Dissertations / Theses on the topic 'Vaccines Effectiveness'
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1
Ming, Wai-kit, and 明偉傑. "Effectiveness of universal rotavirus vaccination: a literature review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B50222995.
Abstract:
Objectives
This study focuses on the evaluation of the use of vaccine in the prevention of severe acute gastroenteritis in the community in the literature. The objectives of this project report include an in depth review of the effectiveness and cost effectiveness of rotavirus vaccination for severe acute gastroenteritis in low and middle income countries (developing countries).
Methods
Publications were identified using computerized bibliographic searches in PubMed (for the period from October 1994 to July 2012). The keywords “effective*”, “vaccin*”, “rotavirus” , “Randomized controlled trial” were used to search for relevant information. Also the keywords “轮状病毒”, “疫苗” , “随机对照试验” were used to search for relevant information in China Journals Full-text Database(中国期刊全文数据库).
Selection criteria:
SSRandomized controlled trials (RCT) in children (<5 years old) comparing rotavirus RV1/RV5/LLR vaccines for use with (1) placebo, (2) no intervention, or (3) another RV1/RV5/LLR vaccine.
Once the identified articles had been screened by the inclusion and exclusion criteria, the content of each was evaluated in relation to the two research questions. International guidelines: CONSORT (for RCT) was also followed in the quality assessment process.
Results
In our review, there were 9 studies included and 2 of them were graded A(i.e. good quality), 5 graded B(i.e. medium quality) and 2 graded C(i.e. poor quality). For the two Grade A studies, vaccine effectiveness was estimated to be 39.3% and 48.3%. For 5 Grade B studies, vaccine effectiveness was estimated to be 19.2% to 63.9%. For 2 Grade C studies, vaccine effectiveness was estimated to be 10.6% and 74.3%. There is a smaller range in vaccine effectiveness in grade A studies. In contrast, there is a greater range in vaccine effectiveness in grade B and C studies. Many low and middle income countries may not have enough training in conducting RCT. However, the Grade A studies showed that rotavirus vaccine is effective. Our review also showed that authors from most of the low income countries suggested that rotavirus vaccine is cost effective to very cost effective, while those from middle income countries suggested that the cost of the vaccine is the key factor.
Conclusion
This review showed evidence of effectiveness of rotavirus vaccine and cost-effectiveness in low and middle income countries (developing countries). China has a huge population and similar situation with other developing countries, hence it is useful to conduct a study on cost-effectiveness on universal vaccination in the near future.published_or_final_version
Public Health
Master
Master of Public Health
2
Boros, Christina Ann. "Factors affecting the immunogenicity and protective efficacy of routine childhood immunisations." Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phb736.pdf.
Abstract:
Includes list of publications arising from the thesis. Bibliography: leaves 327-341. Examines the effect of adverse storage on the immunogenicity of pertussis, diphtheria and tetanus vaccines, the protective efficacy of pertussis vaccines and the effect of premature birth on antibody response to routine childhood immunisations.
3
Yuen, Wing-mei, and 阮泳薇. "Systematic review on the cost effectiveness of human papillomavirus vaccination in Asia and its implication in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48427329.
Abstract:
Background: Human papillomavirus vaccination is newly developed in this decade. There are 2 types of vaccines. Bivalent vaccine targets on HPV types 16, 18 to prevent cervical cancer. Quadrivalent vaccine target on HPV type 6, 11, 16, 18 to prevent genital warts and cervical cancer. England has adopted a population –based HPV vaccination program. In attempt to find out the worthiness to implement the population-based vaccination program in Hong Kong, this project reviewed 15 cost-effectiveness analyses in Asian countries. Asian countries may have the similar characteristics, such as culture, sex behavior, genome, etc, that makes the result more applicable to Hong Kong.
Methodology: Cost-effectiveness analysises of human papillomavirus vaccination were identified by the searching engine MEDLINE (Ovid) by using relevant keywords. All English and Chinese articles relevant to the topic were identified. Articles conducted for the cost-effectiveness of human papillomavirus vaccine in Asian countries were considered as the potential literature for the review.
Result and Discussion: The searching engine identified 259 literatures, 16 of them are in Asian countries, 1 of them did not meet the criteria of quality assessment. 15 of them are included in this review. 6 different model approaches were used in the 15 articles. Results from the same countries in 2 separated articles were heterogeneous. That may probably due to the different assumption and perspectives used. Different perspectives would include different costing. Studies only including the direct cost would likely over-estimate the cost-effectiveness of the vaccine. The threshold value adopted would also affect the result. A stricter threshold value would under-estimate the cost-effectiveness. Some low-and-middle income countries has no available data on the vaccination because the vaccine is not available in the market, the data would only rely on the past literature or international data. 12 out of the 15 studies showed that the vaccination is cost-effective in the countries.
Conclusion and Implication: the ICER is sensitive to the price of the vaccine, the efficacy, the duration of protection, the discount rate, the screening coverage rate, and the age of receiving vaccination, the vaccination coverage rate and the cervical cancer or genital warts incidence rate. Some studies showed that regular screening combined with vaccination program would be cost-effective. In the studies comparing the 2 types of vaccines, all the results showed that quadrivalent vaccine dominant to the bivalent vaccine. Moreover, the vaccination would decrease the cervical cancer incidence by 20% to 90%. In view of the prevalence of HPV type and the high incidence rate of genital warts. The quadrivalent vaccine is likely beneficial to Hong Kongpublished_or_final_version
Public Health
Master
Master of Public Health
4
Cheung, Ka-mei Camy, and 張嘉楣. "The cost-effectiveness of human pappillomavirus vaccines in men : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193771.
Abstract:
Background
Human Papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. It is the leading cause of genital warts and cervical cancer, and is strongly associated with oropharyngeal and other anogenital cancers. To date, two prophylactic HPV vaccines are available, both of which have shown high efficacies in protection against vaccine-type HPV infection and HPV-associated diseases in both males and females. Despite the proven efficacies, male vaccination has not been included in any national vaccination programme worldwide. In Hong Kong, vaccine uptake remains low despite the Department of Health’s recommendation, and a routine comprehensive vaccination programme is yet to be adopted. However, very limited cost-effectiveness data are available to guide policy makers on the economic potential of implementing routine HPV vaccination, especially that of extending vaccination to males. This systematic review is among the first to evaluate the latest cost-effectiveness analyses of HPV vaccination in men and apply the synthesis to the context of Hong Kong, which will help local policy makers in their consideration of implementing a comprehensive HPV vaccination programme in Hong Kong, especially whether to extend vaccination to males.
Methodology
A systematic review was conducted to retrieve literatures that provide full economic evaluations of cost-effectiveness analyses of HPV vaccination programmes that included males, by searching in the MEDLINE (Ovid system) using relevant keywords. English articles that provide full economic evaluations of cost-effectiveness analyses of HPV vaccination programmes in men or in both sexes in the age group of 9-45 years were considered as potential studies for inclusion in this review.
Results
The literature search identified 117 studies, 107 among them failed to meet the inclusion criteria, 2 were duplicated studies, 1 did not meet the quality assessment criteria described by Drummond et al. A total of 7 studies were included in this review. All studies adopted dynamic models, except one using static model, which did not take into account the effect of herd immunity on HPV transmission. The studies measured the cost-effectiveness using different assumptions on vaccine costs, coverage, efficacies, duration of protection, costing and perspectives. Only several studies took a societal perspective in their analyses and included non-medical and indirect costs. 4 among all studies explored the cost-effectiveness of extending HPV vaccination to males, 2 only focused on female-only HPV vaccination with indirect benefits to males, and 1 only evaluated vaccination of the men who have sex with men (MSM) population. The discrepancies in different costing and outcome measures lowered the comparability of cost-effectiveness analyses. Yet, in general, the studies reported vaccine efficacies and duration of protection to significantly impact the cost-effectiveness of vaccination in both sexes. Moreover, vaccine coverage is critical to influence cost-effectiveness, for male vaccination would only be cost-effective given a female vaccine coverage of 50% or below.
Conclusion and Implications
Evidence from recent cost-effectiveness analyses suggested that vaccinating 12-year-olds is cost-effective. School-based immunization programmes are recommended to vaccinate the population at an early age before sexual debut for better clinical and economic benefits. Extending HPV vaccination to boys will be cost-effective when female vaccine coverage is low. Given a low vaccine uptake rate among schoolgirls in Hong Kong, policy makers should consider expanding vaccination to boys when implementing a routine immunization programme by synthesizing findings from epidemiological and economic evaluations.published_or_final_version
Community Medicine
Master
Master of Public Health
5
Lau, Tin-wai. "Effectiveness of influenza vaccine among elderly people living in residential care homes during outbreak situations." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724177.
6
Mezones, Holguín Edward, Díaz Rafael Bolaños, Víctor Fiestas, César Sanabria, Aguado Alfonso Gutiérrez, Fabián Fiestas, Víctor J. Suárez, Morales Alfonso J. Rodríguez, and Adrian V. Hernández. "Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children." The Journal of Infection in Developing Countries, 2015. http://hdl.handle.net/10757/337985.
Abstract:
emezones@gmail.comIntroduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 yearsold. Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.
This study was funded by Instituto Nacional de Salud, Lima, Peru
Revisión pór pares
7
Mezones, Holguín Edward, Aybara Carlos Canelo, Clark Andrew David, Janusz Cara Bess, Bárbara Jaúregui, Palza Seimer Escobedo, Adrian V. Hernandez, et al. "Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru." Elsevier B.V, 2015. http://hdl.handle.net/10757/582635.
Abstract:
Objective
To evaluate the cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine (PCV10) versus the 13-valent PCV (PCV13) to the National Immunization Schedule in Peru for prevention of pneumococcal disease (PD) in children <5 years of age.
Methods
The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (version 2.0) was applied from the perspective of the Government of Peru. Twenty successive cohorts of children from birth to 5 years were evaluated. Clinical outcomes were pneumococcal pneumonia (PP), pneumococcal meningitis (PM), pneumococcal sepsis (PS) and acute otitis media from any causes (AOM). Measures included prevention of cases, neurological sequelae (NS), auditory sequelae (AS), deaths and disability adjusted life years (DALYs). A sensitivity analyses was also performed.
Findings
For the 20 cohorts, net costs with PCV10 and PCV13 were US$ 363.26 million and US$ 408.26 million, respectively. PCV10 prevented 570,273 AOM; 79,937 PP; 2217 PM; 3049 PS; 282 NS; 173 AS; and 7512 deaths. PCV13 prevented 419,815 AOM; 112,331 PN; 3116 PM; 4285 PS; 404 NS; 248 AS; and 10,386 deaths. Avoided DALYs were 226,370 with PCV10 and 313,119 with PCV13. Saved treatment costs were US$ 37.39 million with PCV10 and US$ 47.22 million with PCV13. Costs per DALY averted were US$ 1605 for PCV10, and US$ 1304 for PCV13. Sensitivity analyses showed similar results. PCV13 has an extended dominance over PCV10.
Conclusion
Both pneumococcal vaccines are cost effective in the Peruvian context. Although the net cost of vaccination with PCV10 is lower, PCV13 prevented more deaths, pneumococcal complications and sequelae. Costs per each prevented DALY were lower with PCV13. Thus, PCV13 would be the preferred policy; PCV10 would also be reasonable (and cost-saving relative to the status quo) if for some reason 13-valent were not feasible.This study was presented at 9th International Symposium of Pneumococci and Pneumococcal Diseases, Hyderabad, India, March 2014, and supported by the National Council of Science, Technology and Technological Innovation of Peru (CONCYTEC) and International Clinical Epidemiology Network (INCLEN Trust)
This study was made possible through the financial support of the Instituto Nacional de Salud (National Institute of Health, Lima, Peru) and the PROVAC Initiative of the Pan American Health Organization (Washington, DC, USA).
8
Marlow, Robin. "Assessing the impact and cost-effectiveness of rotavirus vaccines in the United Kingdom." Thesis, University of Bristol, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.705468.
9
Sharma, Aditya. "Cost-effectiveness of Hepatitis A and Hepatitis B Vaccination for Jail Inmates." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08272007-114829/.
Abstract:
Despite evidence that viral hepatitis poses a significant risk to public health, universal vaccination has not yet been implemented. The risk for viral hepatitis infection is particularly high among injection drug users and other individuals who do not attend regular health care visits. Jails provide a structural opportunity to vaccinate these high risk individuals. HAV and HBV vaccines administered on an accelerated three week schedule could dramatically decrease the lifetime risk for contracting viral hepatitis among jail detainees. Assuming that 75% of detainees would accept vaccination, 33% have previous exposure to HAV, 25% have previous exposure to HBV, and independent future healthcare costs were US $317,000, the US health care system would save $12 per individual with a vaccinate upon entry program in comparison to no intervention. This savings translates into an economic benefit amounting to about US$ 5,000,000 saved if all new jail inmates in a given year were immunized. A vaccination upon entry program for HAV/HBV in jails should be widely implemented with coordination between the corrections system and public health agencies to reduce the growing cost of viral hepatitis infection.
10
Koh, Naoko. "Cost-benefit analysis of influenza vaccination for children in Hong Kong." Thesis, Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971866.
11
Fitzner, Karen A. "An economic assessment of influenza prevention in Hong Kong." Thesis, Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19670254.
12
Macías, Hernández Alejandro E., Fortino Solórzano Santos, Velasco Hugo M. Aguilar, Agüero María L. Ávila, Fernando Bazzino Rubio, Bellei Nancy C. Junqueira, Pablo E. Bonvehí, et al. "Influenza tetravalent vaccines in national immunization programs for Latin-American countries." Comunicaciones Cientificas Mexicanas S.A. de C.V, 2020. http://hdl.handle.net/10757/655697.
Abstract:
Since 2012-2013 influenza season, World Health Organization (who) recommends the formulation of tetravalent vaccines. Globally, many countries already use tetravalent vaccines in their national immunization programs, while in Latin America only a small number. Two Influenza b lineages co-circulate, their epidemiological behavior is unpredictable. On average they represent 22.6% of influenza cases and more than 50% in predominant seasons. The lack of concordance between recommended and circulating strains was 25 and 32% in the 2010-2017 and 2000-2013 seasons, respectively. There are no clinical differences between influenza A and B. It occurs more frequently from five to 19 years of age. Influenza b has a higher proportion of attributable deaths than influenza a (1.1 vs. 0.4%), or 2.65 (95% ci 1.18-5.94). A greater number of hospitalizations when the strains mismatch (46.3 vs. 28.5%; p <.0001). Different evaluations have demonstrated its cost effectiveness. The compilation of this information supports the use of quadrivalent vaccines in Latin American countries.Revisión por pares
13
Lau, Tin-wai, and 劉天慧. "Effectiveness of influenza vaccine among elderly people living in residential care homes during outbreak situations." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39724177.
