, Campbell H, Shi T, Zhang S, Li Y, Openshaw P, A Wedzicha J, R Falsey A, Miller M, Beutels P, Antillon M, Bilcke J, Li X, Bont L, Pollard A, Molero E, Martinon-Torres F, Heikkinen T, Meijer A, Fischer TK, van den Berge M, Giaquinto C, Mikolajczyk R, Hackett J, Tafesse E, Lopez AG, Dieussaert I, Dermateau N, Stoszek S, Gallichan S, Kieffer A, Demont C, Cheret A, Gavart S, Aerssens J, Wyffels V, Cleenewerck M, Fuentes R, Rosen B, Nair H, Campbell H, Shi T, Zhang S, Li Y, Openshaw P, A Wedzicha J, R Falsey A, Miller M, Beutels P, Antillon M, Bilcke J, Li X, Bont L, Pollard A, Molero E, Martinon-Torres F, Heikkinen T, Meijer A, Fischer TK, van den Berge M, Giaquinto C, Mikolajczyk R, Hackett J, Tafesse E, Lopez AG, Dieussaert I, Dermateau N, Stoszek S, Gallichan S, Kieffer A, Demont C, Cheret A, Gavart S, Aerssens J, Wyffels V, Cleenewerck M, Fuentes R, Rosen B. Cost of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infection Management in Young Children at the Regional and Global Level: A Systematic Review and Meta-Analysis. J Infect Dis 2020; 222:S680-S687. [DOI: 10.1093/infdis/jiz683] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection (ALRI) in young children aged <5 years.
Methods
We aimed to identify the global inpatient and outpatient cost of management of RSV-ALRI in young children to assist health policy makers in making decisions related to resource allocation for interventions to reduce severe morbidity and mortality from RSV in this age group. We searched 3 electronic databases including Global Health, Medline, and EMBASE for studies reporting cost data on RSV management in children under 60 months from 2000 to 2017. Unpublished data on the management cost of RSV episodes were collected through collaboration with an international working group (RSV GEN) and claim databases.
Results
We identified 41 studies reporting data from year 1987 to 2017, mainly from Europe, North America, and Australia, covering the management of a total of 365 828 RSV disease episodes. The average cost per episode was €3452 (95% confidence interval [CI], 3265–3639) and €299 (95% CI, 295–303) for inpatient and outpatient management without follow-up, and it increased to €8591(95% CI, 8489–8692) and €2191 (95% CI, 2190–2192), respectively, with follow-up to 2 years after the initial event.
Conclusions
Known risk factors (early and late preterm birth, congenital heart disease, chronic lung disease, intensive care unit admission, and ventilator use) were associated with €4160 (95% CI, 3237–5082) increased cost of hospitalization. The global cost of inpatient and outpatient RSV ALRI management in young children in 2017 was estimated to be approximately €4.82 billion (95% CI, 3.47–7.93), 65% of these in developing countries and 55% of global costs accounted for by hospitalization. We have demonstrated that RSV imposed a substantial economic burden on health systems, governments, and the society.
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Affiliation(s)
- Shanshan Zhang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Lily Zainal Akmar
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Freddie Bailey
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Brunhilde Schweiger
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines
| | - Leilani T Nillos
- Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines
| | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | | | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- ReSViNET Foundation, Zeist, The Netherlands
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Root ED, Lucero M, Nohynek H, Stubbs R, Tallo V, Lupisan SP, Sanvictores DM, Nillos LT, Simões EA. Distance to health services modifies the effect of an 11-valent pneumococcal vaccine on pneumonia risk among children less than 2 years of age in Bohol, Philippines. Int J Epidemiol 2018; 46:706-716. [PMID: 27605588 DOI: 10.1093/ije/dyw217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/13/2022] Open
Abstract
Background Both vaccine trials and surveillance studies typically use passive surveillance systems to monitor study outcomes, which may lead to under-reporting of study outcomes in areas with poor access to care. This detection bias can have an adverse effect on conventional estimates of pneumonia risk derived from vaccine trials. Methods We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent pneumococcal vaccine (PCV) among children less than 2 years of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographical information system. The study was conducted using 11 729 children who received three doses of any study vaccine (PCV11) or placebo. Multivariate Cox proportional hazards models were used to examine major risk factors for pneumonia diagnosis and the relationship between distance to Bohol Regional Hospital (BRH) and vaccination with PCV with risk for pneumonia diagnosis. Results There was a significant interaction effect between distance from BRH and vaccination with PCV11 on pneumonia risk. Among children living 12 km from BRH, vaccination with PCV11 was associated with a decreased hazard ratio for radiographic pneumonia, compared with vaccination with the study placebo [0.57, 95% confidence interval (CI) 0.37-0.86). However, for children living 1 km from BRH, there was little difference in risk of radiographic pneumonia diagnosis between children vaccinated with PCV11 and those given the study placebo. Conclusion Children living close to BRH had no documented reduction in the primary study outcome from PCV11, whereas those at greater distance experienced a substantial reduction. Because of detection bias caused by distance to BRH, in spatial analysis of vaccine trial results it may be necessary to adjust estimates of pneumonia risk and vaccine efficacy. Failure to consider the geographical dimension of trials may lead to underestimates of efficacy which might influence public health planning efforts.
