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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 Unpublished data on the management cost of RSV episodes were collected through collaboration with an international working group (RSV GEN) and claim databases.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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Mulligan K, Harris DR, Monte D, Stoszek S, Emmanuel P, Hardin DS, Kapogiannis BG, Worrell C, Meyer WA, Sleasman J, Wilson CM, Aldrovandi GM. Obesity and dyslipidemia in behaviorally HIV-infected young women: Adolescent Trials Network study 021. Clin Infect Dis 2010; 50:106-14. [PMID: 19947855 DOI: 10.1086/648728] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The goal of this study was to determine the nature and prevalence of abnormalities in lipids, glucose metabolism, and body composition in behaviorally human immunodeficiency virus (HIV)-infected young women and the relationship of these abnormalities to different classes of antiretroviral therapy regimens. METHODS We conducted a cross-sectional, multicenter study involving 173 behaviorally HIV-infected women aged 14-24 years and 61 HIV-seronegative control subjects. HIV-infected women were categorized as follows: antiretroviral therapy naive (n=85), receiving a regimen containing a nonnucleoside reverse-transcriptase inhibitor (NNRTI; n=33), receiving a regimen containing a protease inhibitor (PI; n=36), or receiving a regimen not containing an NNRTI or a PI (n=19). Measurements included fasting lipid levels, glucose and insulin levels before and 2 hours after an oral glucose challenge, high-sensitivity C-reactive protein (hsCRP) levels, anthropometry, fat distribution (measured by dual energy X-ray absorptiometry), and antiretroviral therapy and medical histories. Race-adjusted results were compared across groups and within HIV-infected groups. RESULTS The median age of participants was 20 years. Of HIV-infected subjects, 77% were African American, 35% smoked cigarettes, and 32% reported exercising regularly. More than 40% had a body mass index > or =25. Triglycerides; total, high-density lipoprotein (HDL), and non-HDL cholesterol; and hsCRP levels differed significantly among groups, with higher levels being most common among those receiving antiretroviral therapy. Indices of glucose metabolism did not differ among groups. In general, cholesterol levels, hsCRP levels, and indices of glucose metabolism worsened as body mass index increased. CONCLUSIONS Obesity, dyslipidemia, and inflammation were prominent among HIV-infected adolescent women and, coupled with other risk factors, may accelerate the lifetime risk of cardiovascular disease and other adverse events. These results underscore the need for a multifaceted approach to addressing risk reduction in this population.
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Affiliation(s)
- Kathleen Mulligan
- University of California, San Francisco, San Francisco General Hospital Div. of Endocrinology, Bldg. 30, Rm. 3501K, 1001 Potrero Ave., San Francisco, CA 94110, USA.
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Shebl FM, El-Kamary SS, Saleh DA, Abdel-Hamid M, Mikhail N, Allam A, El-Arabi H, Elhenawy I, El-Kafrawy S, El-Daly M, Selim S, El-Wahab AA, Mostafa M, Sharaf S, Hashem M, Heyward S, Stine OC, Magder LS, Stoszek S, Strickland GT. Prospective cohort study of mother-to-infant infection and clearance of hepatitis C in rural Egyptian villages. J Med Virol 2009; 81:1024-31. [PMID: 19382251 DOI: 10.1002/jmv.21480] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although persistent transmission of hepatitis C virus (HCV) from infected mothers to their infants is reported in 4-8%, transient HCV perinatal infection also occurs. This prospective cohort study determined perinatal HCV infection- and early and late clearance-rates in 1,863 mother-infant pairs in rural Egyptian villages. This study found 15.7% and 10.9% of pregnant women had HCV antibodies (anti-HCV) and HCV-RNA, respectively. Among 329 infants born of these mothers, 33 (10.0%) tested positive for both anti-HCV and HCV-RNA 2 months following birth-29 (12.5%) having HCV-RNA positive mothers and 4 (with transient infections) having mothers with only anti-HCV. Fifteen remained HCV-RNA positive at one and/or 2 years (persistent infections), while 18 cleared both virus and antibody by 1 year (transient infections). Among the 15 persistent cases, 7 cleared their infections by 2 or 3 years. At 2- to 6- and at 10- to 12-month maternally acquired anti-HCV was observed in 80% and 5% of infants, respectively. Four perinatally infected and one transiently infected infant were confirmed to be infected by their mothers by the sequence similarity of their viruses. Viremia was 155-fold greater in mothers of infants with persistent than mothers of infants with transient infections. Maternal-infant transmission of HCV is more frequent than generally reported. However, both early and late clearance of infection frequently occurs and only 15 (4.6%) and 8 (2.4%) infants born of HCV-RNA positive mothers had detectable HCV-RNA at one and 2-3 years of age. Investigating how infants clear infection may provide important information about protective immunity to HCV.
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Affiliation(s)
- Fatma M Shebl
- Department of Epidemiology and Preventive Medicine or Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Al-Sherbiny M, Osman A, Mohamed N, Shata MT, Abdel-Aziz F, Abdel-Hamid M, Abdelwahab SF, Mikhail N, Stoszek S, Ruggeri L, Folgori A, Nicosia A, Prince AM, Strickland GT. Exposure to hepatitis C virus induces cellular immune responses without detectable viremia or seroconversion. Am J Trop Med Hyg 2005. [PMID: 16014830 DOI: 10.4269/ajtmh.2005.73.1.0730044] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Sporadic cases of cell-mediated immunity (CMI) in persons exposed to hepatitis C (HCV) but evidently uninfected have been reported. To further define this, we measured CMI in individuals without evidence of HCV infection, that is, negative for HCV-antibodies (anti-HCV) and RNA, residing in a rural Egyptian community where prevalence of anti-HCV was 24%. Cell-mediated immunity (CMI) measured by interferon-gamma (IFN-gamma) enzyme-linked immunospot (ELISPOT) assay, confirmed by intracellular staining using flow cytometry, against HCV peptides was measured in seronegative individuals with high-risk (HR) and low-risk (LR) exposures to HCV. Thirteen of 71 (18.3%) HR subjects but only 1 of 35 (2.9%) LR subjects had detectable CMI (P = 0.032). These data are compatible with the hypothesis that exposures to HCV may lead to development of HCV-specific CMI without anti-HCV and ongoing viral replication. We speculate induced CMI clears HCV sometimes when anti-HCV is not detectable, and HCV-specific CMI is a useful surrogate marker for exposure to HCV.
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