Disease burden due to vaccinable diseases in the Spanish population aged less than 15 years old

OBJECTIVES: To estimate the burden of disease due to vaccinable diseases and the relative importance of these diseases in the health of the Spanish population aged less than 15 years old. METHODS: Disease burden was measured in disability-adjusted life years (DALYs). DALYs were computed by adding years of life lost (YLL) to years lived with disability (YLD). The DALYs of the Spanish population aged less than 15 years old were estimated for 1999 and were stratified by diseases according to the classification system of the Global Burden of Disease (adapted to the aim of the study), age group and gender. Diseases included in the childhood vaccination schedule, varicella, and pneumococcal disease were targeted for this study. The sources used were: the national mortality register to compute YLL, the Epidemiologic Surveillance National Network, hospital discharge data (CMBD) and the scientific literature to compute YLD due to vaccinable diseases, and World Health Organization estimates (Euro-A) or, when these were lacking, morbidity hospital data (Hospital Morbidity Survey) to compute the YLD due to non-vaccinable diseases. RESULTS: The burden of disease due to vaccinable diseases was 1.2% of global DALYS (the overall DALYs rate was 46,57/1,000 habitants): excluding meningococcal disease (0.5% to 3.3%), diseases included in the vaccination schedule represented 0.00% to 0.03%, depending on age groups, except meningococcal infection (between 0.5% and 3.3%). Pneumococcal meningitis represented 0.06% to 0.65% and varicella 0.00% to 0.15%, also depending on age groups. CONCLUSIONS: Disease burden due to vaccinable diseases is a good indicator of the health of the young population in Spain. This measure summarizes and combines information on mortality, morbidity and disability caused by diseases. The DALYs attributable to diseases included in the vaccination schedule demonstrate that immunization programs have achieved their goals.     

Recent trends in mortality, years of life lost (YLLs), and disability-adjusted life years (DALYs) attributable to tobacco in Japan

To assess recent trends in mortality and disease burden from tobacco in Japan, the present study estimated the number of deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) attributable to tobacco for the years 1985 and 1995. Since smoking prevalence is a very poor measure of population exposure to tobacco, this study employed an alternative measure of the attributable fractions based on excess lung cancer mortality. It is suggested that there was a significant increase in both the absolute numbers and age-standardized rates of tobacco-attributed mortality and disease burden over the decade, in particular from lung cancer and chronic obstructive pulmonary disease. In 1995, tobacco already accounted for 12% of total mortality, 16% of total male mortality and 7% of total female mortality. The burden of disease attributable to tobacco amounted to 10% of the total YLLs and 7% of total DALYs, suggesting that tobacco is probably a single major risk factor of mortality and morbidity in Japan.     

Burden of four vaccine preventable diseases in older adults

BackgroundImplementation of additional targeted vaccinations to prevent infectious diseases in the older adults is under discussion in different countries. When considering the added value of such preventive measures, insight into the current disease burden will assist in prioritization. The aim of this study was derive the first estimates of the disease burden in adults aged 50 years or over in the Netherlands for influenza, pertussis, pneumococcal disease and herpes zoster.MethodsThe average annual disease burden for these four diseases in the Netherlands was calculated for the period 2010–2013 using the disability-adjusted life years (DALY) measure. Disease models and parameters were obtained from previous research. Where possible we adapted these models specifically for older adults and applied age-specific parameters derived from literature. The disease burden based on these adapted models and parameters was compared with the disease burden based on the general population models.ResultsThe estimated average annual disease burden was from high to low: pneumococcal disease (37,223 DALYs/year), influenza (7941 DALYs/year), herpes zoster (942 DALYs/year), and pertussis (812 DALYs/year). The adaptation of models and parameters specifically for the elderly resulted in a higher disease burden compared to the use of general population models.ConclusionsAmong older adults, the disease burden in the period 2010–2013 was highest for pneumococcal disease, mostly because of high mortality, followed by influenza. Disease burden of herpes zoster and pertussis was relatively low and consisted mostly of years lived with disability. Better information on the course of infectious diseases and long-term consequences would enable more accurate estimation of disease burden in older adults.     