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Affiliation(s)
- Elisabeth Dowling Root
- Department of Geography and Division of Epidemiology, Ohio State University, Columbus, OH, USA
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Hanna Nohynek
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Rebecca Stubbs
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA and
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | | | | | - Eric Af Simões
- Children's Hospital of Colorado, University of Colorado, Denver, CO, USA
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Lucero MG, Inobaya MT, Nillos LT, Tan AG, Arguelles VLF, Dureza CJC, Mercado ES, Bautista AN, Tallo VL, Barrientos AV, Rodriguez T, Olveda RM. National Influenza Surveillance in the Philippines from 2006 to 2012: seasonality and circulating strains. BMC Infect Dis 2016; 16:762. [PMID: 27993136 PMCID: PMC5168815 DOI: 10.1186/s12879-016-2087-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background The results of routine influenza surveillance in 13 regions in the Philippines from 2006 to 2012 are presented, describing the annual seasonal epidemics of confirmed influenza virus infection, seasonal and alert thresholds, epidemic curve, and circulating influenza strains. Methods Retrospective analysis of Philippine influenza surveillance data from 2006 to 2012 was conducted to determine seasonality with the use of weekly influenza positivity rates and calculating epidemic curves and seasonal and alert thresholds using the World Health Organization (WHO) global epidemiological surveillance standards for influenza. Results Increased weekly influenza positive rates were observed from June to November, coinciding with the rainy season and school opening. Two or more peaks of influenza activity were observed with different dominant influenza types associated with each peak. A-H1N1, A-H3N2, and two types of B viruses circulated during the influenza season in varying proportions every year. Increased influenza activity for 2012 occurred 8 weeks late in week 29, rather than the expected week of rise of cases in week 21 as depicted in the established average epidemic curve and seasonal threshold. The intensity was severe going above the alert threshold but of short duration. Southern Hemisphere vaccine strains matched circulating influenza virus for more surveillance years than Northern Hemisphere vaccine strains. Conclusions Influenza seasonality in the Philippines is from June to November. The ideal time to administer Southern Hemisphere influenza vaccine should be from April to May. With two lineages of influenza B circulating annually, quadrivalent vaccine might have more impact on influenza control than trivalent vaccine. Establishment of thresholds and average epidemic curve provide a tool for policy-makers to assess the intensity or severity of the current influenza epidemic even early in its course, to help plan more precisely resources necessary to control the outbreak. Influenza surveillance activities should be continued in the Philippines and funding for such activities should already be incorporated into the Philippine health budget. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2087-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marilla G Lucero
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines.