14
Channing, Liezl. "Cost-effectiveness analysis of MVA85 vaccine: a new TB vaccine candidate." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9448.
Abstract:
Includes bibliographical references.Tuberculosis (TB) remains a major public health concern. The BCG vaccine is, currently, the only vaccine against TB and, although it provides some protection against disseminated forms of TB, its effectiveness in preventing primary infection and disease progression to pulmonary TB is highly varied. A number of potential new TB vaccine candidates have been identified and are, currently, undergoing clinical trials. One such candidate is MVA85A. This study aims to assess the potential cost-effectiveness of a new TB vaccine, the MVA85A vaccine. The study compares two TB vaccine strategies, from the perspective of the South African Government: i. BCG, given at birth, which is the current standard of care in South Africa; and ii BCG, given at birth, together with a booster vaccine (MVA85A) given at 4 months, which is the potential new strategy. The study employs Decision Analytical Modelling, through the use of a Markov model, to estimate the costs and outcomes of the two strategies. The cumulative costs and outcomes of each intervention are used to calculate the cost-effectiveness ratio (CER) (i.e. the cost per TB case averted and the cost per TB death averted) for each intervention. These two cost-effectiveness ratios are compared using an incremental cost-effectiveness ratio (ICER), which represents the additional cost per additional benefit received. The results of the cost-effectiveness analysis indicate that the MVA85A strategy is both more costly and more effective – there are fewer TB cases and deaths from TB – than BCG alone. The Government would need to spend an additional USD 1,105 for every additional TB case averted and USD 284,017 for every additional TB death averted. Given the disappointing results of the MVA85A vaccine clinical trial – showing an efficacy of only 17.3%, this study will predominantly contribute to establishing an efficacy threshold for future vaccines. Our research also contributes to the body of knowledge on economic evaluations involving new TB vaccines as - to the best of our knowledge - this is the first cost-effectiveness analysis conducted using trial data involving a novel TB vaccine and providing a direct comparison with BCG vaccination. Furthermore, it provides a standardized Markov model, which is relatively simple to adapt to local settings and, which could be used in the future, to estimate the potential cost-effectiveness of new TB vaccines in children between the ages of 0–10 years.
15
Leung, May-bo Mabel, and 梁美寶. "The cost effectiveness of varicella vaccination program : a systemic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206948.
Abstract:
Background
Chickenpox is a common infectious disease among children. Ever since a live attenuated vaccine was developed in 1970s, different countries have adopted different vaccination program against chickenpox. Hong Kong recently has commenced a routine childhood varicella vaccination program. The objective of this study is to evaluate whether routine childhood varicella vaccination is cost effective and the implications to Hong Kong.
Methodology
Literature search was done on electronic databases: Medline and Embase for articles relevant to the topic. A total of 9 articles were retrieved for this systemic review. All 9 studies focus on the cost effectiveness of childhood varicella vaccination with comparison to no vaccination or other interventions.
Findings
Routine childhood varicella vaccination program is cost effective especially from the societal perspective. The longer the vaccination program takes place, the more cost effective it would be. The cost effectiveness ratio is most sensitive to the coverage rate and the vaccine price.
Conclusion
It remains unclear whether the routine childhood varicella vaccination program in Hong Kong would be cost effective or not. As the Hong Kong program has adopted the most recent recommendations towards varicella vaccines that the review articles were not included.published_or_final_version
Public Health
Master
Master of Public Health
16
Glenn, L. Lee. "Limited Effectiveness of Psoralen- and Ultraviolet-Inactivated Vaccinia Virus on Shiv Infection." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/7517.
Abstract:
Excerpt: The title and conclusions of the study recently published by Jones et al. (1) concluded that monkeys were protected from dying from a form of simian-human immunodeficiency virus (SHIV) by an psoralen- and ultraviolet-inactivated vaccinia virus in a multi-envelope DNA-VV-protein (DVP). However, the findings in the study are more equivocal than indicated by the title because the effectiveness of the modified vaccinia virus was not decisively demonstrated.
17
Itria, Alexander. "Análise e determinação de custos específicos e consequências econômico-sociais na incorporação da vacina contra meningite e doença meningocócica C conjugada na rotina do Programa Nacional de Imunização/PNI." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-12012012-092948/.
Abstract:
As avaliações econômicas em saúde, que se propõe a estudar a alocação mais eficiente de recursos, apresentam expansão nos últimos 20 anos. Para as vacinas especificamente, há crescente surgimento das avaliações econômicas de programas de vacinação dado aumento dos preços das novas vacinas. Nesse cenário tem-se que a doença meningocócica continua sendo um agravo de extrema importância na população mundial, com características peculiares quando se consideram manifestações, morbi-mortalidade e ocorrência nas diferentes regiões. Não são suficientemente conhecidas as causas do início de uma epidemia em um dado momento e lugar, mas sabe-se que são necessários a presença concomitante de múltiplos fatores, como características do agente etiológico, do hospedeiro e do meio ambiente. Isto inclui a susceptibilidade da população, condições climáticas favoráveis, situação socioeconômica precária, tornando a prevenção primária da doença difícil, sendo necessária uma intervenção específica como as vacinas. Há diversas complicações da doença meningocócica, principalmente as sequelas, sendo as mais comuns a perda auditiva, as amputações, necrose de pele e convulsões. O Brasil, através do Programa Nacional de Imunizações / PNI, incluiu em sua agenda de Avaliação de Tecnologias em Saúde, via Secretaria de Vigilância Sanitária do Ministério da Saúde, avaliações econômicas locais para introdução de novas vacinas no calendário nacional de vacinação, sendo uma delas a vacina antimeningocócica C conjugada. Assim o objetivo desta tese é desenvolver um estudo complementar de custo-efetividade para a vacina conjugada contra a doença meningocócica C, com inclusão de estimativas suplementares de custos adicionais, para análise da sua repercussão sobre as razões incrementais encontradas em estudo original. A fim de aprofundar os estudos que medem as proporções de sequelas e os custos indiretos, bem como a inserção de novos custos. A hipótese sugere que a medição e valoração de custos envolvidos com sequelas da doença, aprimora os resultados do estudo de custo-efetividade e agregar elementos adicionais nas decisões dos gestores. Foram realizadas na cidade de Sorocaba entrevistas junto aos doentes e familiares com questionários de rotina de gastos e de qualidade de vida - EuroQol (EQ-5D), sendo inseridos nas análise de custoefetividade, os gastos diversos realizados pelas famílias, ora denominado de Gastos Familiares . A tese teve como resultado o fato que o melhor detalhamento e inserção de gastos familiares no tratamento de pessoas que adquiriram deficiências em consequência de sequelas, alterou a relação de custo-efetividade no programa de vacinação da doença meningocócica. A análise de sensibilidade mostrou que esses dados, quando extrapolados resultam num valor incremental ainda mais próximo no valor ideal de custo-efetividadeThe economic evaluations in health, which proposes to study the more efficient allocation of resources, an expansion in the last 20 years. For vaccines specifically, there is increasing emergence of economic evaluations of vaccination programs because price increases of new vaccines. In this scenario have that meningococcal disease still a disorder of extreme importance in the world population with peculiar characteristics when considering events, morbidity, mortality and incidence in different regions. Are not sufficiently known cause of the beginning of an epidemic in a given time and place, but it is known that it takes the concomitant presence of multiple factors like characteristics of the agent, host and environment. This includes the susceptibility of the population, favorable climatic conditions, poor socioeconomic situation, making the primary prevention of the disease hard and requires specific interventions such as vaccines. There are several complications of meningococcal disease, mostly the sequels, the most common hearing loss, amputations, skin necrosis and seizures. Brazil, through the National Immunization Program / PNI, included in its agenda for Technology Assessment in Health via the Health Surveillance Secretariat of the Ministry of Health, local economic assessments for the introduction of new vaccines in national vaccination schedule, one of which meningococcal C conjugate vaccine. So the purpose of this thesis is to develop a complementary study of cost-effectiveness for the conjugate vaccine against meningococcal C disease, with inclusion of supplementary estimates of additional costs for analysis of its impact on the incremental ratios found in the original study. In order to deepen the studies that measures the proportions of sequels and indirect costs, as well as the inclusion of new costs. The hypothesis suggests that the measurement and valuation of costs involved with sequelae of disease, improves the results of cost-effectiveness and add additional elements in the decisions of managers. Were held in the city of Sorocaba interviews with the patients and family questionnaires for routine expenditures and quality of life - EuroQol (EQ-5D), and inserted into the cost-effectiveness, the spending made by many families, sometimes called \"Family Expenditures\". The thesis resulted in the fact that better detail and inclusion of family spending in treating people who have acquired disabilities as a result of disability, has changed the costeffectiveness in the program of vaccination for meningococcal meningitis. The sensitivity analysis showed that these data, when extrapolated result in incremental value even closer to the ideal value of cost-effectiveness
18
Donauer, Stephanie. "Determining the Post-Licensure Effectiveness of Pentavalent Rotavirus Vaccine using Observational Study Designs." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1368026785.
19
Wong, Kwan-ting, and 王筠婷. "The cost-effectiveness of 13-valent pneumococcal conjugate vaccine for older adults : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206978.
Abstract:
BACKGROUND: Despite the current recommendation by the Centre for Health Protection (CHP)of Hong Kong for adults aged 65 years or above to receive 23-valent pneumococcal polysaccharide vaccine (PPV23), pneumococcal disease(PD) has become the second leading causes of death in Hong Kong. A relatively new pneumococcal vaccine –13-valent pneumococcal conjugate vaccine (PCV13) was approved by the US Food and Drug Administration (FDA) in December 2011 and the European Medicines Agency (EMA) in July 2013 for the prevention of invasive disease caused by S. pneumoniae for older adults aged 50 years or above. It was shown to overcome some of the limitations of PPV23and potentially confer benefits to older adults in the prevention of PD.
OBJECTIVES: To systematically review available literatures to examine whether PCV13 is superior to PPV23 or no vaccination in terms of the cost-effectiveness in the prevention of PD in older adults aged 50 years or above.
METHODS: Two databases, PubMed and ISI Web of Science, were used to search for published journals. The year range of search in these databases was confined to10 years.
RESULTS: A total of 318studies were identified initially and 10studies were included in this systematic review. Studies were conducted in the US, Colombia and European Union (EU) countries e.g. Italy, Germany, Netherlands and Spain. Different perspectives including societal, payer and health system were considered. The use of PCV13 was compared to either PPV23 or no vaccination in older adults aged 50 years or above. The coverage of PCV13 ranged from 42.4% to 70%, conferring an efficacy between 58% and 93.9%. The cost-effectiveness of PCV13 was expressed through the number of avoided cases/deaths for PD including invasive pneumococcal disease(IPD), inpatient and outpatient community-acquired pneumonia (CAP) as well as the incremental cost-effectiveness ratios (ICERs),either in cost per quality-adjusted life-year (QALY) gained or cost per life-year gained (LYG).Overall, PCV13 is shown to avoid more pneumococcal cases compared to PPV23 or no vaccination and is cost-effective in older adults aged 50 years of above.
CONCLUSION: PCV13 is considered to be more cost-effective in older adults compared to PPV23 or no vaccination based on the current systematic review. Randomized controlled trials and cost-effectiveness evaluations are suggested to be conducted in Hong Kong and Asia-specific regions in order to obtain clinical and economic data of PCV13 in the Asian population. Policy-makers should also consider the effects of serotype replacement on the change in serotype distribution in local setting from time to time so that vaccines with appropriate serotype formulations could be researched.published_or_final_version
Public Health
Master
Master of Public Health
20
Skull, Susan. "Effectiveness of influenza and pneumococcal vaccination against hospitalisation for community-acquired pneumonia among persons >65 years /." Connect to thesis, 2007. http://repository.unimelb.edu.au/10187/1998.
Abstract:
Although there are well-documented benefits from influenza vaccine and 23-valent pneumococcal polysaccharide vaccine (23vPPV) against invasive pneumococcal disease and laboratory confirmed influenza, their effectiveness against pneumonia remains controversial for community-based persons aged >=65years. At the time of this research, within Australia, only the government of Victoria publicly funded these vaccines for elderly persons. With continued growth of the elderly population, the subsequent adoption of an Australia-wide program, and increasing uptake of similar programs in other countries, there is a need for data clarifying the impact of vaccination on pneumonia. This research estimates incremental vaccine effectiveness of 23vPPV over and above influenza vaccine against hospitalisation with community-acquired pneumonia (CAP) in the elderly.
21
Rose, Johnie II. "Simulating The Impacts Of Mass Vaccination With Live Attenuated Human Rotavirus Vaccine In A Developing Country." Cleveland, Ohio : Case Western Reserve University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1259956594.
Abstract:
Thesis(Ph.D.)--Case Western Reserve University, 2010Title from PDF (viewed on 2010-01-28) Department of Epidemiology and Biostatistics Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center
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Conde, Mônica Tilli Reis Pessôa. "Efetividade da vacina conjugada contra o meningococo C em menores de dois anos." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-03112014-085727/.
