P. Garrido

Economic benefits for the family of inactivated subunit virosomal influenza vaccination of healthy children aged 3-14 years during the annual health examination in private paediatric offices.

Taking the results of a prospective cohort study by our group that evaluated the effectiveness of the inactivated subunit virosomal influenza vaccine (Inflexal V), Crucell-Berna) in the prevention of influenza-related diseases and the reduction of its negative economic consequences, the economic costs and benefits for the family of vaccinating a theoretical cohort of 1000 healthy children aged 3-14 years with no risk factors with one dose of vaccine during the yearly health examination were quantiified. The economic analysis was carried out from the family perspective and the time horizon of the study was established at 6 months. In the base case, the net present value was 21,551.62 euros (21.5 euros per vaccinated child), and the benefit-cost ratio was 2.15, meaning that 1.15 euros is saved per euro invested.

Contacts with children and young people and adult risk of suffering herpes zoster

We carried out a matched case-control study to analyze the possible association between exposure to the children and the risk of suffering herpes-zoster in adulthood. Cases of herpes zoster in immunocompetent healthy patients aged ≥ 25 years seen in the dermatology department of the Sagrado Corazón Hospital in 2007-2008 were matched with four controls. Data were analyzed using conditional logistic regression. 153 cases and 604 matched controls were included. Contacts with children were significantly associated with a reduction in the risk of suffering herpes zoster in adulthood (adjusted OR 0.56 [0.37-0.85]). Herpes-zoster vaccination in immunocompetent people aged ≥ 50 years could counteract the possible negative effects of mass varicella vaccination in childhood on the epidemiology of herpes zoster in adults.

Vacunas frente al virus de la varicela zóster

In Western countries, two attenuated varicella vaccines derived from the OKA strain are licensed: Varilrix® GlaxoSmithKline (OKA/RIT strain) and Varivax® Merck Sharp and Dohme (OKA/Merck strain). Currently, in Spain, varicella vaccination is only included in the Ministry of Health, Social Services and Equality official vaccination calendar for administration in adolescents who have not had the disease. Given the good results obtained in Navarra and Madrid with universal administration of the vaccine in children, it would be desirable to include the vaccine in the routine immunization schedule, with the administration of two doses at 15-18 months of age in the future. The protective efficacy of the attenuated herpes zoster vaccine was evaluated in the Shingles Prevention Study, which showed that in the short term (0-4 years) the vaccine reduced the incidence of herpes zoster by 53%, post-herpetic neuralgia by 66%, and the disease burden in immunocompetent persons aged ≥60 years by 61%. Another study demonstrated protective efficacy in persons aged 50-59 years. Over time, the protective efficacy decreases, but remains at acceptable levels, especially for post-herpetic neuralgia and the disease burden. Recently, the results of a controlled clinical trial (phase III) conducted in 18 countries to assess the protective efficacy of the inactivated subunit vaccine (glycoprotein E) adjuvanted with the adjuvant AS01B were published. The study inferred that the vaccine significantly reduced the incidence of herpes zoster in the short term (3.2 years) in people aged ≥50 years. Vaccine protection did not decrease with age at vaccination, ranging between 96.8% and 97.9% in all age groups.a b s t r a c t In Western countries, two attenuated varicella vaccines derived from the OKA strain are licensed: Varilrix® GlaxoSmithKline (OKA/RIT strain) and Varivax® Merck Sharp and Dohme (OKA/Merck strain). Currently, in Spain, varicella vaccination is only included in the Ministry of Health, Social Services and Equality official vaccination calendar for administration in adolescents who have not had the disease. Given the good results obtained in Navarra and Madrid with universal administration of the vaccine in children, it would be desirable to include the vaccine in the routine immunization schedule, with the administration of two doses at 15-18 months of age in the future. The protective efficacy of the attenuated herpes zoster vaccine was evaluated in the Shingles Prevention Study, which showed that in the short term (0-4 years) the vaccine reduced the incidence of herpes zoster by 53%, post-herpetic neuralgia by 66%, and the disease burden in immunocompetent persons aged ≥60 years by 61%. Another study demonstrated protective efficacy in persons aged 50-59 years.

