Budget Impact and Cost-Effectiveness of Including a Pentavalent Rotavirus Vaccine in the New Zealand Childhood Immunization Schedule

ObjectivesTo estimate: 1) rotavirus disease burden in New Zealand children aged under 5 years, and 2) health benefits, budget impact, and cost-effectiveness of incorporating a pentavalent rotavirus vaccine (PRV) into the national immunization schedule.MethodsA static equilibrium model was developed to evaluate health benefits and budget impact of vaccinating five successive birth cohorts with PRV at $50 per dose and 85% coverage (three doses). Cost-effectiveness was estimated from the societal perspective in year 5 of the program, with future health benefits discounted at 3.5% per annum.ResultsBy the age of 5 years, one in five children will have sought medical advice for rotavirus gastroenteritis and one in 43 will have been hospitalized. In 2009, we estimate 1506 hospitalizations (476 per 100,000; 95% confidence interval 451, 502), 3086 Emergency Department (ED) presentations not requiring hospitalization, plus 10,120 cases of rotavirus gastroenteritis managed solely in primary care. The annual societal cost is $7.07 million, including 41% from hospitalization and 25% from caregiver income loss. Health benefits will increase and the cost of illness will decline by 78% in year 5 as successive birth cohorts are immunized. In the fifth year, 1191 hospitalizations, 2442 ED treated cases, 9762 primary care consultations, and 0.8 deaths will be averted. It requires six vaccinated children to avoid one primary care consultation, 49 to avert one hospitalization, and 73,357 to prevent one death. The incremental cost is $2.99 million and the break-even price per vaccine dose is $32.39 at 2006 prices. The cost is $2509 to avert one hospitalization and $305 to prevent one case seeking health-care assistance. The cost per life-year gained in year 5 is $143,097 and the cost per quality-adjusted life-year (QALY) gained is $46,092 (US$26,774). The cost per QALY is sensitive to incidence rates, vaccine price and efficacy, loss of quality of life by the child, case fatality, and caregiver income loss.ConclusionsFrom a societal perspective, addition of PRV to the New Zealand childhood immunization schedule would confer important clinical gains at a modest cost per QALY gained.     

儿童医院感染轮状病毒经济损失的病例对照研究

6 d,病例组平均延长6.49 d,两组差异有统计学意义(P＜0.05).结论 轮状病毒医院感染的发生增加了患儿的医疗费用,延长了住院日,降低了病床周转率,认真做好医院感染监控工作和标准预防可获得良好经济效益和社会效益.     

口服轮状病毒活疫苗安全性观察

兰州生物制品研究所生产的口服轮状病毒活疫苗已在全国各地开始使用 ,并准备在我省范围内推广使用。为了保护儿童的身体健康 ,减少疫苗的异常反应 ,在推广使用前对该疫苗进行服苗后安全性观察 ,现将观察结果总结如下。材料与方法1　疫苗　卫生部兰州生物制品研究所生产的口服轮状病毒活疫苗 ,批号为 2 0 0 0 0 6 0 3;安慰剂用颜色相近的草莓汁(购于超市 )。2　观察对象及分组　某市某幼儿园 3个小班和部分中班儿童 94人按班分成 2组 ,其中中班选择月龄与小班相近的儿童。3　服苗方法　用手打开易开启瓶盖 ,用吸管吸取疫苗 ,直接喂于儿童 ,每…     

轮状病毒感染的流行病学与疫苗的发展现状

轮状病毒（Rotavirus，RV）能引起人和动物腹泻，并以A组最常见，是婴幼儿腹泻的主要病原因^[1]。在美国，仅1997年7月—1998年6月的1年里就约270万5岁以下婴幼儿因RV感染而患胃肠炎。世界各国每年约有100万儿童死于RV所致腹泻^[1]，目前尚无有效的治疗药物，停留在对症治疗水平，由此看来疫苗的发展非常必要。经过十几年的研制，多种RV疫苗研制工作已取得重大进展，     