Abstract:
Objetivo: Estimar o impacto da vacina conjugada contra o meningococo C (VCMC), na incidência e mortalidade, nas coortes de nascidos com e sem indicação de vacinação, no município de São Paulo (MSP); e estimar a efetividade direta da VCMC segundo esquema do Programa Nacional de Imunização. Métodos: O impacto foi avaliado por estudo descritivo, abrangendo casos de doença meningocócica (DM) notificados ao MSP, de 1998 a 2012. A definição de caso é a adotada pelo Ministério da Saúde. Descreveu-se o comportamento da DM no MSP para todo período e analisou-se a tendência da incidência e mortalidade da DM global e por faixa etária de 2008 a 2012, utilizando o modelo de Poisson. O impacto da VCMC foi analisado por meio das razões de taxas de incidência e mortalidade nos períodos anterior e posterior a introdução da VCMC. Estimou-se a fração prevenida na população (FPP) para mensurar o impacto, comparando-se taxas de incidência e mortalidade globais da DM, por faixa etária e sorogrupo C, de 2012 com as de 2009. Para estimativa da efetividade da VCMC utilizou-se estudo de caso-controle de base populacional, com quatro controles para cada caso, pareado pela área de residência dos casos. Casos e controles foram selecionados entre nascidos a partir de janeiro/2009. Casos eram aqueles com DM pelo sorogrupo C confirmado por cultura e/ou reação em cadeia de polimerase em tempo real, de 2011 a 2013, internados em hospitais do MSP, notificados à vigilância do município. Controles foram selecionados entre crianças residentes na vizinhança dos casos, sem história de DM. A efetividade da vacina foi estimada pela fórmula (1-odds ratio para vacinação). As odds ratios (OR) não ajustadas e ajustadas e respectivos intervalos de confiança (IC95 por cento ) foram estimados por regressão 11 logística condicional múltipla. A associação entre ser vacinado com VCMC e a variável dependente, DM pelo sorogrupo C, foi mensurada pela estimativa da OR após ajuste para potenciais confundidores. Resultados: O impacto da VCMC na incidência da DM por todos os sorogrupos, mensurado pela FPP foi de 62,7 por cento , 69,6 por cento e 61,4 por cento para, respectivamente menores um, um e dois anos; na DM pelo sorogrupo C de 81,6 por cento e 67,9 por cento para menores de dois anos e de dois a três anos. Houve impacto na taxa de mortalidade global da DM medido pela FPP de 86,2 por cento e 77,8 por cento respectivamente para menores de dois anos e de dois a três anos e na mortalidade da DM pelo sorogrupo C a FPP foi de 84,2 por cento para menores de quatro anos. A efetividade da VCMC foi de 97,7 por cento (IC95 por cento :99,6 por cento -89,6 por cento ) ajustada para idade, número de pessoas no quarto da criança e renda familiar. Conclusões: A estratégia brasileira com a VCMC resultou em elevado impacto nas coortes de nascidos com indicação de vacinação, mais acentuado nas taxas de mortalidade, sugerindo que a vacina confere não só proteção para a doença, mas também para formas mais graves. A VCMC foi altamente efetiva na faixa etária alvo.Objective: To assess the impact of meningococcal C conjugate vaccine (MCCV), to estimate incidence and mortality rates of meningococcal disease (MD) in birth cohorts recommended and not recommended for vaccination and to measure direct vaccine effectiveness of the National Vaccination Program immunization schedule. Methods: We assessed the impact of MCCV in a descriptive study including cases of MD reported in the city of Sao Paulo, Brazil, from 1998 to 2012. We used the standard case definition recommended by the Brazilian Ministry of Health for MD reporting. We assessed changes in the disease epidemiology in the city for the entire study period and estimated incidence and mortality rates of MD (overall and by age group) from 2008 to 2012 using Poisson regression models. We conducted an impact analysis of MCCV by comparing incidence and mortality rates of MD before and after vaccine introduction. We also estimated the population prevented fraction (PPF) by comparing incidence and mortality rates of MD between 2009 and 2012 in the entire population and by age group and serogroup C. To measure vaccine effectiveness, we carried out a population-based case-control study matched for area of residence with a 4-to-1 ratio of controls to cases. Cases and controls were selected among children born from January 2009. Cases were those children admitted to the citys hospitals who were diagnosed with MD serogroup C (MDC) confirmed by culture and/or real-time polymerase chain reaction and reported to the surveillance system from 2011 to 2013. Controls were selected among children with no history of MD from neighboring areas of cases. We calculated vaccine effectiveness using the formula (1 odds ratio [OR] for 13 vaccination) and estimated crude and adjusted ORs and related 95 per cent confidence intervals (95 per cent CI) by conditional multiple logistic regression. We assessed the association between MCCV vaccination and MDC the dependent variable by estimating OR after adjustment for the potential confounders. Results: There was an impact of MCCV on the incidence of MD in all serogroups, the PPF among children under age one, age one, and age two were 62.7 per cent , 69.6 per cent , and 61.4 per cent , respectively; and in serogroup C, the PPF in children under age two and age two to three were 81.6 per cent and 67.9 per cent . There was also an impact on the overall mortality rate of MD, the PPF in children under age two and age two to three were 86.2 per cent and 77.8 per cent ; and on mortality of MDC, the PPF was 84.2 per cent in children under age four. MCCV effectiveness in children was 97.7 per cent (95 per cent CI 99.6 per cent 89.6 per cent ) after adjusting for age, number of persons per room, and household income. Conclusions: The MCCV strategy implemented in Brazil had a high impact on birth cohorts recommended for vaccination. This impact was more pronounced on mortality rates, which suggests that, in addition to preventing disease, MCCV can prevent more severe forms of MD. MCCV proved highly effective in the age groups targeted.
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Carvalho, Ieda Silva. "Custo-utilidade da vacinação contra Papilomavírus humano no Brasil." Dissertação apresentada ao Programa de Pós-Graduação do Instituto de Saúde Coletiva, como requisito parcial para a obtenção do título de mestre em Saúde Coletiva, 2013. http://www.repositorio.ufba.br/ri/handle/ri/13110.
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O câncer de colo de útero (CCU) é um importante problema de saúde em todo o mundo. O HPV é o principal fator associado a esta doença. Para a prevenção primária da infecção foi desenvolvido a vacina quadrivalente que protege contra os tipos HPV 16, 18, 11 e 6. Objetivo: este estudo analisou a relação custo-efetividade e custo-utilidade da adição da vacina contra HPV para Sistema Único de Saúde brasileiro, em comparação ao rastreamento pelo exame citopatológico, programa existente. Método: foi adaptado um modelo de Markov da história natural da infecção por HPV para estimar custo e qualidade de vida para uma coorte hipotética de meninas de 10 anos de idade acompanhadas por 70 anos. Duas estratégias foram comparadas: vacinar e rastrear (estratégia alternativa) em relação ao rastreamento (estratégia base). No modelo a cobertura para o rastreamento foi de 77,1% e para a vacina 95%. A taxa de desconto aplicada para calcular custos e efeitos futuros de saúde foi de 5%. A análise de sensibilidade foi realizada para avaliar as incertezas quanto à cobertura vacinal, a sensibilidade do exame citopatológico e o valor da vacinação. Resultados: o modelo simulou que a adição da vacina poderia reduzir em 76,18% o risco de morrer por CCU, evitando 12.072 óbitos por esta doença a um custo médio de US$ 633.559,32/óbitos evitados, com um ganho de 1.389.478 anos de vida ajustado por qualidade. Quanto aos anos de vida ganhos ajustado por qualidade (AVAQ), a estratégia base (rastreamento) representaria um custo médio de US$ 11,62/AVAQ enquanto a estratégia teste (vacina e rastreamento) teria um custo médio de 241,66 US$/ AVAQ. A razão de custo-efetividade incremental (RCEI) desta estimativa foi de US$ 5.504,46/AVAQ. Conclusão: Esta análise, apesar das limitações metodológicas, demonstra que a incorporação, pelo SUS, da vacina quadrivalente ao programa de rastreamento pode ser uma alternativa custo-efetiva para reduzir a mortalidade por CCU.
Salvador
24
De, La Hoz Fernando. "Hepatitis B vaccination in the Columbian Amazon : effectiveness and factors influencing vaccine coverage." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2003. http://researchonline.lshtm.ac.uk/1544171/.
Abstract:
A vaccination coverage survey was carried out in the Colombian Amazon, a former high endemic area for hepatitis B, involving 3573 children less than II years old. It was carried out in Leticia, Puerto Narifio, and Araracuara, both urban and rural areas. Children were selected using a one stage cluster sampling, randomly selecting clusters in urban and rural areas where all children under 11 were surveyed. At the same time blood samples were taken from all children with known vaccination status (n=1603), and from their mother, when she was available (n=8l2). These samples were processed for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (Anti-HBc) and antibodies to HBsAg (Anti- HBs). A sample of children without vaccination data available was also bled to compare their results with those of children with vaccination data. Full vaccination coverage was found to range between 39% and 69% among different areas while hepatitis B vaccination ranged between 73% and 95%. Factors which improve the likelihood of being fully vaccinated in this study were: Age above one year, living in Leticia, being. affiliated to the social security, mother's years of schooling. Health worker's knowledge on vaccine contraindications and perceptions of logistical barriers against vaccination or importance of hepatitis B as a public health problem were also related to full vaccine coverage. Prevalence of hepatitis B infection reached 5% among those who were bled (8211603) while HBsAg positive status was 1.6% (26/1603). Since the introduction of the vaccine prevalence of hepatitis B infection has fallen from 40%, an 85% reduction, while carrier prevalence has fallen from 5%, a 68% reduction. Age above 7 years, living in a rural area, birth delivery supervised by other than a MD or nurse, and being born from an Anti-HBc+ mother were the most important general factors related to being infected with HBV. Having an incomplete schedule for hepatitis B vaccine was associated with an increase in the risk of being Anti- HBc or HBsAg+. However, some characteristics of the vaccination process were related to being HBsAg+/Anti-HBc+. Delays in receiving the first dose of hepatitis B after birth and delays to receiving the second dose after the first dose were associated with an increased risk of being HBsAg+/Anti-HBc+. None of these characteristics were related to being Anti-Hlic+ alone. In conclusion, the introduction of a recombinant Cuban manufactured hepatitis B vaccine has produced a marked decline in the high infection prevalence of children in the Colombian Amazon area. A higher coverage has been achieved from the beginning of the program though intervals from birth to first dose and between doses are too long leading to new infections that could have been avoided. There is still room to make improvements in the control program, including the implementation of a surveillance system of the HBV serological status for pregnant women, in order to ensure better vaccination schemes for those born to infected or HBsAg+ mothers.
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Bennett, Aisleen May. "Rotavirus transmission in the context of reduced vaccine effectiveness in low income countries." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3019186/.
Abstract:
Introduction. Rotavirus vaccine has been introduced into over 80 countries with substantial impact on rotavirus disease. However vaccine effectiveness is reduced in low-income countries. Patterns of rotavirus transmission could explain some of the observed reduced vaccine effectiveness, and vaccine-mediated reductions in rotavirus transmission may increase overall vaccine impact. A detailed understanding of rotavirus transmission in low income countries (LIC) is required to inform policy decisions to improve vaccine performance, however such data are currently lacking. Methods. Mixture models were used as a novel method to estimate population level incidence of rotavirus in young children from serology data and describe transmission patterns in India and Malawi. Surveillance data from Queen Elizabeth Central Hospital, Malawi, were used to describe the ongoing burden of rotavirus disease after vaccine introduction and investigate for vaccine indirect effects. To investigate whether rotavirus vaccine could reduce the infectiousness of a child with rotavirus disease a household transmission study was conducted in Blantyre, Malawi to describe rates of rotavirus transmission from a symptomatic index child to household contacts, investigate predictors of viral shedding density in the index child and identify risk factors for transmission. In a final study transmission of vaccine virus from vaccinated infants to unvaccinated contacts was evaluated to investigate for horizontal transmission of vaccine virus. Results. Mixture models described clear differences in patterns of rotavirus incidence in young children from India and Malawi. Analysis of surveillance data showed that rotavirus remains an important cause of hospitalised diarrhoeal disease in Blantyre despite high vaccine coverage, and identified some evidence of an indirect effect in unvaccinated infants. Household studies found a high rate of transmission of infection to household contacts (434/665, 65%) but a lower rate of transmission for disease (37/698, 5.3%). Disease severity in the index child was associated with an increased risk of transmission to household contacts, independent of viral shedding density. Rates of transmission of vaccine virus to household contacts were very low (2/151, 1.3%). Conclusions. These studies demonstrate that rotavirus remains a significant cause of admitted diarrhoeal disease in Blantyre, Malawi and describe some evidence of a vaccine indirect effect. Transmission rates of rotavirus infection to household contacts are associated with disease severity in the index child. As vaccine provides incremental protection against severe disease, vaccination therefore has potential to reduce the infectiousness of a vaccinated index child. Horizontal transmission of vaccine virus is infrequent and unlikely to make a substantial contribution to rotavirus vaccine indirect effects in this setting. In view of high vaccine coverage future studies should consider mathematical models to make inferences on the impact of vaccine and inform ongoing vaccine strategy.
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Ädel, Lukas, and Oskar Eliasson. "The Development and Effectiveness of Malware Vaccination : An Experiment." Thesis, Blekinge Tekniska Högskola, Institutionen för datavetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-19711.
Abstract:
Background. The main problem that our master thesis is trying to reduce is malware infection. One method that can be used to accomplish this goal is based on the fact that most malware does not want to get caught by security programs and are actively trying to avoid them. To not get caught malware can check for the existence of security-related programs and artifacts before executing malicious code and depending on what they find, they will evaluate if the computer is worth infecting. The idea is that by identifying these checks we could "vaccinate" a system with data-points that trigger these checks and trick the malware into believing that a system is protected and skip it. Objectives. This thesis will research common malware evasion techniques to find what data-points malware avoids and develop a vaccine with the found data-points. To test the effectiveness of the vaccine an experiment will be conducted where malware will be executed on different systems to observe their behavior. Methods. The vaccine concept will be tested by gathering data-points with a background review of related works and performing an experiment. In the experiment a virtual machine without protective measures is used as a baseline which can be compared to a virtual machine with the vaccine. It is also interesting to see how a vaccine compares to an antivirus solution and how / if it would cooperate with an antivirus solution, so two more virtual machines are added to the experiment, one with just an antivirus software installed, and a second one with antivirus installed plus the vaccine. On these four systems, a set of malware will be executed and their behavior and activity (Windows API calls) will also be measured and compared. Results. This experiment showed that our vaccine was effective in reducing malware behavior, 70% of the malware did reduce their activity when exposed to the vaccine compared to the baseline. The results also indicate that the vaccine was effective in cooperation with an antivirus program, 85% of the malware did reduce their activity on this virtual machine compared to the baseline. Conclusions. From the results, we can conclude that of our created systems the system that reduced the most malware activity was the system with antivirus plus vaccine. This shows that vaccination can be a viable option for researchers to further study.
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Rondy, Marc. "Efficacité post autorisation de mise sur le marché de la vaccination antigrippale saisonnière contre l’hospitalisation avec une grippe confirmée virologiquement chez l’adulte en Europe." Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0684/document.
