Economic analysis for national immunization program planning: A case of rotavirus vaccines in Burundi

BackgroundIn Burundi, diarrhea is the third leading cause of mortality among children under five years of age. This study conducted an economic analysis of rotavirus vaccination program in Burundi.MethodsA Markov model was constructed to simulate clinical and economic outcomes for the 2019 birth cohort for a period of 5 years. Empirical costing data were collected. ICER per episode averted, ICER per death averted, ICER per DALY averted, net present value, and budget impact were estimated for 4 brands of WHO pre-qualified rotavirus vaccines. One-way and probabilistic sensitivity analysis as well as threshold analysis were performed.ResultsFor the base case, while all four WHO pre-qualified rotavirus vaccines were cost-effective (ICER < 3 GDP per capita), three of them (i.e. Rotarix, Rotavac and Rotasiil) were very cost-effective (ICER <1 GDP per capita) from both the provider and societal perspectives. The vaccines were still very cost-effective at a price increase of up to US$ 5.09, US$ 3.16, US$ 3.89, and US$ 2.69 for Rotarix, RotaTeq, Rotavac, and Rotasiil, respectively. Probabilistic sensitivity analysis indicated that vaccination programs with Rotarix, RotaTeq, Rotavac, and Rotasiil are cost-effective at a probability of 93.8%, 27%, 99.1%, and 92.7%, respectively. All vaccination programs were cost-beneficial with a net present value in the range of US$ 5,214,912 and US$ 11,135,997.The budget required to run the vaccination program, estimated with break-even prices, ranged between US$ 42,249,498 and US$ 53,487,935 for a 5-year time period. When compared to the GDP of Burundi in 2019, these are are less than 2%.ConclusionThe rotavirus vaccine is good value for money. Findings from this study offer evidence on potential economic benefits as well as the required budget for different rotavirus vaccination programs, which could be useful for future planning related to rotavirus vaccine coverage in Burundi after graduation from GAVI.     

Impact of maternal and pre-existing antibodies on immunogenicity of inactivated rotavirus vaccines

Rotavirus (RV) is a major pathogen causing severe diarrhea in infants and children aged less than 5 years. Vaccination is an economically feasible and effective strategy to prevent rotavirus infections. However, immune efficacy of live vaccines could be interfered by maternal antibodies and pre-existing antibodies of children. To develop an inactivated rotavirus vaccine (IRV), we had previously isolated a wild-type human rotavirus strain ZTR-68-A (G1P[8]) from the fecal samples of infants having severe diarrhea in a region endemic for the presence of this pathogen. In our present study, we assessed whether the presence of maternal and pre-existing antibodies in newborn BALB/c mice affected the immunogenicity of IRV administered to these animals. Our results indicate that maternal antibodies, generated from either vaccine immunization or rotavirus infection, showed partial influence with the immune responses generated by two doses of IRV vaccination. Increasing the number of immunizations can significantly improve the titer of serum neutralizing antibody and a seroconversion rate of up to 100%. In newborn mice, single-virus infection did not elicit detectable levels of serum neutralizing antibodies. After an IRV vaccination, the immune responses of these mice remained unaffected, with no significant differences in titers compared with those of control-group mice. In summary, choosing a suitable immunization dose and dosing frequency is essential for the immune effectiveness of IRV. The results of this study will provide animal experimental support for the IRV clinical research in future.     

Impact of rotavirus vaccination on diarrheal hospitalizations in children younger than 5 years of age in a rural southern Mozambique

BackgroundRotavirus vaccine (Rotarix®) was introduced in Mozambique through its Expanded Program of Immunization in September 2015. We assessed the impact of rotavirus vaccination on childhood gastroenteritis-associated hospitalizations post-vaccine introduction in a high HIV prevalence rural setting of southern Mozambique.MethodsWe reviewed and compared the trend of hospitalizations (prevalence) and incidence rates of acute gastroenteritis (AGE), and rotavirus associated-diarrhea (laboratory confirmed rotavirus) in pre- (January 2008–August 2015) and post-rotavirus vaccine introduction periods (September 2015–December 2020), among children <5 years of age admitted to Manhiça District Hospital.ResultsFrom January 2008 to December 2020, rotavirus vaccination was found to contribute to the decline of the prevalence of AGE from 19% (95% CI: 18.14–20.44) prior to the vaccine introduction to 10% (95% CI: 8.89–11.48) in the post-introduction period, preventing 40% (95 % IE: 38–42) and 84% (95 % IE: 80–87) of the expected AGE and laboratory confirmed rotavirus cases, respectively, among infants. Similarly, the overall incidence of rotavirus was 11.8-fold lower in the post-vaccine introduction period (0.4/1000 child-years-at-risk [CYAR]; 95% CI: 0.3–0.6) compared with the pre-vaccination period (4.7/1000 CYAR; 95% CI: 4.2–5.1) with the highest reduction being observed among infants (16.8-fold lower from the 15.1/1000 CYAR in the pre-vaccine to 0.9/1000 CYAR in the post-vaccine eras).ConclusionsWe documented a significant reduction in all-cause diarrhea hospitalizations and rotavirus positivity after vaccine introduction demonstrating the beneficial impact of rotavirus vaccination in a highly vulnerable population.     