Evolving Patterns of Nutritional Deficiencies Burden in Low- and Middle-Income Countries: Findings from the 2019 Global Burden of Disease Study

Low- and middle-income countries (LMICs) suffered the most from nutritional deficiencies (NDs). Although decades of efforts have reduced it, little is known about the changing trajectory of ND burden in LMICs. By extracting data of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we calculated indicators of incidence and disability-adjusted life years (DALYs) to measure the burden of NDs and its main subcategories in LMICs, including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, dietary iron deficiency, and other nutritional deficiencies by sex, age and spatial patterns. In LMICs, ND incidence still increased in the age group 15+ born before 2005, especially in males. The effort of reducing the DALYs of NDs has generated a strong decline in per age group. In the main subcategories of NDs, protein-energy malnutrition incidence in males age 45+ born before 1970 still increased. Despite vitamin A deficiency incidence and dietary iron deficiency, DALYs strongly experienced decreases over three decades while still remaining at the heaviest level in 2019, especially in females and children under 5 years. The top largest tendency estimates occurred in Mali’ females and Bhutan’ males. Zimbabwe was the only country with increased DALYs rate tendency in both sexes.     

Towards estimating the burden of disease attributable to second-hand smoke exposure in Polish children

Objectives

To estimate the burden of disease attributable to second-hand smoke (SHS) exposure in Polish children in terms of the number of deaths and disability adjusted life years (DALYs) due to lower respiratory infections (LRI), otitis media (OM), asthma, low birth weight (LBW) and sudden infant death syndrome (SIDS).

Materials and Methods

Estimates of SHS exposure in children and in pregnant women as well as information concerning maternal smoking were derived from a national survey, the Global Youth Tobacco Survey, and the Global Adult Tobacco Survey in Poland. Mortality data (LRI, OM, asthma, and SIDS), the number of cases (LBW), and population data were obtained from national statistics (year 2010), and DALYs came from the WHO (year 2004). The burden of disease due to SHS was calculated by multiplying the total burden of a specific health outcome (deaths or DALYs) by a population attributable fraction.

Results

Using two estimates of SHS exposure in children: 48% and 60%, at least 12 and 14 deaths from LRI in children aged up to 2 years were attributed to SHS, for the two exposure scenarios, respectively. The highest burden of DALYs was for asthma in children aged up to 15 years: 2412, and 2970 DALYs, for the two exposure scenarios, respectively. For LRI, 419 and 500 DALYs, and for OM, 61 and 77 DALYs were attributed to SHS, for the two exposure scenarios, respectively. Between 13% and 27% of SIDS cases and between 3% and 16% of the cases of LBW at term were attributed to SHS exposure.

Conclusions

This study provides a conservative estimate of the public health impact of SHS exposure on Polish children. Lack of comprehensive, up to date health data concerning children, as well as lack of measures that would best reflect actual SHS exposure are major limitations of the study, likely to underestimate the burden of disease.     

Sensitivity analysis in summary measure of population health in France

BACKGROUND: The aim of this study is to provide estimates of the French burden of disease, using the WHO Global Burden of Disease methodology and to perform sensitivity analysis on different set of mortality data. METHODS: The burden of disease is measured by disability-adjusted life years (DALYs) that take into account both mortality and morbidity data. Results were obtained using French mortality data for the years 2000 and 2001 and morbidity data estimated by WHO for France. Sensitivity analyses were conducted using different mortality data sets and various life tables as mortality norms. Calculations were also performed with and without discounting and age-weighting. RESULTS: In France, the annual burden of disease was about 12.4 million DALYs. Depending on the mortality data set and the choice of social values used for calculation, results could be quite different. The use of WHO estimates for mortality resulted in an underestimation of 2.6% of total DALYs with respect to French data. Changes of the mortality norm imply changes in the number of years of life lost (YLLs), whereas the use of discounting and age-weighting mainly modifies the ranking of diseases. CONCLUSION: DALYs constitute a summary measure of population health, which is a powerful tool for the grading of health problems, allowing to compare fatal and non-fatal diseases. Nevertheless, the validity of results obtained depends primarily on the validity of the input data. Collecting morbidity data (mainly incidence) at the national level is hence an important step in order to assess more accurately the specific burden of diseases in France.     