Abstract:
Notre objectif était de mesurer chez les adultes en Europe l’efficacité des vaccins (EV) anti-grippaux saisonniers contre l’hospitalisation avec une grippe confirmée en laboratoire. Nous avons coordonné une étude cas-témoins multicentrique dans 29 hôpitaux de 12 pays entre 2011 et 2017. Nous avons fait une analyse des données groupées lors de chaque saison grippale. Entre 2011-12 et 2016-17, nous avons recruté 3436 cas de grippe et 5969 témoins. L’EV tous virus confondus était de 26% ; elle était de 40% chez les 18-64 ans, 25% chez les 65-79 ans et 23% chez les 80 ans et plus. Par saison, l’EV variait entre 15% en 2016-17 et 44% en 2013-14. L’EV était particulièrement basse chez les seniors lors des saisons grippales dominées par le sous-type de grippe A(H3N2), atteignant 10% en 2011-12 et 2016-17 chez les personnes âgées de 80 ans et plus. Nos résultats suggèrent une EV faible à modérée contre la grippe hospitalisée chez l’adulte. Le renforcement et l’évaluation de modes de prévention complémentaires, tels que l’usage prophylactique d’antiviraux, la vaccination du personnel soignant et les approches non-pharmaceutiques (masque, hygiène des mains) devraient être une prioritéOur objective was to measure seasonal influenza vaccine effectiveness (IVE) against hospitalisation with laboratory-confirmed influenza in Europe among adults. Between 2011 and 2017, we coordinated a multicenter case-control study in 29 hospitals in 12 countries. We pooled and analysed the data after every season. Between 2011-12 and 2016-17, we recruited 3436 influenza cases and 5969 controls. Pooled across seasons, IVE against any influenza was 26%; 40% patients aged 18-64 yeas, 25% among those aged 65-79 years, and 23% among those aged ≥80 years. Season specific IVE ranged between 15% in 2016-17 and 44% in 2013-14. IVE was particularly low among elderly in seasons dominated by the A(H3N2) viruses; it was 10% in 2011-12 and 2016-17 in people aged ≥80 years. Our results suggest a low to moderate IVE against influenza hospitalisation in adults. Evaluating complementary prevention options, such as prophylactic antiviral use, vaccination of health care workers and non-pharmaceutical interventions should be a priority
28
Constenla, Dagna Oriana. "Evaluating the cost-effectiveness of vaccine introduction and its potential policy implications in Latin America." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424933.
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Torvaldsen, Siranda. "The epidemiology and prevention of pertussis in Australia." University of Sydney. Paediatrics and Child Health, 2001. http://hdl.handle.net/2123/808.
Abstract:
Pertussis (whooping cough) remains an important public health problem in Australia. Although mortality and morbidity from pertussis declined dramatically following the introduction of mass vaccination programs in 1953, the level of morbidity remains unacceptably high for a vaccine-preventable disease. Aims and methods The primary aims of this thesis were (i) to ascertain the epidemiology of pertussis in Australia between 1993 and 2000 by analysing and interpreting sources of routinely collected data on pertussis; and (ii) to examine the effectiveness of vaccination against pertussis in a number of ways. Data from three primary national sources (notifications of disease, hospitalisations for pertussis and death certificates) were used to examine the burden from pertussis in Australia over these eight years. Analyses included the age distribution of cases, temporal and geographic trends, comparisons of notification and hospitalisation data, and the impact of differences in the method of diagnosis of notified cases between years and age groups. In addition to analyses at the national level using data from the national databases, further detailed analyses were undertaken at the State level for New South Wales (NSW), the most populous Australian State. Pertussis vaccine coverage was estimated using data from the recently established Australian Childhood Immunisation Register (ACIR); these data were also used to track the transition from whole-cell to acellular pertussis vaccines. The different types of studies used to evaluate vaccine effectiveness were reviewed, and a method suitable for ongoing estimation of vaccine effectiveness in Australia was developed. This was then applied to the NSW data, to determine the effectiveness of pertussis vaccination in this State. Main findings The annual notification rate for pertussis in Australia ranged from 23�59 per 100 000 population over the eight years. Infants had the highest notification and hospitalisation rates in Australia � they accounted for 5percent of notifications, 61percent of hospitalisations and 100percent of deaths. Age-specific notification and hospitalisation rates in children aged less than two years strongly suggested a protective effect of vaccination, with the greatest reduction in rate coinciding with eligibility to receive a second dose of pertussis vaccine at four months of age. Notification rates among 5�9 year olds progressively decreased in successive age cohorts, consistent with an effect of the introduction in 1994 of a pertussis vaccine booster for preschool-aged children. Although adults (persons aged 15 years or more) accounted for half the notifications, they had the lowest notification rate. The highest numbers of pertussis notifications were in 1997, when most jurisdictions experienced an epidemic. Notification and hospitalisation rates varied across the States and Territories and also across smaller geographic regions in NSW. Areas and years with high notification rates tended to also have high hospitalisation rates, suggesting that trends in notifications reflected trends in incidence. The number of infant hospitalisations in NSW between July 1993 and June 1999 exceeded the number of notifications by 32percent, highlighting the extent of under-notification. Overall, and particularly amongst those aged more than 12 months, the majority of cases notified in NSW were based on the results of serological tests. The proportion diagnosed by culture of the organism was greatest in infants; the proportion diagnosed by serological tests increased with age. There was no evidence that the use of serology had increased since 1994 in NSW, hence changes in notification rates after this time are unlikely to be attributable to increased use of serological diagnosis. ACIR records indicated that in December 2000, 92percent of one-year-old children had received three doses of diphtheria-tetanus-pertussis (DTP) vaccine and 90percent of two-year-olds had received four doses. Vaccine coverage varied by jurisdiction. Since 1997, there was an increased use of DTP vaccines containing acellular pertussis components with a corresponding decrease in the use of vaccines containing whole-cell components. In 2000, almost all DTP vaccines administered contained acellular pertussis components. The results of the vaccine effectiveness study showed that pertussis vaccination was highly effective at preventing pertussis in NSW children, as measured by notified cases. Vaccine effectiveness was highest (91percent) in the youngest age group (8�23 months) and lowest (78percent) in the oldest age group (9�13 years). The screening method has not previously been used to estimate pertussis vaccine effectiveness in Australia. Conclusions This thesis demonstrates the value of integrating varied data sources in estimating the disease burden from pertussis. The data presented here show that the disease burden is substantial in all age groups, despite high levels of vaccine coverage in infants and children. This problem of disease control does not appear to be due to lack of vaccine effectiveness, but there is evidence of waning immunity over time. The analyses presented here form a basis for the ongoing monitoring of trends in pertussis epidemiology following the replacement of whole-cell by acellular pertussis vaccines, and will assist consideration of the need for additional booster doses in adolescents and adults.
30
Kind, André B. "Cost-effectiveness of a human papillomavirus vaccine : a comparative study between Switzerland, Romania and the Gambia /." Basel, 2009. http://www.public-health-edu.ch/new/Abstracts/KA_26.05.09.pdf.
31
Lyons, N. A. "Foot-and-mouth disease in Kenya : epidemiology, disease impact and vaccine effectiveness on large-scale dairy farms." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2172943/.
Abstract:
Foot-and-mouth disease (FMD) is endemic in Kenya where serotypes A, O, SAT1 and SAT2 are frequently encountered. Despite the importance of the dairy industry and the frequent reporting of disease, the epidemiology of FMD and field-based vaccine effectiveness has been poorly described in these endemic settings. Additionally, the disease impact has been inadequately characterised, despite the importance of such information when allocating scarce resources for animal health in national disease control strategies. The objectives of this doctoral thesis were to gain field experience of FMD in endemic settings and to use appropriate outbreaks to assess the vaccine effectiveness, gather evidence to optimise the use of vaccines and inform national policy, and to estimate disease impact. Outbreaks on two large-scale dairy farms located within Nakuru County, Kenya, were investigated and detailed descriptions of the outbreaks are presented. Both farms regularly used locally produced, aqueous adjuvanted, non-NSP purified quadrivalent (A, O, SAT1, SAT2) vaccine every 4-6 months. The first attended outbreak was caused by serotype SAT2 and evidence was found of limited or no vaccine effectiveness. At the second outbreak, due to serotype O, there was evidence of increasing protection with increasing number of doses. The reasons behind the vaccine poor effectiveness are discussed and are likely to include poor match with the field strain and inappropriate schedules in youngstock. Virus neutralisation test data were made available from the vaccine manufacturer who sample animals on farms using routine prophylactic vaccination. The influence of maternally derived antibody on the response to vaccination was investigated with these data and recommendations on vaccine schedules and future research priorities are made based on the evidence presented. On the farm that had SAT2, analysis of the disease impact was performed using individual animal data. Longitudinal analysis of individual milk yields utilising generalised estimating equations and an autoregressive variance structure to account for the correlation of yields for individual animals was performed. Predictions of 305-day milk yields were made based on previous lactations in the same herd. Despite a clear herd level impact, no difference was found between recorded clinical FMD cases and non-cases. More detailed analysis revealed significant reductions among older animals in earlier stages of lactation but younger cows were able to recover sufficiently so that no overall impact was seen. The impact of clinical disease on the rate of clinical mastitis and culling was analysed utilising a historical cohort approach with survival analysis over a 12-month period after the commencement of the outbreak. Hazard ratios (HR) were generated using Cox regression accounting for nonproportional hazards by inclusion of time-varying effects. There was good evidence of an increased rate of mastitis in the first month after the onset of the outbreak (HR=2.9, 95%CI 0.97-8.9, P=0.057) although the effect on culling was less clear. The implications of these findings for policy and further research are discussed.
32
O'Grady, Kerry-Ann. "Pneumonia in Indigenous children in the Northern Territory, Australia, and the effectiveness of pneumococcal conjugate vaccine : 1997 - 2005." Thesis, University of Melbourne, 2008. http://purl.org/au-research/grants/nhmrc/359341.
33
Thielmann, Anika [Verfasser]. "Deficits of Vaccine Storage in German General Practices and the Effectiveness of a Web-Based Education Program to Improve Vaccine Storage Knowledge of Practice Personnel (Keep Cool) / Anika Thielmann." Bonn : Universitäts- und Landesbibliothek Bonn, 2020. http://d-nb.info/122258882X/34.
34
Glassner, Kathleen M. "Cost-Effectiveness Analysis of Targeted Herpes Zoster Vaccination in Adults 50-59 at Increased Cardiovascular Risk." Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7401.
Abstract:
Background: Over the last twenty years the incidence of herpes zoster (HZ) infection, also known as shingles, has been increasing among adults for unknown reasons. The economic burden of HZ is currently estimated at over $1 billion per year in the United States (U.S.) and is expected to increase as the susceptible adult population ages. HZ is caused by a re-activation of the varicella zoster virus (VZV), chicken pox, and more than 95% of adults living today carry the virus with a lifetime risk of 1 in 3 for developing HZ. In 2006 the FDA approved a vaccine for the prevention of HZ in adults 60 years and older and in 2011 approval was expanded to include adults age 50-59 years. Since 2006 rates of adult immunization for HZ have been modest, as of 2015 approximately two-thirds of the US population ≥ 60 are still unvaccinated and more than 94% of those ages 50-59 have not been vaccinated. There is now accumulating evidence of a significantly elevated risk of ischemic stroke (IS) within the first 12 months following infection with HZ. Every 40 seconds someone in the U.S. suffers a stroke with an estimated 795,000 strokes per year. In the U.S. stroke is a significant cause of disability with costs estimated at $33 billion per year including cost of healthcare, medication, and lost productivity. As the population in the U.S ages, the risk of both HZ infection and stroke will increase significantly thus impacting mortality, morbidity, and healthcare costs. The CDC Advisory Committee for Immunization Practices (ACIP) currently recommends routine vaccination against HZ for adults ≥ 60 but does not recommend vaccination for adults age 50-59 years and does not provided any guidance or recommendations for adults who may be at increased risk of stroke associated with HZ infection. The current ACIP vaccination recommendations for HZ are predominately based on clinical trial efficacy data and cost-effectiveness analyses (CEAs) in adults ≥ 60. These prior analyses did not included costs associated with the recent evidence demonstrating increased risk of stroke up to one year following HZ infection.
Aims: The objectives of this study were as follows; 1) To assess the cost-effectiveness of a targeted HZ vaccination strategy for adults age 50-59 years at increased cardiovascular (CV) risk in whom vaccination is approved but not recommended; 2) To develop a white paper directed at payers, providers, and policy makers translating the findings from the analysis into appropriate population health dissemination, implementation, and adoption priority recommendations.
Methods: A decision analytic Markov Model (MM) was used to compare costs and outcomes between two vaccination strategies; usual-care (no current vaccine recommendation) and targeted vaccination in adults age 50-59 years with cardiovascular disease (CVD) in a hypothetical cohort of 100,000 adults age 50-59 years. The private payer perspective was used as it best represents this population of adults age 50-59 years who are predominately employed and covered under employer sponsored commercial insurance. The simulated cohort was assessed for incidence of IS within 12 months following HZ infection occurring within the fifth decade of life. Risk was assessed from the age at entry to the analysis, median age 55, up to age 60 using TreeAge Pro 2017 software. The cohort was then aged out to 100 years or death, whichever came first. Costs were calculated using 2016 U.S. dollars.
Findings: As it relates to aim one, compared to usual-care targeting HZ vaccination in adults age 50-59 years with prevalent CVD was cost-effective with an incremental cost-effectiveness ratio (ICER) of $55,517 per quality of life-year (QALY) gained which falls well below the standard willingness-to-pay (WTP) threshold of $100,000 utilized in previous HZ CEAs (Le & Rothberg, 2015, 2016; Pellissier, Brisson, & Levin, 2007). The incremental cost of vaccinating the target population using a benchmark vaccination rate of 60% was $30.59 per person compared to $12.98 in the usual-care group with ICERs of $55,517 and $55,470 respectively. Moreover, when comparing the cost of universal vaccination in the entire 50-59 year old cohort cost-effectiveness was maintained with an incremental cost of $176.51 per person and an ICER of $55,523. Adopting the targeted strategy resulted in 162 fewer cases of HZ and 14 fewer strokes per 100,000 persons. Regarding aim two, following safety and efficacy, cost-effectiveness analysis are considered an essential metric in vaccine policy making and a substantial driver of vaccine adoption by policymakers, payers, and providers. Translating these favorable cost-effectiveness findings to policymakers, payers, and providers is necessary to help close the adoption curve gap in order to facilitate and inform effective and timely implementation strategies for HZ vaccination in this targeted population.
Conclusions: This study demonstrated that targeted HZ vaccination in patients age 50-59 years at increased CV risk is cost-effective and thus updating ACIP policy recommendations regarding vaccination in this population for whom the vaccine is currently FDA approved but not recommended should be considered. Furthermore, this study showed that universal vaccination in the general 50-59 year old population is cost-effective. Given the very limited data on cost-effectiveness of HZ vaccination in adults age 50-59 years, which has resulted in a lack of recommendation for this population, and recent evidence of IS risk the results of this study demonstrating cost-effectiveness of a targeted HZ vaccination strategy directly support the National Adult Immunization Plan (NAIP) to improve adult immunization uptake by providing economic evaluations which can be used to inform policymakers, payers, and providers.