口服轮状病毒减毒活疫苗对轮状病毒腹泻保护效果的病例对照研究

目的评价口服轮状病毒减毒活疫苗（Oral Rotavirus Attenuated Live Vaccine,ORV）,对2月龄~5岁儿童轮状病毒腹泻住院病例的保护效果。方法对2007~2009年,在天津市儿童医院住院的838例轮状病毒腹泻病例,按性别、年龄和居住地1∶1设配对对照,计算ORV的保护效果及其95%可信区间（Confidence Interval,CI）。结果 1剂ORV的保护效果为70.8%（95%CI 57.5%~80.0%）,接种1剂ORV对2~11月龄儿童的保护效果高于12~23月龄儿童（分别为81.3%和54.0%）。结论 1剂ORV可中等程度地预防住院轮状病毒腹泻。     

The Impact of Socio-Economic Determinants on the Vaccination Rates with Rotavirus and Human Papiloma Virus Vaccine

Background

Socio-economic inequalities may have an impact on the uptake of selfpaid vaccines. The aim of the study was to identify the effect of some socio economic determinants on vaccination rates with self-paid human papilloma virus (HPV) and rotavirus (RV) vaccines.

Methods

Vaccination coverage data, available in electronic database cepljenje.net (administered by the National Institute of Public Health), were collected at administrative unit level. The socio-economic determinants (the average gross pay in euros, the unemployment rate, the educational and households structure, the population density, the number of inhabitants, the number of children aged from 0 to 4, the number of women aged from 15 to 30) were extracted from Statistical Office of the Republic of Slovenia web page. The strength of the correlation between socioeconomic variables and self-paid HPV and RV vaccination rates was determined.

Results

Rotavirus vaccination rates show a slight negative correlation with the number of residents per administrative unit (ρ=−0.29, p=0.04), and no correlation with other socio-economic variables. Likewise, no correlation has been found between HPV vaccination rates and the selected socio-economic variables.

Conclusion

Ecological study did not reveal any correlations between socio economic variables and vaccination rates with RV and HPV self-paid vaccines on administrative unit level.     

轮状病毒感染性疾病流行病学及其疫苗的研究

轮状病毒（rotavirus,RV）是婴幼儿腹泻最常见的病原体。全球3岁以下90％儿童受到感染,中国香港5岁以下儿童感染率为97％拉。。感染的普遍性表明,提高公共卫生水平和公众的卫生观念对减少RV感染无显著效果。RV感染已成为发达国家和发展中国家一个重要的公共卫生问题。迄今为止,对RV感染最有效的预防和控制措施,仍是研究和使用RV疫苗。笔者就RV流行病学、疫苗研究和疫苗使用效益进行综述。     

Detection of Novel Rotavirus Strain by Vaccine Postlicensure Surveillance

Surveillance for rotavirus-associated diarrhea after implementation of rotavirus vaccination can assess vaccine effectiveness and identify disease-associated genotypes. During active vaccine postlicensure surveillance in the United States, we found a novel rotavirus genotype, G14P[24], in a stool sample from a child who had diarrhea. Unusual rotavirus strains may become more prevalent after vaccine implementation.     

口服轮状病毒疫苗的研究现状

轮状病毒是引起世界范围内儿童严重急性腹泻的最主要病原,也是导致发展中国家婴幼儿死亡的主要原因之一。接种轮状病毒疫苗是减少重症腹泻发病和死亡的最好方法,轮状病毒疫苗的研究方向主要是口服减毒活疫苗。本文对目前国内外使用的口服轮状病毒疫苗的研究现状作综述。     