| | - Marianette T Inobaya
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Leilani T Nillos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Alvin G Tan
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Vina Lea F Arguelles
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Christine Joy C Dureza
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Edelwisa S Mercado
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Analisa N Bautista
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Veronica L Tallo
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Agnes V Barrientos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Tomas Rodriguez
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
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Tanskanen A, Nillos LT, Lehtinen A, Nohynek H, Sanvictores DHM, Simões EA, Tallo VL, Lucero MG. Geographic Information System and tools of spatial analysis in a pneumococcal vaccine trial. BMC Res Notes 2012; 5:51. [PMID: 22264271 PMCID: PMC3298525 DOI: 10.1186/1756-0500-5-51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 01/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this Geographic Information System (GIS) study was to obtain accurate information on the locations of study subjects, road network and services for research purposes so that the clinical outcomes of interest (e.g., vaccine efficacy, burden of disease, nasopharyngeal colonization and its reduction) could be linked and analyzed at a distance from health centers, hospitals, doctors and other important services. The information on locations can be used to investigate more accurate crowdedness, herd immunity and/or transmission patterns. METHOD A randomized, placebo-controlled, double-blind trial of an 11-valent pneumococcal conjugate vaccine (11PCV) was conducted in Bohol Province in central Philippines, from July 2000 to December 2004. We collected the information on the geographic location of the households (N = 13,208) of study subjects. We also collected a total of 1982 locations of health and other services in the six municipalities and a comprehensive GIS data over the road network in the area. RESULTS We calculated the numbers of other study subjects (vaccine and placebo recipients, respectively) within the neighborhood of each study subject. We calculated distances to different services and identified the subjects sharing the same services (calculated by distance). This article shows how to collect a complete GIS data set for human to human transmitted vaccine study in developing country settings in an efficient and economical way. CONCLUSIONS The collection of geographic locations in intervention trials should become a routine task. The results of public health research may highly depend on spatial relationships among the study subjects and between the study subjects and the environment, both natural and infrastructural. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN62323832.
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Affiliation(s)
- Antti Tanskanen
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines.
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Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreño RAN, Nohynek H, Riley ID, Makela H. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev 2009; 2009:CD004977. [PMID: 19821336 PMCID: PMC6464899 DOI: 10.1002/14651858.cd004977.pub2] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pneumonia, caused by Streptococcus pneumoniae, is a major cause of morbidity and mortality among children in low-income countries. The effectiveness of pneumococcal conjugate vaccines (PCVs) against invasive pneumococcal disease (IPD), pneumonia, and mortality needs to be evaluated. OBJECTIVES To update the 2004 review on the efficacy of PCVs in preventing vaccine-serotypes IPD (VT-IPD) , X-ray defined pneumonia among HIV-1 negative children, and other new outcomes. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1990 to Week 4 February 2009); and EMBASE (1974 to March 2009). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing PCV with placebo, or another vaccine, in children under two with IPD and clinical / radiographic pneumonia as outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies, extracted data, and evaluated their corresponding risks of bias. Differences were resolved by discussion. Meta-analysis used the inverse variance method. MAIN RESULTS We identified 11 publications from six RCTs conducted in Africa, US, Philippines and Finland where 57,015 children received PCV; while 56,029 received placebo or another vaccine. Seven publications provided high quality evidence on PCV efficacy against IPD and four provided moderate quality evidence against pneumonia. None of the five trials with all-cause mortality data were powered to investigate this outcome. Only two trials have data on all-cause admissions.The main analysis for this review involved HIV-1 negative children and used the pooled results of random-effects model, intent-to-treat analysis (ITT).Pooled vaccine efficacy (VE) for VT-IPD was 80% (95% confidence interval (CI) 58% to 90%, P < 0.0001); all serotypes-IPD, 58% (95% CI 29% to 75%, P = 0.001); World Health Organization X-ray defined pneumonia was 27% (95% CI 15% to 36%, P < 0.0001); clinical pneumonia, 6% (95% CI 2% to 9%, P = 0.0006); and all-cause mortality, 11% (95% CI -1% to 21%, P = 0.08). Analysis involving HIV-1 positive children had similar findings. AUTHORS' CONCLUSIONS PCV is effective in preventing IPD, X-ray defined pneumonia, and clinical pneumonia among HIV-1 negative and HIV-1 positive children under two years. The impact was greater for VT-IPD than for all serotypes-IPD, and for X-ray defined pneumonia than for clinical pneumonia. An 11% reduction with a 95% CI of -1% to 21% and a P = 0.08 is compatible with reduction in all-cause mortality.
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Affiliation(s)
- Marilla G Lucero
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Vernoni E Dulalia
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Leilani T Nillos
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Gail Williams
- School of Population Health, Queensland UniversityAustralian Centre for International and Tropical Health and NutritionHerston RoadHerstonQueenslandAustralia4006
| | - Rhea Angela N Parreño
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Hanna Nohynek
- National Institute for Health and WelfareDepartment of Vaccines, Unit of Clinical TrialsMannerheimintie 166HelsinkiFinland00300
| | - Ian D Riley
- School of Population Health, Queensland UniversityAustralian Centre for International and Tropical Health and NutritionHerston RoadHerstonQueenslandAustralia4006
| | - Helena Makela
- National Institute for Health and WelfareDepartment of Vaccines, Unit of Clinical TrialsMannerheimintie 166HelsinkiFinland00300
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