E. David G. McIntosh

The cost-burden of paediatric pneumococcal disease in the UK and the potential cost-effectiveness of prevention using 7-valent pneumococcal conjugate vaccine.

We modelled the epidemiology and cost of pneumococcal disease in children in the UK and the cost-effectiveness of immunisation with 7-valent pneumococcal conjugate vaccine (PCV). We estimated the incidence of pneumococcal meningitis, pneumococcal septicaemia, all-cause pneumonia and all-cause otitis media (OM). We further estimated the impact of vaccination with associated costs and outcomes. Vaccine cost was pound 39.25 per dose with a pound 10 administration cost; vaccination schedule and efficacy were taken from a recent trial. We estimated that in each UK annual birth cohort there are 881,146 episodes of these infections and 149 deaths associated with pneumococcal meningitis, pneumococcal septicaemia or all-cause pneumonia and that PCV would prevent 54,384 episodes and 29 deaths. NHS cost per life year gained was estimated at pound 31,512, close to the limit at which PCV would be considered cost-effective.

Epidemiology and prevention of meningococcal disease: a critical appraisal of vaccine policies

Meningococcal disease is characterized by a marked variation in incidence and serogroup distribution by region and over time. In several European countries, Canada and Australia, immunization programs, including universal vaccination of infants or toddlers with catch-up campaigns in children and adolescents, aimed at controlling disease caused by meningococcal serogroup C have been successful in reducing disease incidence through direct and indirect protection. More recently, meningococcal conjugate vaccines targeting disease caused by serogroups A, C, W-135 and Y have been licensed and are being used in adolescent programs in the USA and Canada while a mass immunization campaign against serogroup A disease has been implemented in Africa. Positive results from clinical trials using vaccines against serogroup B disease in various age groups suggest the possibility of providing broader protection against serogroup B disease than is provided by the currently used outer membrane vesicle vaccines. The purpose of our review of meningococcal epidemiology and assessment of existing policies is to set the stage for future policy decisions. Vaccination policies to prevent meningococcal disease in different regions of the world should be based on quality information from enhanced surveillance systems.

Cost-effectiveness studies of pneumococcal conjugate vaccines.

The 7-valent pneumococcal conjugate vaccine is licensed in many countries for the prevention of pediatric pneumococcal disease. The vaccine is known to be highly immunogenic in infants and young children, and has been shown to be efficacious not only in decreasing disease in pediatric age groups but also in adults through herd immunity. Cost-effectiveness analyses of this vaccine have been performed in a number of countries. The present review compiles, summarizes and critiques these analyses. The range of values for cost-effectiveness, as measured in cost per life-years gained, in the studies reviewed, ranges from US

Vaccine Hesitancy and Refusal

14,000 to

Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data

147,000 with one outlier at

Healthcare-associated infections: potential for prevention through vaccination:

504,000. For cost per quality-adjusted life years the range is US

Efflux: How Bacteria Use Pumps to Control Their Microenvironment

26,000 to

Paediatric infections: prevention of transmission and disease--implications for adults.

66,000. Recommendations for the use of the vaccine will take account not only of these ratios but also of the absolute burden of disease. Performing cost-effectiveness analyses for healthcare interventions in infants and children is one means of redressing inequalities.

Potential Cost-Effectiveness of Pneumococcal Conjugate Vaccine (PCV) in Turkey

O ver the past few years, an increasing number of European pediatricians, particularly primary care pediatricians, are facing the growing threat of vaccine hesitancy and refusal, a sort of a “cultural epidemic,” which seems to progressively affect the families of children under their care. In several communities, a growing number of individuals are delaying or refusing available recommended and/or mandatory vaccinations for themselves and their children. Furthermore, vaccination is increasingly perceived as unsafe and unnecessary by a rising number of parents, although it has been widely proven and recognized to be one of the greatest, safest, and most successful public health measures ever adopted. Pediatricians have a potential major influence on parental vaccine decisions. However, their task is complicated by the complexity of the vaccine hesitancy phenomenon and its multifactorial nature. Programs based on physiciantargeted communication interventions, designed to reduce vaccine hesitancy in mothers of infants seen by trained physicians and to increase physician confidence in communicating about vaccines, are reported to have failed to reduce maternal vaccine hesitancy or to improve physician self-efficacy. Our aim is to describe vaccine hesitancy and refusal in an effort to further raise the awareness of pediatricians on this potential threat for their communities, and, in particular, for children under their care.

Recent progress in the development of vaccines for infants and children

Background Worldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed. Objectives To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey. Methods A multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter)national literature and publicly available data from the Turkish Statistical Institute (TÜÏK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained. Results Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US