轮状病毒疫苗免疫效果及人体反应观察

为了解国产轮状病毒疫苗在北京市儿童中的使用效果和人体反应,在东城区和西城区选择112名7月龄～4岁儿童为对象.所用疫苗为兰州生物制品研究所生产,服疫苗前和服苗4～5周后采血,用中和试验检测轮状病毒Ⅰ、Ⅱ、Ⅲ、Ⅳ型和LLR型抗体.服苗前、后双份血清检测均合格者53人,此53人服苗后各型抗体阳转率为63.16%～76.47%,≥4倍增长率为45.28%～60.38%,各型中和抗体免疫前后平均值增长2.77～3.72倍.112人服苗后的副反应观察表明,低热反应发生率为6.25%,高热发生率为1.79%.本次观察使用的轮状病毒疫苗对各型均有较稳定的免疫原性和安全性,7～11月龄婴儿对轮状病毒疫苗有成熟的免疫反应能力.     

上海某区儿童血清轮状病毒LLR型疫苗株的免疫水平

[目的]了解2012年上海部分0～5周岁儿童的血清轮状病毒LLR型中和抗体水平及不同年龄段儿童轮状病毒感染的情况,为疫苗的研究提供科学数据。[方法]在2012年6—8月上海市静安区儿保门诊部就诊的儿童中,筛选无发热、无轮状病毒感染疑似症状的健康儿童血清标本210份,采用微量中和试验方法检测儿童血清对轮状病毒LLR型疫苗株的中和抗体水平,并对检测结果进行统计学分析。[结果]210份0～5周岁儿童血清中,轮状病毒LLR型中和抗体阳性率为27.1%,中和抗体几何平均滴度（GMT）为1∶35.36;0～6个月婴儿血清中和抗体阳性率为16.0%,GMT为1∶28.72;7～11个月儿童血清中和抗体阳性率为2.5%,GMT为1∶25.88。1～2周岁儿童的中和抗体阳性率为20.0%,GMT为1∶30.78,2～3周岁儿童的中和抗体阳性率为20.0%,GMT为1∶32.99,该两年龄组（段）间差异无统计学意义。3～4周岁儿童的中和抗体阳性率为56.67%,GMT为1∶54.84,4～5周岁儿童的中和抗体阳性率为63.33%,GMT为1∶44.55,此两年龄组（段）儿童的阳性率和GMT均显著高于3周岁以下各年龄组,此两组间阳性率差异无统计学意义。[结论]0～3周岁儿童中和抗体水平较低,特别是7～11个月年龄组为最低,提示可能为轮状病毒感染的高危儿童群体。     

Rotavirus infection in Brazil: epidemiology and challenges for its control

Worldwide, rotaviruses account for 600,000 to 870,000 deaths per year among infants and young children. In Brazil, rotaviruses were first seen in 1976 by scanning electron microscopy of stool samples from diarrheic infants in Belém, Pará. Hospital-based studies have shown that rotaviruses are associated with 12-42% of cases of acute diarrhea. In addition, community-based studies yielded an average of 0.25 rotavirus-related diarrheal episodes per child per year. G types 1 to 4 account for about two-thirds of circulating strains, but the (unusual) P[8],G5 genotype has been claimed to cause over 10% of rotavirus diarrheal episodes. It has been shown that over 70% of children develop rotavirus antibodies by the age of 4-5 years. The tetravalent rhesus-human rotavirus vaccine (RRV-TV) conferred 35% protection according to a two-year follow-up study in Belém, Pará, Brazil, but reached an efficacy of 60% during the first year of life. RRV-TV was also shown to be 75% protective against very severe gastroenteritis in northern Brazil. Vaccination with RRV-TV has been suspended recently in the United States because of the detection of intussusception as a side effect. Therefore, further vaccine trials in Brazil will probably involve rotavirus candidate vaccines other than RRV-TV.     

Species H Rotavirus Detected in Piglets with Diarrhea,Brazil, 2012

We determined nucleotide and deduced amino acid sequences of the rotavirus gene encoding viral protein 6 from 3 fecal samples collected from piglets with diarrhea in Brazil, 2012. The analyses showed that the porcine rotavirus strains in Brazil are closely related to the novel species H rotavirus.