The health burden of preventable disease in Australia: a systematic review

Objective : A systematic review was conducted to determine the health burden of preventable disease in Australia. Methods : The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) statement guidelines were followed to identify, screen and describe the protocols used in the systematic review. Results : Eleven studies were included in the review. Data on the health burden associated with lifestyle‐related risk factors were extracted by disease with outcomes reported in attributable number and proportion of deaths, years of life lost, years lived with disability and disability‐adjusted life years (DALYs). Around one‐third of DALYs was attributed to all modifiable risk factors. The range of estimates of DALYs attributable to each prioritised risk factor was: combined dietary risk factors, 7.2% to 9.7%; tobacco, 7.9% to 9.0%; alcohol, 5.1% to 12.2%; high body mass, 5.5% to 8.3%; and physical inactivity, 1.2% to 5.5%. Conclusions : Although the methods used to estimate preventable health burden varied greatly between studies, all found that a substantial amount of death and disability was attributable to lifestyle‐related risk factors. Implications for public health : There is a large health burden in Australia caused by modifiable risk factors and further action is warranted to address this burden.     

Burden of disease from inadequate water,sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries

BackgroundTo develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries.MethodsFor each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.FindingsAn estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016.ConclusionsDespite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.     

Estimating the burden of disease from water,sanitation, and hygiene at a global level

We estimated the disease burden from water, sanitation, and hygiene at the global level taking into account various disease outcomes, principally diarrheal diseases. The disability-adjusted life year (DALY) combines the burden from death and disability in a single index and permits the comparison of the burden from water, sanitation, and hygiene with the burden from other risk factors or diseases. We divided the world's population into typical exposure scenarios for 14 geographical regions. We then matched these scenarios with relative risk information obtained mainly from intervention studies. We estimated the disease burden from water, sanitation, and hygiene to be 4.0% of all deaths and 5.7% of the total disease burden (in DALYs) occurring worldwide, taking into account diarrheal diseases, schistosomiasis, trachoma, ascariasis, trichuriasis, and hookworm disease. Because we based these estimates mainly on intervention studies, this burden is largely preventable. Other water- and sanitation-related diseases remain to be evaluated. This preliminary estimation of the global disease burden caused by water, sanitation, and hygiene provides a basic model that could be further refined for national or regional assessments. This significant and avoidable burden suggests that it should be a priority for public health policy.     

Cross-national comparability of burden of disease estimates: the European Disability Weights Project

OBJECTIVE: To investigate the sources of cross-national variation in disability-adjusted life-years (DALYs) in the European Disability Weights Project. METHODS: Disability weights for 15 disease stages were derived empirically in five countries by means of a standardized procedure and the cross-national differences in visual analogue scale (VAS) scores were analysed. For each country the burden of dementia in women, used as an illustrative example, was estimated in DALYs. An analysis was performed of the relative effects of cross-national variations in demography, epidemiology and disability weights on DALY estimates. FINDINGS: Cross-national comparison of VAS scores showed almost identical ranking orders. After standardization for population size and age structure of the populations, the DALY rates per 100000 women ranged from 1050 in France to 1404 in the Netherlands. Because of uncertainties in the epidemiological data, the extent to which these differences reflected true variation between countries was difficult to estimate. The use of European rather than country-specific disability weights did not lead to a significant change in the burden of disease estimates for dementia. CONCLUSIONS: Sound epidemiological data are the first requirement for burden of disease estimation and relevant between-countries comparisons. DALY estimates for dementia were relatively insensitive to differences in disability weights between European countries.     

Disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157

Surveys carried out between 1990 and 2000 indicated that the incidence of STEC O157-associated gastroenteritis in The Netherlands was 1250 cases/year (median), of which 180 visited a general practitioner, 40 are reported and 0.6 are fatal, mainly in the elderly. There are approximately 20 cases of STEC O157-associated haemolytic-uraemic syndrome (HUS) per year, mainly in children. There are 2.5 HUS patients per year who develop end-stage renal disease (ESRD). There are an estimated 2 HUS-related and 0.5 ESRD-related fatalities per year. The mean disease burden associated with STEC O157 in the Dutch population is 116 (90% confidence interval 85-160) Disability Adjusted Life Years (DALYs) per year. Mortality due to HUS (58 DALYs), and ESRD (21 DALYs) and dialysis due to ESRD (21 DALYs) constitute the main determinants of disease burden. Sensitivity analysis indicates that uncertainty associated with model assumptions did not have a major effect on these estimates.     

Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation

Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.     