Herpes zoster and postherpetic neuralgia in Catalonia (Spain)

The objective of the study was to analyze the descriptive epidemiology and costs of herpes zoster (HZ) and postherpetic neuralgia (PHN) in people aged ≥50 years in Catalonia (Spain). The incidence of HZ in Catalonia was estimated by extrapolating the incidence data from Navarre (Spain) to the population of Catalonia. The incidence of PHN was estimated according to the proportion of cases of HZ in the case series of the Hospital del Sagrado Corazón de Barcelona that evolved to PHN. Drug costs were obtained directly from the prescriptions included in the medical record (according to official prices published by the General Council of the College of Pharmacists). The cost of care was obtained by applying the tariffs of the Catalan Health Institute to the number of outpatient visits and the number and duration of hospital admissions. The estimated annual incidence of HZ was 31 763, of which 21 532 (67.79%) were in patients aged ≥50 years. The respective figures for PHN were 3194 and 3085 (96.59) per annum, respectively. The mean cost per patient was markedly higher in cases of PHN (916.66 euros per patient) than in cases of HZ alone (301.52 euros per patient). The cost increased with age in both groups of patients. The estimated total annual cost of HZ and its complications in Catalonia was € 9.31 million, of which 6.54 corresponded to HZ and 2.77 to PHN. This is the first Spanish study of the disease burden of HZ in which epidemiological data and costs were collected directly from medical records. The estimated incidence of HZ is probably similar to the real incidence. In contrast, the incidence of PHN may be an underestimate, as around 25% of patients in Catalonia attend private clinics financed by insurance companies. It is also probable that the costs may be an underestimate as the costs derived from the prodromal phase were not included. In Catalonia, HZ and PHN cause an important disease burden (21 532 cases of HZ and 3085 de PHN with an annual cost of € 9.31 million) in people aged ≥50 years, in whom vaccination is indicated.

Cost-effectiveness of rifampin for 4 months and isoniazid for 6 months in the treatment of tuberculosis infection

OBJECTIVES To assess the cost-effectiveness ratio of rifampin for 4 months and isoniazid for 6 months in contacts with latent tuberculosis infection. METHODS The cost was the sum of the cost of treatment with isoniazid for 6 months or with rifampin for 4 months of all contacts plus the cost of treatment of cases of tuberculosis not avoided. The effectiveness was the number of cases of tuberculosis avoided with isoniazid for 6 months or with rifampin for 4 months. When the cost with one schedule was found to be cheaper than the other and a greater number of tuberculosis cases were avoided, this schedule was considered dominant. The efficacy adopted was 90% for rifampin for 4 months and 69% for isoniazid for 6 months. A sensitivity analysis was made for efficacies of rifampin for 4 months of 80%, 69%, 60% and 50%. RESULTS Of the 1002 patients studied, 863 were treated with isoniazid for 6 months and 139 with rifampin for 4 months The cost-effectiveness ratio with isoniazid for 6 month was € 19759.48/avoided case of tuberculosis and € 8736.86/avoided case of tuberculosis with rifampin for 4 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies from 60%. CONCLUSIONS Rifampin for 4 months was more cost-effective than isoniazid for 6 months.

Economic benefits of inactivated influenza vaccines in the prevention of seasonal influenza in children

The aim of this study was to systematically review published studies that evaluated the efficiency of inactivated influenza vaccination in preventing seasonal influenza in children. The vaccine evaluated was the influenza-inactivated vaccine in 10 studies and the virosomal inactivated vaccine in 3 studies. The results show that yearly vaccination of children with the inactivated influenza vaccine saves money from the societal and family perspectives but not from the public or private provider perspective. When vaccination does not save money, the cost-effectiveness ratios were very acceptable. It can be concluded, that inactivated influenza vaccination of children is a very efficient intervention.