推拿治疗婴幼儿轮状病毒性肠炎42例

目的 :观察推拿在治疗婴儿轮状病毒性肠炎中的疗效。方法 :将72例确诊患儿随机分为二组 ,两组患儿一般治疗相同 ,治疗组加推拿疗法。结果 :治疗组症状消失时间明显缩短 ,止泻时间治疗组为(38 5±15 5)h ,对照组(50 2±18 5)h ,差异有显著性意义(P<0 01)。治疗组总有效率为95% ,对照组为80 %(P<0 05)。结论 :推拿治疗婴儿轮状病毒性肠炎安全、有效、简便、价廉     

双苓止泻口服液治疗婴幼儿轮状病毒肠炎疗效观察

目的:评价双苓止泻口服液治疗小儿轮状病毒肠炎的疗效。方法:64例轮状病毒肠炎患儿随机分成双苓止泻口服液治疗组和常规治疗对照组。结果:治疗组和对照组总有效率分别为93.75％和87.5％,两组比较有显著性差异(P<0.05)。结论:双苓止泻口服液治疗小儿轮状病毒肠炎见效快,疗效肯定,不良反应少。     

思密达治疗小儿轮状病毒肠炎临床观察

目的　为了研究思密达治疗小儿轮状病毒肠炎的效果。 方法　 我们于 2 0 0 1年 5月～ 2 0 0 2年 3月在儿科门诊及住院病人中选择了 14 5例 ,随机分为治疗组和对照组 ,6天总有效率分别为 98%和 90 % ,有显著性差异 (P <0 0 5 )。治疗组平均恢复时间为 3d ,对照组为 4d(P <0 0 1) ,同时在主要观察指标治疗组均明显优于对照组 ,两者差异有显著性 (P <0 0 5 )。 结果　提示口服思密达治疗小儿轮状病毒肠炎与对照组疗效相比 ,差异有显著性。 结论　 思密达治疗小儿轮状病毒性肠炎能缩短病程安全有效。     

抗轮状病毒牛初乳治疗轮状病毒性肠炎的初步研究

为了给临床提供特异有效的治疗婴幼儿轮状病毒感染的生物制剂，以ＳＡ１１轮状病毒免疫受孕乳牛，制备抗轮状病毒免疫牛初乳，从临床治疗角度，对８０例婴幼儿急性轮状病毒感染性腹泻，４３例应用抗轮状病毒牛初乳治疗，３７例应用思密达治疗，对两组进行了疗效对比观察。结果表明：抗轮状病毒免疫牛初乳治疗组的总有效率，显效率和７２小时粪便病毒转阴率分别达９１％，７９％和８９％；而思密达治疗组的疗效及７２小时大便病毒转阴率则相应为４１％，２４％和３９％，差异均有非常显著意义。为临床治疗婴幼儿轮状病毒感染性腹泻提供了安全有效，特异性强的治疗手段     

Neonatal hypocalcaemia associated with rotavirus diarrhoea

We observed an association between rotavirus diarrhoea and hypocalcaemia in several patients and therefore started a prospective evaluation with measurement of calcium levels in all patients with rotavirus infection during a period of 8 months. We report on 54 infants with rotavirus gastro-enteritis. Serum concentrations of sodium, potassium, and total and ionized calcium were measured on admission. If hypocalcaemia was detected, total and ionized calcium were measured every day until recovery. Calcium was supplemented as calcium gluconate which was added to milk. Out of 54 newborns with rotavirus gastro-enteritis, 20 developed hypocalcaemia. All these newborns had severe diarrhoea. Seven infants were admitted because of convulsions, but EEG and ultrasonographic examination of the brain revealed no abnormalities. Once the infants' clinical condition and the consistency and frequency of the stool had improved, calcium concentrations increased and remained within the reference range without supplementation. Conclusion Rotavirus gastro-enteritis seems to be a cause of neonatal hypocalcaemia. Received: 26 June 1997 and in revised form: 20 December 1997 / Accepted: 26 December 1997     

中西医结合治疗溃疡性结肠炎经验

溃疡性结肠炎(UlcerativeColitis UC)又称非特异性结肠炎,是一种病因尚不十分清楚的直肠和结肠慢性非特异性炎症性疾病.其病变主要限于大肠粘膜和粘膜下层,临床表现为腹泻、黏液脓血便、腹痛等,是临床常见的疑难杂症之一.笔者从2003年3月～2005年6月应用四神丸治疗该病48例,效果满意.     

武汉市儿童医院婴幼儿腹泻轮状病毒的VP4型别分析

目的研究武汉市儿童医院腹泻门诊A组轮状病毒VP4基因的分子流行病学特征. 方法利用聚丙烯酰胺凝胶电泳,将检测出的A组轮状病毒阳性样利用多重RT-PCR技术对VP4基因进行分型研究. 结果武汉地区793份腹泻患儿粪便样本经检测轮状病毒阳性257例,阳性率为32.4%.其中P [8]型232例(90.3%),P [4]型3例(1.2%),P [8]与P [4]混合感染15例(5.8%),尚有7例(2.7%)未能分出型别.对检测结果按采样时间、年龄和性别分布分别进行了分析. 结论武汉地区A组轮状病毒以P[8]型为主要流行基因型,患儿以6月至1岁为主,男女性别差异不大,武汉地区婴幼儿腹泻A组轮状病毒VP4基因分型研究将为轮状病毒疫苗的研制提供基础.