Disability-Adjusted Life-Years for Drug Overdose Crisis and COVID-19 Are Comparable During the Two Years of Pandemic in the United States

ObjectivesThe drug overdose crisis with shifting patterns from primarily opioid to polysubstance uses and COVID-19 infections are 2 concurrent public health crises in the United States, affecting the population of sizes in different magnitudes (approximately < 10 million for substance use disorder [SUD] and drug overdoses vs 80 million for COVID-19 within 2 years of the pandemic). Our objective is to compare the relative scale of disease burden for the 2 crises within a common framework, which could help inform policy makers with resource allocation and prioritization strategies.MethodsWe calculated disability-adjusted life-years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs.ResultsWe estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in 2 years since March 2020. COVID-19 burden was dominated by the fatal burden (> 95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and nonfatal burdens (47%). The highest disease burden was among individuals aged 30 to 39 years for SUD (27%) and 50 to 64 years for COVID-19 (31%).ConclusionsDespite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden with the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and postpandemic recovery.     

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change.Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata.Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation.Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics.Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.     

The global burden of occupational noise-induced hearing loss

BACKGROUND: Excessive noise is a global occupational health hazard with considerable social and physiological impacts, including noise-induced hearing loss (NIHL). This paper describes the worldwide morbidity of occupational NIHL in the year 2000. METHODS: The proportion of the population exposed to occupational noise was estimated using noise exposure data from the US National Institute for Occupational Safety and Health (NIOSH), adjusted by data on the distribution of the work force by occupational category and economic sector, and economic activity rates in each WHO subregion. These values for the exposed population and risk measures for NIHL were used to develop estimates of the attributable fraction (AF) of adult-onset hearing loss resulting from occupational noise exposure. The AFs were applied to WHO estimates of total disability-adjusted life years (DALYs) from adult-onset hearing loss to estimate the DALYs due to occupational noise. RESULTS: Worldwide, 16% of the disabling hearing loss in adults (over 4 million DALYs) is attributed to occupational noise, ranging from 7% to 21% in the various subregions. The effects of the exposure to occupational noise are larger for males than females in all subregions and higher in the developing regions. CONCLUSIONS: Occupational noise is a significant cause of adult-onset hearing loss. The majority of this NIHL burden can be minimized by the use of engineering controls to reduce the generation of noise at its source.     

The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities

Aim : Cancer burden measured in disability adjusted life years (DALYs) captures survival and disability impacts of incident cancers. In this paper, we estimate the prospective burden of disease arising from 27 cancer sites diagnosed in 2006, by sex and ethnicity; and determine how its distribution differs from that for incidence rates alone. Methods : Using a prospective approach, Markov and cancer disease models were used to estimate DALYs with inputs of population counts, incidence and excess mortality rates, disability weights, and background mortality. DALYs were discounted at 3.5% per year. Results : The age standardised Māori:non‐Māori incidence rate ratios were 1.00 for males and 1.19 for females, whereas for DALYs they were greater at 1.42 for males and 1.68 for females. The total burden of cancer for 2006 incident cases (i.e. not age standardised) was estimated to be approximately 127,000 DALYs. Breast (27%), lung (14%) and colorectal (13%) cancers for females and lung (16%), colorectal (14%), and prostate (16%) cancers for males were the top contributors. By ethnicity, Māori experienced a substantially higher burden from lung cancer (around 25% for both sexes). Conclusions: Due to Māori both having higher rates of cancers with a worse survival (e.g. lung cancer), and tending to have worse survival for each cancer site, ethnic disparities in the age‐standardised DALY burden were greater than those for incidence (rate ratios of 1.52 and 1.07 respectively, sexes pooled).     

Alcohol consumption and burden of disease in the Americas: implications for alcohol policy.

OBJECTIVES: To describe patterns of alcohol consumption in the Americas, to estimate the burden of disease attributable to alcohol in the year 2000, and to suggest implications for policies to reduce alcohol-related disease burden. METHODS: Two dimensions of alcohol exposure were included in this secondary data analysis: average volume of alcohol consumption and patterns of drinking. There were two main outcome measures: mortality (number of deaths) and disability-adjusted life years (DALYs) lost (number of years of life lost due to premature mortality and disability). Separate estimates were obtained for different sexes, age groups and WHO regions. RESULTS: Despite regional variations, alcohol consumption in the Americas averaged more than 50% higher than worldwide consumption. Patterns of irregular heavy drinking prevailed. Alcohol consumption caused a considerable disease burden: 4.8% of all the deaths and 9.7% of all DALYs lost in the year 2000 were attributable to drinking, with most of the burden occurring outside North America. Intentional and unintentional injuries accounted for 59.8% of all alcohol-related deaths and 38.4% of the alcohol-related disease burden. Of all risk factors compared here, alcohol accounted for the greatest proportion of risk, followed by smoking. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-related disease in the Americas. Given the epidemiological structure of this burden, injury prevention including, but not restricted to, prevention of traffic injuries, as well as appropriate treatment options, should play an important role in comprehensive plans to reduce the alcohol-related public health burden.     