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Oliveira, Janessa de Fátima Morgado de. "Efetividade da vacinação contra gripe no contexto brasileiro: análise comparativa do programa nas regiões Nordeste e Sul." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-10092012-102229/.
Abstract:
Introdução: Desde 1999, o serviço público de saúde tem promovido a vacinação anual de idosos contra a gripe no país. Poucos estudos avaliaram a efetividade da intervenção focalizando especificamente sua contribuição para a redução da mortalidade atribuível aos surtos de gripe. Objetivos: O presente estudo teve como propósito comparar a mortalidade por gripe e pneumonia de idosos (65 anos ou mais) antes e depois do início da vacinação nas regiões Nordeste e Sul do Brasil, e comparar os resultados obtidos para cada região, procurando referenciar hipóteses relativas às diferentes condições climáticas e condições socioeconômicas. Métodos: Dados oficiais de população e de mortalidade por gripe e pneumonia foram levantados junto às agências governamentais (Fundação IBGE e DATASUS) responsáveis pelo gerenciamento dessas informações. Foram estimados coeficientes semanais de mortalidade com ajuste por diferenças na distribuição por sexo e por idade. Para a identificação de surtos de gripe e a estimação da mortalidade especificamente atribuível a esses surtos, foi utilizado o modelo de Serfling. As taxas foram estudadas para os períodos 1999-2009 (em que a vacinação foi realizada) e 1996-1998 (em que a vacinação não foi realizada). Foram descritas e analisadas a magnitude das taxas em cada período, sua possível redução associada à vacinação e a ocorrência de variação sazonal. Os indicadores resultantes da comparação entre os dois períodos foram objeto de análise comparativa entre as regiões Nordeste e Sul. Resultados: Durante o período de vacinação, a média anual do número de períodos com excesso de mortalidade foi reduzida em 32,8 por cento na região Sul; em 4,5 por cento na região Nordeste. Na região Sul, a duração média de tais períodos foi reduzida em 66,2 por cento e a mortalidade por semana foi reduzida em 43,9 por cento . Na região Nordeste; a duração média de tais períodos aumentou 22,2 por cento e a mortalidade atribuível à influenza por semanaaumentou 140,2 por cento . Conclusão: O presente estudo reforça a hipótese de quea vacinação contra gripe em idosos foi efetiva para a região Sul, mas nãopara a região Nordeste do Brasil. A inadequação entre o período do ano em que a vacinação é realizada e a variação sazonal da mortalidade por gripe epneumonia na região Nordeste são apontadas como possíveis fatores que teriam contribuído para esse achadoIntrodução: Desde 1999, o serviço público de saúde tem promovido a vacinação anual de idosos contra a gripe no país. Poucos estudos avaliaram a efetividade da intervenção focalizando especificamente sua contribuição para a redução da mortalidade atribuível aos surtos de gripe. Objetivos: O presente estudo teve como propósito comparar a mortalidade por gripe e pneumonia de idosos (65 anos ou mais) antes e depois do início da vacinação nas regiões Nordeste e Sul do Brasil, e comparar os resultados obtidos para cada região, procurando referenciar hipóteses relativas às diferentes condições climáticas e condições socioeconômicas. Métodos: Dados oficiais de população e de mortalidade por gripe e pneumonia foram levantados junto às agências governamentais (Fundação IBGE e DATASUS) responsáveis pelo gerenciamento dessas informações. Foram estimados coeficientes semanais de mortalidade com ajuste por diferenças na distribuição por sexo e por idade. Para a identificação de surtos de gripe e a estimação da mortalidade especificamente atribuível a esses surtos, foi utilizado o modelo de Serfling. As taxas foram estudadas para os períodos 1999-2009 (em que a vacinação foi realizada) e 1996-1998 (em que a vacinação não foi realizada). Foram descritas e analisadas a magnitude das taxas em cada período, sua possível redução associada à vacinação e a ocorrência de variação sazonal. Os indicadores resultantes da comparação entre os dois períodos foram objeto de análise comparativa entre as regiões Nordeste e Sul. Resultados: Durante o período de vacinação, a média anual do número de períodos com excesso de mortalidade foi reduzida em 32,8 por cento na região Sul; em 4,5 por cento na região Nordeste. Na região Sul, a duração média de tais períodos foi reduzida em 66,2 por cento e a mortalidade por semana foi reduzida em 43,9 por cento . Na região Nordeste; a duração média de tais períodos aumentou 22,2 por cento e a mortalidade atribuível à influenza por semanaaumentou 140,2 por cento . Conclusão: O presente estudo reforça a hipótese de quea vacinação contra gripe em idosos foi efetiva para a região Sul, mas nãopara a região Nordeste do Brasil. A inadequação entre o período do ano em que a vacinação é realizada e a variação sazonal da mortalidade por gripe epneumonia na região Nordeste são apontadas como possíveis fatores que teriam contribuído para esse achado
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N'Diaye, Dieynaba. "Coût-efficacité des stratégies vaccinales en France, exemple de trois pathologies infectieuses : le tétanos, la rage et les infections materno-fœtales à cytomégalovirus." Thesis, Paris 6, 2014. http://www.theses.fr/2014PA066490/document.
Abstract:
Dans un contexte de ressources limitées, les analyses médico-économiques participent à la réflexion sur l'allocation optimale des budgets disponibles et contribuent à l'identification des priorités de santé publique. Parmi elles, les analyses coût-efficacité permettent de comparer l'efficience de différentes alternatives permettant d'aider à faire un choix. Lorsque ces analyses sont appliquées à la vaccination, elles présentent des particularités que nous avons explorées et illustrées à travers trois pathologies infectieuses prises en charge en France.Vaccination post-exposition conditionnelle au diagnostic de l'immunité avec l'exemple du tétanos, compte-tenu de la disponibilité de tests de diagnostic rapide de l'immunité antitétanique. Vaccination post-exposition conditionnelle à la nature de l'exposition avec l'exemple de la rage, compte-tenu d'un faible niveau de risque.accination préventive avant la période à risque de survenue de l'infection avec l'exemple des infections materno-f¿tales à cytomégalovirus (CMV), compte-tenu des résultats d'un nouveau candidat vaccin.Nos résultats montrent que l'efficience de stratégies vaccinales peut être optimisée si une attention particulière est portée à la mise en place d'un moyen de dépistage de l'immunité sensible et peu coûteux et si ces stratégies sont en adéquation avec le niveau du risque infectieux réel. Le coût-efficacité est également maximisé lorsque la stratégie vaccinale tient compte de l'hétérogénéité du risque infectieux au sein de la population cible. Ces résultats pourraient être utilisés par les autorités de santé pour l'évaluation d'interventions vaccinales futures ou actuellement implémentées en FranceIn a context of limited resources, health economic analyses contribute to the optimal allocation of available budgets and public health priorities assessment. Among them, cost-effectiveness analyses allow to compare the efficiency of several alternatives in order to make an informed choice. When those analyses are applied to immunization interventions, they present specific characteristics that we explored and illustrated based on three infectious diseases in the French context.1) Post-exposure immunization conditional to immunity screening with the example of tetanus and the quick diagnostic tests available to screen tetanus immunity.2) Post-exposure immunization conditional to the type of exposure with the example of rabies in a low-risk context. 3) Preventive vaccination before the at-risk period of infection through the example cytomegalovirus (CMV) infections during pregnancy, with the available results of a new vaccine candidate.Our results showed that efficiency immunization strategies can be maximized if we emphasize on the implementation of screening methods that are sensitive and inexpensive, and if those strategies are in adequacy with the real risk of infection. Efficiency is also optimized when the immunization strategy takes into account the heterogeneity of the risk of infection in the target population. Those results could be used by health authorities in the evaluation of current or future immunization interventions implemented in France
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Ternes, Yves Mauro Fernandes. "Efeito da vacina pneumocócica conjugada na redução de sorotipos vacinais colonizadores da nasofaringe de crianças residentes no município de Goiânia, GO." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/3961.
Abstract:
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Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
Fundação de Apoio à Pesquisa - FUNAPE
10-valent conjugate pneumococcal vaccine (PCV10) was introduced in the routine immunization at Goiania in June, 2010. The aims of this study were: (i) to evaluate the direct effect of PCV10 in preventing vaccine types nasopharyngeal/NP pneumococcal carriage in younger children according to different schedules; (ii) to investigate possible genetic changes that could interfere in the pneumococcal capsular typing. Methods: A cross-sectional population-based household survey was conducted in Goiania, Brazil, from December/2010-February/2011, targeting children aged 7-18 months. To evaluate PPCV10 effectiveness/VE, NP swabs, clinical and demographic data, and vaccination dates were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type (VT) carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by positivity in culture after of NP secretions in enrichment broth and isolates serotyping was performed by Quellung reaction. The nontypeable isolates were processed by conventional multiplex PCR (cmPCR). Rate ratio/RR was calculated as the ratio between the prevalence of VTs carriage in children vaccinated with different schedules (exposed) and not vaccinated to PCV10 (non-exposed). Adjusted RR was estimated using Poisson regression. VE on VT carriage was calculated as 1-RR*100. Results: The prevalence of pneumococcal carriage in a total of 1,287 children was 41.0% (95%CI: 38.4%-43.7%). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Serotypes 6B (11.6%), 6A (9,8%), 23F (7.8%), 14 (6.8%), 19F (6.6%), and 19A (6,3%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction on pneumococcal VT carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2%-57.1%; p=0.030) and 44.0% (95%CI: 14.2%-63.5%; p=0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p=0.905). We identified 13 samples with a genetic variation that underestimated the capsular typing for 19F by cmPCR. Conclusion: PCV10 was associated with high protection against vaccine-type carriage for children vaccinated before the second year of life, for 2p+0 and 3p+0 schedules. The identification of genetic variations (19Fv) allowed adapt the molecular technique (cmPCR) for capsular typing samples from Latin America. The continuous evaluation of carriage serotype is mandatory to evaluate the long-term effectiveness and impact of pneumococcal vaccine on serotypes reduction.
A vacina pneumocócica conjugada 10-valente (PCV10) foi introduzida no calendário básico de imunização em Goiânia em junho de 2010. Este estudo teve como objetivos: (i) Avaliar o efeito direto da PCV10 na redução de sorotipos vacinais de Streptococcus pneumoniae (pneumococo) na nasofaringe (NP) de crianças, de acordo com diferentes esquemas vacinais; (ii) investigar possíveis alterações genéticas que possam interferir na tipagem capsular dos pneumococos isolados. Métodos: Um estudo de corte transversal aninhado a um inquérito domiciliar de base populacional foi conduzido em Goiânia, de dezembro/2010 a fevereiro/2011, em crianças de 7-18 meses. Para avaliar a efetividade da PCV10 (VE), swabs de NP, dados clínicos e demográficos e datas da administração da vacina foram obtidos de 1.287 crianças durante as visitas domiciliares. As variáveis de desfecho e de exposição foram portador (colonização) por tipos vacinais (VTs) da PCV10 e esquemas vacinais (3p+0, 2p+0 e dose única – catch-up), respectivamente. A colonização pelo pneumococo foi definida pela positividade à cultura das secreções de NP em caldo enriquecido, e a sorotipagem dos isolados foi realizada pela reação de Quellung. Os isolados não tipáveis foram submetidos à PCR multiplex convencional (cmPCR). A razão de prevalência (rate ratio/RR) foi calculada como a razão entre a prevalência de VTs em crianças vacinadas com diferentes esquemas vacinais (expostas) e não vacinadas pela PCV10 (não expostas). A RR ajustada foi estimada utilizando a regressão de Poisson. A VE no estado de portador por VTs foi calculada como (1-RR) x 100. Resultados: A prevalência de portador pelo pneumococo no total de 1.287 crianças foi 41,0% (IC95%; 38,4-43,7). Os sorotipos presentes na PCV10 e PCV13 foram 35,2% e 53,0%, respectivamente. Os sorotipos mais frequentes foram 6B (11,6%), 6A (9,8%), 23F (7,8%), 14 (6,8%), 19F (6,6%) e 19A (6,3%). Após ajustar pelas variáveis de confusão, crianças que receberam os esquemas 2p+0 ou 3p+0 apresentaram uma redução significativa dos VTs, com VE igual a 35,9% (IC95%: 4,2-57,1; p=0,030) e 44,0% (IC95%: 14,2-63,5; p=0,008), respectivamente, quando comparado com crianças não vacinadas. Crianças que receberam dose única catch-up não apresentaram VE significante (p=0.905). Foram identificadas 13 amostras que apresentaram uma variação gênica que subestimava a tipagem capsular do 19F pela técnica cmPCR. Conclusões: a PCV10 foi associada a uma proteção significativa contra colonização nasofaringeana de VTs crianças menores de um ano, quando utilizados os esquemas vacinais 3p+0 ou 2p+0. A identificação de variações genéticas do sorogrupo 19 (19Fv) permitiu adequar a técnica de cmPCR para tipagem de amostras da América Latina. O monitoramento contínuo de sorotipos no portador é fundamental na avaliação da efetividade a longo prazo e o impacto da vacinação na redução dos sorotipos vacinais.
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Cardoso, Cristiane Wanderley. "Efetividade da vacina meningocócica C conjugada e caracterização da Neisseria meningitidis em Salvador, Bahia." Centro de Pesquisas Gonçalo Moniz, 2014. https://www.arca.fiocruz.br/handle/icict/9046.
