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Background Herd protection of Haemophilus influenzae type b (Hib) conjugate vaccine has been associated with excessive decrease of invasive Hib diseases, i.e., pneumonia and meningitis, with increased national or regional Hib vaccine coverage. Only a few studies have examined herd protection at the individual level and even less evidence is available from Asia. We examined Hib vaccine herd protection against radiologically confirmed pneumonia among children less than 2 years old.  相似文献
2.
Atkins KE  Shim E  Pitzer VE  Galvani AP 《Vaccine》2012,30(3):552-564
Rotavirus infection causes severe gastroenteritis (RVGE) in children worldwide. Its disease burden has been reduced in countries where mass vaccination programs have been introduced. However, England and Wales have not yet implemented such a mass vaccination program. This paper uses a dynamic model to predict the effect of a mass vaccination program in England and Wales beginning in the fall of 2011. The dynamic model is parameterized with country-specific data for the introduction of a rotavirus vaccine. We report the impact of vaccination, in both the short- and long-term, on disease incidence reduction, timing of seasonal epidemics and the level of herd protection. Our results predict that vaccination can reduce the burden of severe RVGE by 70% and delay the rotavirus epidemic peak by two and a half months with a coverage of 95%. Our calculations further show that herd protection accounts for about a quarter of the reduction in RVGE incidence. If vaccine-induced protection does not wane over three years, severe RVGE in children under five years of age could be eliminated within two years after the introduction of vaccination. This work lays the foundation for policy-makers to determine the impact of a mass vaccination program against rotavirus in England and Wales.  相似文献
3.
Several recently published European cost-effectiveness studies on the 7-valent pneumococcal conjugate vaccine (PCV-7: Prevnar®) have included net-indirect vaccine benefits for non-vaccine protected groups into their studies, which might be too optimistic an approach given recent data. Net-indirect effects result from herd protection minus serotype replacement effects. In this study we analyze the impact of net-indirect effects in non-vaccine protected groups of 5 years of age and older with updated assumptions regarding epidemiologic data and health care unit costs. Without net-indirect benefits for non-vaccine protected groups included the cost-effectiveness ratio is estimated at €72,360 per QALY. In order to obtain cost-effectiveness ratios below the threshold of €50,000 per QALY – which is in the middle of the range that is often referred to in the Netherlands – the net-indirect protective effect should at least be 16% of which has been observed in the USA after the introduction of PCV-7.  相似文献
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This paper presents the first cost–benefit comparison of improved water supply investments and cholera vaccination programs. Specifically, we compare two water supply interventions – deep wells with public hand pumps and biosand filters (an in-house, point-of-use water treatment technology) – with two types of cholera immunization programs with new-generation vaccines – general community-based and targeted and school-based programs. In addition to these four stand-alone investments, we also analyze five combinations of water and vaccine interventions: (1) borehole + hand pump and community-based cholera vaccination, (2) borehole + hand pump and school-based cholera vaccination, (3) biosand filter and community-based cholera vaccination, (4) biosand filter and school-based cholera vaccination, and (5) biosand filter and borehole + hand pump. Using recent data applicable to developing country locations for parameters such as disease incidence, the effectiveness of vaccine and water supply interventions against diarrheal diseases, and the value of a statistical life, we construct cost–benefit models for evaluating these interventions. We then employ probabilistic sensitivity analysis to estimate a frequency distribution of benefit–cost ratios for all four interventions, given a wide variety of possible parameter combinations. Our results demonstrate that there are many plausible conditions in developing countries under which these interventions will be attractive, but that the two improved water supply interventions and the targeted cholera vaccination program are much more likely to yield attractive cost–benefit outcomes than a community-based vaccination program. We show that implementing community-based cholera vaccination programs after borehole + hand pump or biosand filters have already been installed will rarely be justified. This is especially true when the biosand filters are already in place, because these achieve substantial cholera risk reductions on their own. On the other hand, implementing school-based cholera vaccination programs after the installation of boreholes with hand pump is more likely to be economically attractive. Also, if policymakers were to first invest in cholera vaccinations, then subsequently investing in water interventions is still likely to yield positive economic outcomes. This is because point-of-use water treatment delivers health benefits other than reduced cholera, and deep boreholes + hand pumps often yield non-health benefits such as time savings.  相似文献
5.
当疫苗在人群中的覆盖率达到一定比例时,群体保护效果将保护未接种疫苗者。但传统疫苗临床评价采用的个体随机设计无法评估疫苗的群体保护效果。相较于个体随机设计,整群随机设计可以更全面地评估疫苗的总体保护效应。近年来,在疫苗临床的Ⅲ、Ⅳ期临床试验中,整群随机设计变得更加常见。但目前国内对整群随机设计在疫苗临床试验中的应用了解较少。因此,本文对整群随机设计在疫苗临床试验中的应用进行综述,为今后我国开展相关方面的研究提供参考。  相似文献
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疫苗的公共卫生意义在于疫苗的群体保护效应,即当疫苗接种率达到一定水平时,疫苗接种将会直接保护接种人群和间接保护未接种人群。扩大疫苗接种率达到足够的群体保护是预防甚至是根除某些传染性疾病的基本策略。此外,群体保护的评价在制定公共卫生策略方面具有十分重要的作用。近年来,国外关于疫苗群体保护的研究日益增多,包括人群观察性研究和群随机对照临床研究,但国内还未见相关的文献报道。本文旨在对评价疫苗群体保护的研究设计及方法进行阐述,为我国在该领域的相关研究提供参考。  相似文献
7.
Objectives:  We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects.
Methods:  Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older.
Results:  We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates.
Conclusions:  Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings.  相似文献
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