Estimates of alcohol-related oesophageal cancer burden in Japan: systematic review and meta-analyses

ObjectiveTo refine estimates of the burden of alcohol-related oesophageal cancer in Japan.MethodsWe searched PubMed for published reviews and original studies on alcohol intake, aldehyde dehydrogenase polymorphisms, and risk for oesophageal cancer in Japan, published before 2014. We conducted random-effects meta-analyses, including subgroup analyses by aldehyde dehydrogenase variants. We estimated deaths and loss of disability-adjusted life years (DALYs) from oesophageal cancer using exposure distributions for alcohol based on age, sex and relative risks per unit of exposure.FindingsWe identified 14 relevant studies. Three cohort studies and four case-control studies had dose–response data. Evidence from cohort studies showed that people who consumed the equivalent of 100 g/day of pure alcohol had an 11.71 fold, (95% confidence interval, CI: 2.67–51.32) risk of oesophageal cancer compared to those who never consumed alcohol. Evidence from case-control studies showed that the increase in risk was 33.11 fold (95% CI: 8.15–134.43) in the population at large. The difference by study design is explained by the 159 fold (95% CI: 27.2–938.2) risk among those with an inactive aldehyde dehydrogenase enzyme variant. Applying these dose–response estimates to the national profile of alcohol intake yielded 5279 oesophageal cancer deaths and 102 988 DALYs lost – almost double the estimates produced by the most recent global burden of disease exercise.ConclusionUse of global dose–response data results in an underestimate of the burden of disease from oesophageal cancer in Japan. Where possible, national burden of disease studies should use results from the population concerned.     

Meeting Report: WHO Workshop on modelling global mortality and aetiology estimates of enteric pathogens in children under five. Cape Town, 28–29th November 2018

Investment in vaccine product development should be guided by up-to-date and transparent global burden of disease estimates, which are also fundamental to policy recommendation and vaccine introduction decisions. For low- and middle-income countries (LMICs), vaccine prioritization is primarily driven by the number of deaths caused by different pathogens. Enteric diseases are known to be a major cause of death in LMICs. The two main modelling groups providing mortality estimates for enteric diseases are the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle and the Maternal Child Epidemiology Estimation (MCEE) group, led by Johns Hopkins Bloomberg School of Public Health. Whilst previous global diarrhoea mortality estimates for under five-year-olds from these two groups were closely aligned, more recent estimates for 2016 have diverged, particularly with respect to numbers of deaths attributable to different enteric pathogens. This has impacted prioritization and investment decisions for vaccines in the development pipeline.The mission of the Product Development for Vaccines Advisory Committee (PDVAC) at the World Health Organisation (WHO) is to accelerate product development of vaccines and technologies that are urgently needed and ensure they are appropriately targeted for use in LMICs. At their 2018 meeting, PDVAC recommended the formation of an independent working group of subject matter experts to explore the reasons for the difference between the IHME and MCEE estimates, and to assess the respective strengths and limitations of the estimation approaches adopted, including a review of the data on which the estimates are based.Here, we report on the proceedings and recommendations from a consultation with the working group of experts, the IHME and MCEE modelling groups, and other key stakeholders. We briefly review the methodological approaches of both groups and provide a series of proposals for investigating the drivers for the differences in enteric disease burden estimates.     

江苏省狂犬病疾病负担研究

目的 通过对江苏省狂犬病的疾病负担进行统计分析和综合评价,为制定疾病防制策略提供参考依据.方法 收集2008-2018年江苏省狂犬病疫情资料,进行流行病学特征分析,同时使用世界卫生组织(WHO)公布的计算工具评估因狂犬病早死导致的伤残调整寿命年(DALYs),并结合人力资本法评估早死间接经济负担.结果 2008-201...