Abstract:
Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-12-04T17:14:15Z
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Cristiane Wanderley Cardoso.2014.pdf: 6973850 bytes, checksum: 2b778663b6a0d8b4c10a7a53b6fa3e4d (MD5)Made available in DSpace on 2014-12-04T17:14:15Z (GMT). No. of bitstreams: 1 Cristiane Wanderley Cardoso.2014.pdf: 6973850 bytes, checksum: 2b778663b6a0d8b4c10a7a53b6fa3e4d (MD5) Previous issue date: 2014
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil
Introdução: A doença meningocócica (DM) é causada pela bactéria Neisseria meningitidis, sendo um importante problema de saúde pública no mundo. Atualmente, a Neisseria meningitidis sorogrupo C (NmC) tem sido o principal agente da DM na Bahia. Em 2010 ocorreu uma epidemia de DM pela NmC em Salvador, e a fim de contê-la, a Secretaria Estadual de Saúde introduziu em fevereiro de 2010, a vacina meningocócica C conjugada (MenC) para crianças menores de cinco anos, incluindo campanhas de vacinação para indivíduos de 10 a 24 anos. Objetivos: Descrever a incidência da DM, avaliar a efetividade da vacina MenC e caracterizar os fenótipos e genótipos das cepas circulantes da N. meningitidis nos períodos pré e pós-introdução da vacina MenC. Metodologia: Realizamos um estudo descritivo-analítico, comparando incidências nas coortes de vacinados e não vacinados nos períodos pré e pós-introdução da vacina MenC. Analisamos a efetividade da vacina MenC utilizando o método “screening” e um estudo tipo caso-controle. A efetividade da vacina MenC foi baseada no odds-ratio (IC 95%; pvalor <0,05). Para caracterização molecular da NmC, utilizamos a técnica de Eletroforese em Campo Pulsátil (PFGE) e da Tipagem de Sequências Multilocus (MLST). Resultados: Entre crianças <5 anos, a incidência da DM (2,00 p/100.000 hab.) no período pós-vacina foi significativamente menor (RR 0,27; IC 95%, 0,09-0,75) do que as taxas médias (7,49 p/100.000 hab.) no período pré-vacina. Em ambos estudos, a efetividade de uma única dose da vacina MenC foi elevada, variando entre 79-100% e 89-100% (IC 95%), respectivamente. O fenótipo C:23:P1.14-6 foi o mais prevalente entre os isolados e os casos atribuídos à NmC foram associados ao tipo de sequências 3779 e 3780, ambas pertencentes ao complexo clonal 103. Conclusão: Os resultados dos estudos demonstraram elevada efetividade (100%) da vacina MenC introduzida em Salvador através de campanhas. No ano seguinte à introdução da vacina MenC, houve redução de 50% na incidência da DM em Salvador. Em 2010, a epidemia da DM em Salvador deveuse à expansão do fenótipo C:23:P1.14-6, pertencente ao complexo clonal ST103, o qual já circulava em Salvador desde 1996.
Introduction: Meningococcal disease (MD) is caused by bacterium Neisseria meningitidis and is a major public health problem worldwide. Currently the Neisseria meningitidis serogroup C (NmC) has been the main cause of MD in Bahia, Brazil. In order to contain the 2010 epidemic of MD caused by NmC that occurred in the city of Salvador, the State Department of Health introduced in February 2010 the meningococcal C conjugate vaccine (MenC) to <5 year-old children, including vaccination campaigns for individuals from 10-24 years. Objectives: Describe trends in incidence of MD, estimate the effectiveness of MenC vaccine, and characterize the phenotypes and genotypes of the circulating strains of N. meningitidis in the pre and post-introduction of the MenC vaccine. Methods: A descriptiveanalytical study was realized comparing incidences in cohorts vaccinated and unvaccinated pre and post introduction of the MenC vaccine. We analyze the effectiveness of MenC vaccine using the screening method and a case-control study. The effectiveness of MenC vaccine was based on the odds-ratio (CI 95%). We performed molecular analyses by pulsed field gel electrophoresis (PFGE) and by multi-locus sequencing typing (MLST). Results: Among children <5 years, the incidence of DM in the post-vaccine period (2.00 p/ 100,000 inhabitants) was significantly lower (RR 0.27, 95% CI 0.09 to 0.75) than the rates averages in the pre-vaccine period (7.49 p/ 100,000 inhab.). In both studies the effectiveness of a single dose of MenC vaccine was 100%, CI ranging from 79-100% and 89-100% (CI 95%), respectively. The phenotype C:23:P1.14-6 was the most prevalent among isolates and cases assigned to NmC were associated with the sequences types 3779 and 3780, both belonging to the clonal complex 103 which has been circulating in Salvador since 1996. Conclusions: The results of the studies showed high effectiveness (100%) of MenC vaccine introduced in Salvador through campaigns. In following the introduction of the MenC vaccine, there was a 50% reduction in the incidence of DM in Salvador. In 2010, the epidemic of DM in Salvador was due to the expansion of the phenotype C: 23: P1.14-6 belonging to the ST103 clonal complex, which was circulating in Salvador since 1996.
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Ichihara, Maria Yury Travassos. "Internação por diarréia aguda em menores de 2 anos no Brasil: fatores de risco e efetividade da vacina oral monovalente contra rotavirus humano." Instituto de Saúde Coletiva, 2014. http://repositorio.ufba.br/ri/handle/ri/16322.
Abstract:
Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-03T17:40:16Z
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A diarréia é uma das causas mais freqüentes de atendimentos ambulatoriais e de hospitalização em menores de 5 anos. Bactérias e o rotavírus são os principais agentes etiológicos envolvidos nas diarréias graves, sendo o rotavírus responsável por 22% a 38% das admissões hospitalares. Para abordar o tema sobre a internação de crianças brasileiras menores de 2 anos devido a diarréia foram realizados três estudos casos-controles com base hospitalar. Inicialmente, foi estimada a associação dos fatores de risco e a internação por diarréia aguda (exceto àquela causada por rotavírus) de acordo com as rotas de transmissão dos agentes etiológicos, as várias fontes de infecção e as condições de vida das populações. Foi demonstrado que os principais fatores de risco associados à internação por diarréia foram a falta de esgotamento sanitário e de água de boa qualidade e ter uma ou mais internações prévias devido à diarréia. Em relação à diarréia aguda causada por rotavírus, a OMS recomenda o uso de duas vacinas licenciadas no mundo (Rotarix® e RotaTeq®). A vacina oral monovalente contra rotavirus (G1P[8], Rotarix®) foi introduzida no Programa Nacional de Imunização do Brasil em 2006. A eficácia e efetividade da vacina variam entre países com renda alta e baixa, embora exista forte evidência de proteção cruzada para os genótipos G1-G4 e G9. Avaliamos a efetividade global e genótipo-específica da vacina oral monovalente na prevenção de internação de crianças brasileiras com diarréia causada por rotavirus. Além disso, estimamos a efetividade da vacina global e genótipo-específica por tempo de vacinação após a segunda dose da vacina (até dois anos) e EV para as Regiões brasileiras. Elevadas efetividades geral e genótipo-específica da vacina foram observadas, mesmo num contexto de grande diversidade genotípica e com predominância do genótipo G2P[4]. A duração da proteção global e genótipo-específica da vacina permaneceu até dois anos e foi maior para G1P[8] do que para G2P[4]. Por outro lado, consideramos plausível que a EV poderia variar em diferentes populações e em diferentes períodos de tempo, mediante a grande diversidade genotípica, a ocorrência de genótipos incomuns, de combinações mistas de G e P e de emergência de novas cepas advindas de combinações inter-espécies (homem e animal). Analisamos a EV estratificada por Regiões brasileiras e ficou demonstrado que a EV para a Região Norte foi similar à EV global. Porém a EV para as outras Regiões foi menor, talvez devido ao pequeno número de casos. Baseado nos resultados dos estudos nós recomendamos: 1) implementar ações voltadas para o domínio público (ambiente, saneamento, higiene na comunidade e acesso a serviços de saúde) para reduzir a morbidade por diarréia; 2) a continuidade do uso da vacina oral monovalente no Programa Nacional de Imunização; e 3) o monitoramento de genótipos para detecção precoce de cepas novas e incomuns. Além disso, novos estudos precisam ser conduzidos para avaliar variações da efetividade da vacina entre as Regiões, as sub-regiões e as áreas mais vulneráveis do Brasil. Será importante realizar estudos de custo-efetividade para subsidiar a política nacional de imunização.
Diarrhea has been a frequent reason of visits to the health services and hospitalization among children under five. Bacteria and rotavirus are the main agents involved in severe diarrhea, in which rotavirus is responsible from 22% to 38% of children hospital admissions. To address the issue of hospitalization of Brazilian children under 2 years due to diarrhea, we conducted three hospital based case-control study. Initially, we aimed to estimate the association of risk factors and acute diarrhea hospitalization (except those caused by rotavirus) according to the routes of transmission of etiologic agents, the various sources of infection and the living conditions of populations. It was demonstrated that the main risk factors were lack of sewage and water of good quality, and already having one or more hospitalizations due to diarrhea. In relation to the rotavirus acute diarrhea, the World Health Organization has been recommended the use of two licensed vaccines worldwide (Rotarix ® and RotaTeq ®). The oral monovalent rotavirus vaccine (G1[P8] strain, Rotarix®) was introduced in Brazilian National Immunization Program in 2006. The vaccine efficacy and effectiveness vary between high and low income countries, although there is strong evidence of cross-protection for G1-G4 and G9 genotypes. We evaluated overall and genotype-specific oral monovalent rotavirus VE in preventing RV-A diarrhea hospital admission of Brazilian children. Also, we estimated overall and genotype-specific VE by time since second dose vaccination (up to two years) and VE according to Brazilian Regions. High overall and genotype-specific VE were observed, even though there was a great diversity of rotavirus genotypes circulating in Brazil and a predominance of G2P[4] genotype. The overall and genotype-specific VE lasted for two years after second dose vaccination and it was higher for G1P[8] than G2P[4]. Besides, we considered that it was plausible that RV-A VE could vary in different populations (Regions) and in different periods of time, since there was a great genotype diversity, an occurrence of unusual genotypes, mixed combinations of G and P and emergence of new strains from combinations of inter-species (human and animal). We analyzed the VE for Brazilian Regions and we demonstrated that the VE for Northern Region was similar to the overall VE. However, the VE for other Regions was lower than VE for Northern Region, maybe because of the small number of the cases. Based on the findings of the studies we recommend: 1) to implement actions of the public domain (environment, sanitation, hygiene in the community and access to health services) to reduce the diarrhea morbidity; 2) the continued use of oral monovalent rotavirus vaccine in the National Immunization Program; and 3) the monitoring for early detection of unusual and novel rotavirus genotypes. In addition, new studies should be conducted to evaluate the variations of rotavirus VE in different Regions, sub-Regions and vulnerable areas in Brazil. It might be useful to conduct cost-effectiveness studies to inform national immunization policy.
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Ahmed, Ala'eldin Hassan. "Influenza mortality and hospital admissions for influenza, pneumonia, emphysema and bronchitis during the influenza epidemic 1989-90 : case-control study of risk-factors and effectiveness of influenza vaccine." Thesis, University of Leicester, 1997. http://hdl.handle.net/2381/29347.
Abstract:
General practitioners' records for 315 subjects whose primary or contributory cause of death was influenza between November 4, 1989 and February 23, 1990, and 777 controls, matched for age, sex, and area of residence, who died a year after the epidemic were reviewed. Information was collected on demography, usual place of residence (institutional or non institutional), and existence of chronic illness. Conditional logistic regression analysis for matched case-control studies showed that influenza vaccination reduced mortality by 41% (95% Cl 13 - 60%) for all subjects. Among subjects who received the vaccine for the first time in 1989, vaccination reduced mortality by 9% (95% CI 0 - 50); however among those who had also been vaccinated previously, mortality was reduced by 75% (95% CI 31 - 91). There were no significant differences in the effect of vaccine between subjects who lived in institutions and in the community (p=0.16), or between subjects with high-risk medical conditions and those without (p=0.76). Influenza vaccine is effective in reducing mortality from influenza, and effectiveness seems to be greater after repeated annual vaccination than after first time administration.;Vaccine up-take among cases and controls was only 21.5% but 77% of individuals had an indication for vaccination as recommended by the DoH. There was no significant difference in the proportion of patients in each of the DoH high-risk groups who were vaccinated (x2 = 7, p = 0.07). Multiple logistic regression showed that three factors significantly affected the likelihood of immunisation in 1989 - 90; more frequent consultations with GP during the 12 months before death (OR 1.04, CI 1.03 - 1.04), living in residential care (OR, 1.45, CI 1.17 - 1.79), and 'previous' vaccination (between 1985 - 88) (OR 7.61, CI 6.06 - 9.56).;Of the 315 fatal influenza cases identified 299 (94.9%) were 65 years or older and 263 (83.5%) had an indication for vaccination.
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Yurttas, Can [Verfasser], and Ulrich [Akademischer Betreuer] Lauer. ""PULSED" versus "CONTINUOUS" application of the prodrug 5-FC for enhancing oncolytic effectiveness of a measles vaccine virus armed with a suicide gene / Can Yurttas ; Betreuer: Ulrich Lauer." Tübingen : Universitätsbibliothek Tübingen, 2016. http://d-nb.info/1198120371/34.
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Andrade, Carlos José Coelho de. "Avaliações econômicas do uso da vacina contra o Papilomavírus Humano (HPV) em meninas adolescentes: uma revisão sistemática." Universidade do Estado do Rio de Janeiro, 2010. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=2494.
Abstract:
O câncer de colo do útero persiste como um importante problema de saúde em todo o mundo, em particular nos países em desenvolvimento. Duas vacinas contra o papilomavirus humano (HPV) encontram-se atualmente disponíveis e aprovadas para uso em meninas adolescentes, antes do início da vida sexual: uma bivalente, contra os sorotipos 16 e 18 e outra quadrivalente, contra os sorotipos 6, 11, 16 e 18. Estes imunobiológicos têm por objetivo induzir uma imunidade contra o papilomavírus e, desta forma, atuar na prevenção primária do câncer do colo de útero. As avaliações econômicas podem ser um elemento que auxiliem nos processos de tomada de decisão sobre a incorporação da vacina em programas de imunização nacionais. Estas avaliações foram o objeto central deste trabalho, que teve como objetivo sintetizar as evidências procedentes de uma revisão sistemática da literatura de estudos de avaliação econômica da utilização da vacina contra o HPV em meninas adolescentes e pré-adolescentes. Foi realizada uma busca na literatura nas bases MEDLINE (via Pubmed), LILACS (via Bireme) e National Health Service Economic Evaluation Database (NHS EED) ate junho de 2010. Dois avaliadores, de forma independente, selecionaram estudos de avaliação econômica completa, que tivessem como foco a imunização para HPV em mulheres com as vacinas comercialmente disponíveis direcionada à população adolescente. Após a busca, 188 títulos foram identificados; destes, 39 estudos preencheram os critérios de elegibilidade e foram incluídos na revisão. Por tratar-se de uma revisão de avaliações econômicas, não foi realizada uma medida de síntese dos valores de relação incremental entre custos e efetividade. Os 39 artigos incluídos envolveram 51 avaliações econômicas em 26 países. Predominaram estudos de custo-utilidade (51%). Do ponto de vista da perspectiva da análise, predominou o dos sistemas de saúde (76,4%). A maioria dos trabalhos (94,9%) elegeu meninas, com idade entre 9 e 12 anos, como sua população alvo e desenvolveu simulações considerando imunidade para toda a vida (84,6%). Os modelos utilizados nos estudos foram do tipo Markov em 25 análises, de transmissão dinâmica em 11 e híbridos em 3. As análises de sensibilidade revelaram um conjunto de elementos de incerteza, uma parte significativa dos quais relacionados a aspectos vacinais: custos da vacina, duração da imunidade, necessidade de doses de reforço, eficácia vacinal e cobertura do programa. Estes elementos configuram uma área de especial atenção para futuros modelos que venham a ser desenvolvidos no Brasil para análises econômicas da vacinação contra o HPV.The cervical cancer persists as a major health problem worldwide, particularly in developing countries. Two vaccines against human papillomavirus (HPV) are currently available and approved for use in adolescent girls before the onset of sexual behavior: a bivalent against serotypes 16 and 18 and other quadrivalent against serotypes 6, 11, 16 and 18. These biopharmaceuticals are intended to induce immunity against papillomavirus and thus act in the primary prevention of cervix cancer. The use of vaccine in population programs with the definition of guidelines depends on an elaborate decision making process based on a careful Health Technology Assessment (HTA). The economic evaluations are part of this process. These assessments were the object of this work, which aimed to synthesize the evidence coming from a systematic literature review of studies on the economic evaluation of the use of human papillomavirus vaccination in adolescent girls and pre-teens. We performed a literature search in MEDLINE (via Pubmed), LILACS (via BIREME) and National Health Service Economic Evaluation Database (NHS EED) until June 2010. Two readers independently selected full economic evaluation studies that have focused on immunization for HPV in women with commercially available vaccines targeting the adolescent population. After the search, 188 of these titles were identified, 39 studies met the eligibility criteria and were included in the review. As a review of economic evaluations we did not perform a synthesis of the values of relationship between incremental cost and effectiveness. The 39 articles included 51 economic evaluations in 26 countries. Cost-utility studies predominate (51%). From the standpoint of the perspective of the analysis, there were predominant views of health systems (76.4%). Most studies (94.9%) chose girls, aged between 9 and 12 years as its target population (94.9%) and developed simulations considering immunity for life (84.6%). The models used in the studies were Markov in 25 analysis, transmission dynamics in 11 and hybrid models in 3. The sensitivity analysis revealed a number of important elements of uncertainty and that influenced ICER, a significant part of which related to aspects vaccine: the vaccine costs, duration of immunity, the need for booster doses, vaccine efficacy and program coverage. These elements make up an area of special attention for future models that may be developed in Brazil for economic analysis of vaccination against HPV. Keywords: Papillomavirus infections. Prevention. Vaccine. Cervical neoplasia. Systematic review. Cost-effectiveness.
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Laguzet, Laetitia. "Modélisation mathématique et numérique des comportements sociaux en milieu incertain. Application à l'épidémiologie." Thesis, Paris 9, 2015. http://www.theses.fr/2015PA090058/document.
Abstract:
Cette thèse propose une étude mathématique des stratégies de vaccination.La partie I présente le cadre mathématique, notamment le modèle à compartiments Susceptible - Infected – Recovered.La partie II aborde les techniques mathématiques de type contrôle optimal employées afin de trouver une stratégie optimale de vaccination au niveau de la société. Ceci se fait en minimisant le coût de la société. Nous montrons que la fonction valeur associée peut avoir une régularité plus faible que celle attendue dans la littérature. Enfin, nous appliquons les résultats à la vaccination contre la coqueluche.La partie III présente un modèle où le coût est défini au niveau de l'individu. Nous reformulons le problème comme un équilibre de Nash et comparons le coût obtenu avec celui de la stratégie sociétale. Une application à la grippe A(H1N1) indique la présence de perceptions différentes liées à la vaccination.La partie IV propose une implémentation numérique directe des stratégies présentéesThis thesis propose a mathematical analysis of the vaccination strategies.The first part introduces the mathematical framework, in particular the Susceptible – Infected – Recovered compartmental model.The second part introduces the optimal control tools used to find an optimal vaccination strategy from the societal point of view, which is a minimizer of the societal cost. We show that the associated value function can have a less regularity than what was assumed in the literature. These results are then applied to the vaccination against the whooping cough.The third part defines a model where the cost is defined at the level of the individual. We rephrase this problem as a Nash equilibrium and compare this results with the societal strategy. An application to the Influenza A(H1N1) 2009-10 indicates the presence of inhomogeneous perceptions concerning the vaccination risks.The fourth and last part proposes a direct numerical implementation of the different strategies
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Lopes, Estela Gallucci. "Estudo de campo para avaliação da efetividade de vacinação e de uso de coleiras impregnadas com inseticidas para o controle da leishmaniose visceral canina." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/10/10134/tde-09122015-171330/.
Abstract:
As leishmanioses e particularmente a leishmaniose visceral (LV) são doenças transmitidas por vetores artrópodes candidatas a experimentar uma grande expansão territorial em virtude de problemas relacionados ao aquecimento global. Este evento climático deverá causar grande impacto sobre a distribuição geográfica do artrópode transmissor no Brasil e no mundo. Com efeito, nos últimos 20 anos a situação epidemiológica da LV no Brasil vem se modificando de um padrão esporádico prevalente eminentemente em áreas rurais para uma condição de epidemias peri-urbanas que pode afetar todos os estratos sociais da população, tornando-se uma séria ameaça à saúde pública. As leishmanioses são consideradas até o momento doenças não preveníveis e seu padrão epidemiológico vêm se alterando de forma flagrante, o que demanda urgência para o desenvolvimento de novas ferramentas de controle e tratamento. Dentre as diversas questões levantadas sobre as demandas em pesquisa relacionadas ao controle desta enfermidade, destaca-se a importância de avanços em estudos de epidemiologia quantitativa e modelagem matemática que permitam prever efeitos de vacinações de populações empregando-se imunógenos com eficácia e/ou cobertura vacinal menor que 100%, o que parece ser uma realidade com as vacinas contra leishmanioses desenvolvidas até então pelos laboratórios no mundo todo. O sucesso de estratégias eficazes para o controle da LV depende do conhecimento de diversos parâmetros da dinâmica de infecção nas diferentes populações e espécies que atuam na cadeia epidemiológica da doença. Esse estudo teve objetivo de avaliar a efetividade de vacinas contra leishmaniose em cães bem como da utilização de coleira impregnada com inseticida através de um estudo de coorte realizado em uma região de transmissão moderada de leishmaniose visceral canina. Foram construídas seis coortes compostas por animais não reagentes ao teste rápido TR-DPP® e ao teste EIE-ELISA®. Todos os animais apresentaram estado clínico normal, conforme avaliação semiológica. As coortes compreendem grupos de animais sem qualquer medida de controle (grupo N), grupos de animais com aplicação de coleira (grupo C), grupos de animais vacinados com vacina de subunidade (grupo V1) e grupos de animais vacinados com vacina recombinante (grupo V2) e grupos de animais vacinados e com coleira (grupos V1C e V2C). Foram colhidas amostras de todas as coortes em três tempos com intervalo de seis meses cada, para sorodiagnóstico. A efetividade encontrada ao final de 12 meses de observação para os grupos C, V1, V2, V1C e V2C foram 38,2%, 58,1%, 35%, 68,6% e -36,5% respectivamente com base nos cálculos estatísticos feitos por regressão de Cox para riscos proporcionais. Todas as coortes, mesmo tendo desempenhando alguma efetividade exceto V2C, os resultados dos intervalos de confiança do risco relativo não foram significativos quando comparados ao grupo controle (N).Leishmaniasis and particularly the LV are diseases transmitted by arthropod vectors candidates to experience a wide territorial expansion because of problems related to global warming. This weather event should cause great impact on the geographical distribution of the arthropod transmitter in Brazil and worldwide. Indeed, the past 20 years the epidemiological situation of LV in Brazil has been changing a prevalent sporadic pattern predominantly in rural areas to a condition of peri-urban epidemics that can affect all social strata of the population, making it a serious threat public health. Leishmaniasis are considered so far not preventable disease and its epidemiological pattern have been changing blatantly, which requires urgency to the development of new tools for control and treatment. Among the many questions raised about the demands on research related to the control of this disease, it highlights the importance of advances in quantitative epidemiological studies and mathematical modeling to anticipate vaccinations effects of employing immunogens effectively and / or lower vaccination coverage to 100%, which appears to be a reality with vaccines against leishmaniasis developed so far by laboratories worldwide. The success of effective strategies to control the LV depends on the knowledge of many aspects of the dynamics of infection in different populations and species that act in the epidemiological chain of the disease. This study aims to evaluate the effectiveness of vaccines against leishmaniasis in dogs as well as the use of insecticide impregnated collar with through a cohort study in a high transmission of canine visceral leishmaniasis region. It was built six cohorts composed of non-reactive animals to the rapid test DPP® and EIE-ELISA® test. All the animals had normal clinical status, as symptomatic evaluation. The cohorts include groups of animals without any measure of control (group N), group of animals with collar application (group C), groups of vaccinated animals with subunit vaccine (group V1), group of animals vaccinated with recombinant vaccine (group V2) and groups of animals vaccinated and collar application (V1C and V2C). Samples were collected from all cohorts in three times at intervals of six months each for serodiagnosis. The effectiveness found after 12 months of observation for groups C, V1, V2, V1C and V2C were 38.2%, 58.1%, 35%, 68.6% and -36.5% respectively based on the statistical calculations done by Cox proportional hazards regression to. All cohorts, even though playing some effectiveness except V2C, the results of risk relative confidence intervals were not significant when compared to the control group (N).
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Fernandes, Eder Gatti. "Avaliação de custo-efetividade da introdução da vacina tríplice acelular do adulto (dTpa) no calendário de imunizações de adultos do Programa Nacional de Imunizações no Brasil." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-08052018-120838/.
Abstract:
INTRODUÇÃO: Uma epidemia de coqueluche ocorreu no Brasil, de 2011 a 2014. Isto levou à introdução da vacina tríplice acelular de adultos (dTpa) no calendário público de vacinação da gestante. Existem outras estratégias de vacinação envolvendo a dTpa, que poderiam complementar o controle da doença. Os objetivos deste estudo são descrever a epidemiologia da doença e avaliar custo-efetividade da vacinação de adultos com dTpa. MÉTODOS: 1) Uma revisão de literatura foi realizada nas bases MEDLINE, Excerpta Medica, CRD e Lilacs a partir de 2000. 2) Foi desenvolvido estudo observacional incluindo dados de vacinação e os casos notificados para o sistema de vigilância no Estado de São Paulo (ESP), de 2001 a 2015. 3) Foi realizado estudo descritivo dos pacientes com idade de 20 a <40 anos atendidos em um hospital do ESP entre 2010 e 2014, destacando-se a utilização de serviços de saúde. 4) Foi desenvolvido modelo dinâmico, para comparar a estratégia de vacinação com dTpa aos 20 anos de idade com o programa atual (vacinação com dT). Dados epidemiológicos e de custos foram retirados de sistemas de informação de saúde e da literatura nacional e internacional. Foram considerados como desfecho número de casos e mortes por coqueluche e anos de vida ganho (AVG). Considerouse a perspectiva do sistema de saúde, horizonte temporal de vinte anos e custos em Reais (R$) de 2015. Os resultados foram sumarizados em razão de custo-efetividade incremental (RCEI). Análises de sensibilidade uni e multivariadas foram realizadas. RESULTADOS: 1) Foram revisadas 28 avaliações econômicas de estratégias com dTpa. A vacinação de adolescentes e de adultos foram as mais avaliadas. A correção da subnotificação, uso de modelos dinâmicos, proteção de rebanho e altas coberturas vacinas influenciaram para o bom desempenho das estratégias. 2) Houve aumento de incidência da coqueluche entre 2011 e 2014 e queda da mesma em 2015, em todas as faixas etárias no ESP. Os lactentes foram os principais acometidos, mas a proporção de casos nessa faixa etária apresentou tendência de queda ao longo dos anos. A proporção de casos com idade de 1 a < 4, 5 a = 20 anos aumentou significativamente. Houve queda não significativa na proporção dos casos com idade < 2 meses de idade. 3) Entre 36 casos estudados no hospital, 33,3% passou por consulta prévia, 25,3% por consulta de retorno e 8,33% foram hospitalizados. Hemograma e radiografia de tórax foram os exames mais realizados. Não houve complicações ou óbito. 4) A vacinação de adultos com dTpa, com cobertura vacinal de 40% e efetividade de 75%, incluindo proteção de rebanho para os menores de um ano, evitaria 19.300 casos sintomáticos e 221 óbitos em 10 anos. A RCEI seria R$28.054,38/AVG. Na análise de sensibilidade, os resultados foram mais sensíveis a variações da incidência e à retirada da proteção de rebanho. CONCLUSÃO: O comportamento cíclico da doença é a principal causa da epidemia de coqueluche entre 2011 e 2014 e queda da incidência em 2015. A vacinação de adultos com dTpa não se mostrou custo-efetiva na realidade brasileira de 2015INTRODUCTION: A pertussis outbreak occurred in Brazil from 2011 to 2014. This led to the introduction of the maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) in the public immunization schedule. There are other vaccination strategies involving Tdap, which could complement the strategies of disease control. The objectives of this study are to describe the epidemiology of the disease and to evaluate cost-effectiveness of vaccination of adults with Tdap. METHODS: 1) A review was performed in the MEDLINE, Excerpta Medica, CRD and Lilacs databases from 2000. 2) Observational study was performed including vaccination data and the cases reported data from health surveillance datasets in the State of São Paulo from 2001 to 2015. 3) A descriptive study of patients aged 20 to < 40 years attended at a State of São Paulo hospital between 2010 and 2014 was performed, highlighting the use of health services.4) A dynamic model was developed to compare the vaccination strategy with Tdap at the age of 20 years with the current program (dT vaccination). Epidemiological and cost data were collected from health information systems and national and international studies. Number of cases and deaths by pertussis and life years saved (LYS) were considered as outcome. It was considered the health system perspective, a time horizon of 20 years and costs in 2015 Real (R$). The results were summarized by incremental costeffectiveness ration (ICER). Univariate and multivariate sensitivity analyzes were performed. RESULTS: 1) 28 economic evaluations of strategies with Tdap were reviewed. Vaccination of adolescents and adults were the most evaluated strategies. Underreporting correction, use of dynamic models, herd protection and high vaccination coverage influenced positively the performance of strategies. 2) The incidence of pertussis increased between 2011 and 2014, and its fall in 2015, among all age groups. Infants were the main affected, but the proportion of cases in this age group showed a downward trend over the years. The proportion of cases aged 1 to < 4, 5 to = 20 years increased significantly. There was a non-significant decrease in the proportion of cases aged < 2 months of age. 3) Among 36 cases studied in the hospital, 33.3% had a prior medical visit, 25.3% a return visit, and 8.33% were hospitalized. Blood count and chest X-ray were the most performed exams. There were no complications or death. 4) Vaccination of adults with Tdap, with 40% vaccine coverage and 75% effectiveness, including herd protection for children less than one year, would prevent 19,300 symptomatic cases and 221 deaths in 10 years. The ICER would be R$ 28,054.38/AVG. In the sensitivity analysis, the results were more sensitive to variations in incidence and withdrawal of herd protection. CONCLUSION: The cyclical pattern of the disease is the main cause of the pertussis epidemic between 2011 and 2014, and decreasing incidence in 2015. Adult vaccination with Tdap was not cost-effective in the 2015 Brazilian scenario
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Nunes, Sheila Elke Araújo. "Estimativa dos custos da doença pneumocócica e estudo de custo-efetividade da introdução universal da vacina anti-pneumocócica 10 valente no Brasil." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/7547.
Abstract:
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Introduction: Estimate the costs of treatment of pneumococcal diseases can aid the understanding of reduced economic burden of these after introduction of the pneumococcal conjugate vaccine (PCV), as run in Brazil, in March 2010, which introduced the PCV10 valiant in the National Program Immunization (NPI) for children between 2 and 23 months of age. Cost-effectiveness analysis (CEA) before the introduction indicated that the vaccine was cost-effective (R $ 24.930 / Daly avoided - Disability Adjusted Life Years), in the SUS perspective. Disease burden and the cost of the vaccine were identified as the main drivers of the results for sensitivity analysis. Objectives: Estimate the costs of pneumococcal disease and to evaluate the ratio of incremental cost-effectiveness (ICER) of implementing the PCV-10 brave after introduction into INP Brazil. Methods: Three steps have been performed in the SUS perspective: 1) cost of illness study: medical charts of children 28 days to 35 months of age hospitalized with clinical suspicion of bacterial pneumonia were reviewed to estimate the costs of pneumonia and to other syndromes costs were estimated by therapeutic guidelines; 2) comparison between the three methods of funding: (i) bottom-up / micro-costing by chart review; (ii) top-down / micro-costing through therapeutic guidelines; and (iii) top-down / gross-costing, through reimbursement paid by the SUS. 3) CEA: the strategy to vaccinate with PCV-10 was compared to the non-vaccination. The model used was the PneuModel. In acute otitis media from all causes, pneumococcal meningitis, pneumococcal sepsis and pneumococcal pneumonia were considered. Costs were obtained by microcusteio, epidemiological data from primary studies of population-based, dose costs and vaccination coverage in INP. The discount rate was 5%. Sensitivity analysis was conducted to test the robustness and variability of the model parameters. Results: The cost of study of hospitalized pneumonia records of 52 cases of severe pneumonia and 7 of very serious pneumonia were reviewed. Statistical analyzes of severe pneumonia data revealed that there is difference between the costing methodologies (p=0,015) and to compare the estimated costs by these methods there was no difference between the cost of compensation and the cost for therapeutic guideline (p=0,241). At ACE, annually, vaccination with PCV-10 would prevent 3,942 cases of the disease and 16,514 years of life lost in a cohort of children <1 year. The ICER was R $ 14,230 per DALY averted. In sensitivity analysis, the model was sensitive to variations in incidence and mortality of pneumonia and pneumococcal meningitis. Conclusions: The cost for therapy guideline, uncommonly used in disease cost estimates, was an alternative to funding for compensation, heavily used technique and lower accuracy. After introduction of ICER, using primary data revealed that PCV-10 is a low-cost intervention, as suggested by WHO (<1GDP / per capita - in Brazil, in 2010, US $ 10.933) and, ICER less than previous ACE. Despite uncertainties in critical parameters of the model, using secondary data, ACE can provide evidence to support decision making. After the implementation analysis can result in more accurate estimates and provide evidence to continue vaccination.
Introdução: Estimar os custos do tratamento das doenças pneumocócicas podem auxiliar no conhecimento da redução da carga econômica destas após introdução da vacina anti-pneumocócica conjugada (VPC), como corrido no Brasil, em março de 2010, que introduziu a VPC-10 valente no Programa Nacional de Imunização (PNI), para crianças entre 2 e 23 meses de idade. Análise de custo-efetividade (ACE) antes da introdução indicou que a vacina era custo-efetiva (R$ 24,930/Daly evitado – do inglês, Disability Adjusted Life Years), na perspectiva do SUS. Carga da doença e os custos da vacina foram identificados como os principais direcionadores do resultado para análise de sensibilidade. Objetivos: Estimar os custos da doença pneumocócica e avaliar a razão de custo-efetividade incremental (RCEI) da implementação da VPC-10 valente após introdução no PNI do Brasil. Métodos: Três etapas foram executadas, aplicadas a perspectiva do SUS: 1º) estudo de custo de doenças: prontuários de crianças com 28 dias a 35 meses de idade internadas por suspeita clínica de pneumonia bacteriana foram revisados para estimar os custos da pneumonia e para demais síndromes os custos foram estimados por diretrizes terapêuticas; 2º) comparação entre as três metodologias de custeio: (i) bottom-up/micro-costing através da revisão de prontuários; (ii) top-down/micro-costing através de diretriz terapêutica; e (iii) top-down/gross-costing através de ressarcimento pago pelo SUS. 3º) ACE: a estratégia de vacinar com a VPC-10 foi comparada com a não vacinação. O modelo empregado foi o PneuModel. Neste, otite média aguda por todas as causas, meningite pneumocócica, sepse pneumocócica e pneumonia pneumocócica foram consideradas. Os custos foram obtidos por microcusteio, dados epidemiológicos a partir de estudos primários de base populacional, custos da dose e de cobertura vacinal no PNI. A taxa de desconto aplicada foi de 5%. Análise de sensibilidade foi conduzida para testar a robustez e variabilidade de parâmetros do modelo. Resultados: No estudo de custo da pneumonia hospitalizada prontuários de 52 casos de pneumonias graves e 7 de pneumonias muito graves foram revisados. Análises estatísticas dos dados de pneumonias graves revelaram que há diferença entre as metodologias de custeio (p=0,015) e ao comparar os custos estimados por estas metodologias não houve diferença entre o custeio por ressarcimento e o custeio por diretriz terapêutica (p=0,241). Na ACE, anualmente, a vacinação com VPC-10 evitaria 3.942 casos da doença e 16.514 anos de vida perdidos em uma coorte de crianças <1 ano. A RCEI foi de R$ 14.230 por DALY evitado. Na análise de sensibilidade, o modelo foi sensível às variações de incidência e letalidade de pneumonia e meningite pneumocócica. Conclusões: O custeio por diretriz terapêutica, pouco empregado nas estimativas de custo de doença, se mostrou uma alternativa ao custeio por ressarcimento, técnica muito utilizada e de menor acurácia. A RCEI pós introdução, com dados primários, revelou que a VPC-10 é uma intervenção de baixo custo, como sugerido pela OMS (<1PIB/per capita – no Brasil, em 2010, R$ 10,933) e, com menor RCEI que ACE anterior. Mesmo com incertezas em parâmetros críticos do modelo, usando dados secundários, ACE podem fornecer evidências para apoiar tomadas de decisões. Analise pós-introdução pode resultar em estimativas mais precisas e fornecer evidências para continuar a vacinação.
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Mealing, Nicole. "Statistical approaches to the evaluation of the impact of vaccination programs : a case study exploring rotavirus vaccination in New South Wales." Thesis, 2018. http://hdl.handle.net/10453/125623.
Abstract:
University of Technology Sydney. Faculty of Health.Vaccination programs can provide an effective means to control infectious diseases at a population level. Evaluating the impact of these programs after implementation can be complicated by limitations of routine surveillance systems and lack of routine testing to confirm diagnosis, as well as natural fluctuations in disease rates over time. This thesis provides a structured explanation of statistical methods and how they can be used to address the epidemiological challenges in assessing changes in burden of disease as a result of vaccination programs. It explores statistical approaches to the evaluation of vaccination programs at a population level, using rotavirus vaccination in New South Wales (NSW), Australia, as a case study. A summary of the key features that need to be considered when trying to detect any changes in the burden of infectious diseases due to vaccination is given. An assessment of the impact of the Australian rotavirus vaccination program, introduced in 2007, on hospitalisations and emergency department (ED) presentations of children aged under five years for all-cause gastroenteritis in NSW from July 2001 to June 2013 was conducted. Previously published methods that separate these hospitalisations and ED presentations into those due to rotavirus and those that are not are compared. A simulation study is used to explore these methods in controlled scenarios to determine the most appropriate method for these data. The Australian rotavirus vaccination program had an almost immediate impact and led to a fifty and sixteen percent reduction in the rate of hospitalisations and ED presentations for acute gastroenteritis within the first 2.5 years. These declines were mostly attributed to a decline in the size of the seasonal peak. The methods to determine rotavirus cases from all-cause gastroenteritis cases had different strengths and limitations and the derived estimates varied. No robust method was identified from the simulation study for our data. Each method that relied on using weekly counts of positive rotavirus laboratory tests to estimate rotavirus-attributable cases underestimated the true number of rotavirus cases when their assumptions held. The evaluation of the effectiveness of vaccination programs requires the use of rigorous statistical methods to ensure the robustness and validity of findings. Appropriate statistical methods that account for temporal trends are needed to provide a detailed understanding of any changes in disease burden observed. While this thesis focused on rotavirus disease burden in NSW, Australia, many of the concepts discussed are applicable to other infectious diseases.
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Vazquez, Meredith Hodges. "Economic evaluation of using adenovirus type 4 and type 7 vaccines in United States military basic trainees." Thesis, 2014. http://hdl.handle.net/2152/24825.
Abstract:
Adenoviruses, particularly types 4 and 7, are associated with febrile respiratory illness (FRI) outbreaks in US military basic trainees. Vaccines against these two serotypes controlled FRI in basic trainees until production ceased in the mid-1990s. After contracting a new manufacturer, adenovirus vaccination of military basic trainees resumed in 2011. The purpose of this dissertation was to assess the cost-effectiveness of using the new adenovirus type 4 and type 7 vaccines for the prevention of FRI in US military basic trainees from the perspective of each military branch. Two decision tree models comparing adenovirus vaccination to no adenovirus vaccination were used for this dissertation. The first model is similar to previous models used to assess the cost-effectiveness of the adenovirus vaccine in the military, where the outcome is number of FRI hospitalizations prevented. The second model created for this dissertation used information gathered from published literature and conversations with experts on the adenovirus vaccine. The outcome for the second model was number of training days lost (TDL) averted. Results from part I indicated that adenovirus vaccination of basic trainees was cost-effective as measured by FRI hospitalizations prevented in all US military service branches but the Coast Guard. The model showed that reintroducing the adenovirus vaccine to basic trainees saved the Army $5.8 million, the Navy, $1 million, the Marine Corps, $238,000, and the Air Force, $5.2 million, annually. In addition, adenovirus vaccination prevented 1,221, 543, 317, 677 cases of FRI hospitalization annually in the Army, Navy, Marine Corps, and Air Force respectively. In part II of this study, adenovirus vaccination of basic trainees was the dominant strategy as measured by TDL averted in all US military service branches but the Marine Corps and the Coast Guard. Results indicate that it would cost approximately $37.63 and $563.78 per TDL averted for the Marine Corps and Coast Guard respectively. Both models used for this dissertation provide evidence supporting the cost-effectiveness of using the adenovirus vaccine in US basic trainees in all services but the Coast Guard.text
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Boros, Christina Ann. "Factors affecting the immunogenicity and protective efficacy of routine childhood immunisations / Christina Ann Boros." Thesis, 2001. http://hdl.handle.net/2440/21778.
Abstract:
Includes list of publications arising from the thesis.Bibliography: leaves 327-341.
341, [15] leaves : ill. (some col.) ; 30 cm.
Examines the effect of adverse storage on the immunogenicity of pertussis, diphtheria and tetanus vaccines, the protective efficacy of pertussis vaccines and the effect of premature birth on antibody response to routine childhood immunisations.
Thesis (Ph.D.)--University of Adelaide, Dept. of Paediatrics, 2002?
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Su, Wei-Ju, and 蘇韋如. "Post-licensure Vaccine Effectiveness Study of Pneumococcal Vaccines against Invasive Pneumococcal Disease in Children and Older Adults in Taiwan." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/g9h9m6.
Abstract:
博士國立臺灣大學
流行病學與預防醫學研究所
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Background and Aims: There are limited evidence describing the post-licensure vaccine effectiveness (VE) of a combination of pneumococcal conjugate vaccines (PCVs) of different valences (7-valent PCV, PCV7/10-valent PCV, PCV10/13-valnt PCV, PCV13) and/or the duration of protection they offer against IPD in children. Additionally, most evidence identified 23-valent pneumococcal polysaccharide vaccine (PPV23) VE against IPD in adults comes from western counties. This study was to evaluate the PCV VE before PCV introduction into routine immunization in children and PPV23 VE in the elderly for whom the public-funded PPV23 program targeted at in Taiwan. Methods: A matched case-control study using the national IPD surveillance database and the national vaccination registry was applied to select four age-matched, gender-matched and neighborhood-matched controls for each incident IPD case ≦5 years with disease onsets between October 2007 and December 2013. Conditional logistic regression was used to assess VE against all-serotype and serotype 19A IPD (the dominant serotype) in children. Additionally, we investigated PPV23 VE in adults ≧75 years against IPD from July 2008 to June 2016 using the screening method and the indirect cohort (Broome) method. Results: In children, a similar VE against all-serotype IPD was found between PCV13 (76%; 61–85%) and combined PCV7/PCV10 plus PCV13 (78%; 56–89%). Regarding serotype 19A, a significantly reduced risk was observed for both PCV13 (82%; 63–91%) and combined PCV7/PCV10 plus PCV13 (87%; 61–96%). VE was 81% (69–88%) within 6 months of the last dose of PCV and 19% (95% CI: -21–45%) after 2 years. PPV23 VE estimated with the screening method was 32.5% (95% CI: 17.5–44.7), 33.9% (95% CI: 25.2–41.5) and 43.4% (95% CI: 34.4–51.2) against death within 30 days of IPD onset, all-serotype IPD and PPV23-serotype IPD in adults aged ≧75 years, respectively. VE against PPV23 serotypes by the indirect cohort method was 39.0% ((95% CI: 15.5–50.9) overall, 44.9% (95% CI: 20.8–61.7) within 5 years of vaccination, and 15.5% (95%: -47.1–51.4) after 5 years, respectively. Conclusions: PCVs are effective against IPD during immunization with either the same or with a mixed series, but protection might be differential over time. Furthermore, PPV23 was estimated to have moderate protection against PPV23-serotype IPD in adults aged 75 years and older and the protection may last for about 5 years.