Low reactogenicity of the virosomal subunit influenza vaccine in healthy children without risk factors

Abstract Objectives To estimate the reactogenicity of the inactivated virosomal subunit influenza vaccine in healthy children. Material and methods During the 2004-2005 influenza season we carried out a prospective cohort study in 11 paediatric clinics of the metropolitan region of Barcelona to evaluate the effectiveness, efficiency and reactogenicity of one dose of inactivated virosomal subunit influenza vaccine in healthy children. The vaccine was administered to healthy children aged 3-14 years attended in 5 of the 11 clinics whose parents gave informed consent to participate in the study. These children formed the vaccinated cohort (n=966). The unvaccinated cohort (n=985) was formed by children attended in the other six clinics whose parents agreed to participate. Results Seven point five percent of the 966 children vaccinated suffered one or more local or systemic adverse reactions. The most common were local reactions: erythema (4.04%) and induration (1.76%). Systemic reactions were much less frequent, with malaise (0.72%) and fever (0.52%) the most common. Conclusions The virosomal influenza vaccine has low levels of reactogenicity and is very well tolerated in healthy children.

Vacunas para la deshabituación tabáquica

Smoking is an addiction and is one of the most important public health problems worldwide. It is responsible for premature deaths, chronic illness and considerable economic costs. Even with effective drugs for quitting smoking, cessation rates remain low, and many people start smoking again. Therefore, research has been directed at the development of new treatments, including vaccines against nicotine addiction, in which the antibodies generated would bind to nicotine, thereby reducing the amount reaching the brain. Three types of therapeutic vaccines (NicVAX, TA-NIC and NIC002) are in an advanced stage of development. In addition, vaccines produced by Chilka Ltd, University of Nebraska, Scripps of San Diego, Pharmaceutica AB and others are at the experimental stage. The efficacy of these vaccines is based on blocking part of the circulating nicotine, thereby preventing it reaching the brain and influencing the neurobiological mechanisms of dependence and addiction. Preliminary results indicate that subjects with high levels of anti-nicotine antibodies show high rates of cessation. These vaccines would be compatible and complementary with other smoking cessation treatments. The vaccines would be especially indicated in heavy smokers who have repeatedly tried to stop smoking or who have tried many cessation methods, people heavily motivated to stop smoking, and people with positive attitudes to vaccination. These would be the most suitable candidates for vaccination.

Eficiencia de la vacunación antigripal inactivada virosómica aplicada a niños sanos en la práctica pediátrica privada durante el examen de salud anual

Resumen Los autores realizan una revision de los articulos cientificos que han evaluado la eficiencia de la vacunacion antigripal inactivada virosomal, aplicada de forma universal a ninos sanos. La revision se centra en un estudio efectuado en Cataluna (Espana) desde la perspectiva de la familia, y sus resultados se comparan con los de otros estudios efectuados en Cataluna e Italia desde la perspectiva de la sociedad y del proveedor. El estudio efectuado desde la perspectiva de la familia ha demostrado que la vacunacion de los ninos sanos en edad preescolar y escolar con una sola dosis de vacuna antigripal inactivada virosomal en el ambito privado, ademas de proporcionar importantes beneficios de salud a los ninos vacunados, aporta beneficios socioeconomicos a la familia: en el caso base (coste de la vacunacion, 18,73 euros; coste de la visita medica pediatrica, 40 euros; coste de un episodio de consuno de antibioticos, 7,8 euros, y coste del absentismo escolar, 20 euros, y del laboral, 40 euros por dia) se ahorran 1,15 euros por cada euro invertido. Cuando el estudio se realiza desde la perspectiva de la sociedad, el ahorro de dinero es menor (0,8 euros por euro invertido). Por ultimo, cuando el analisis se realiza desde la perspectiva del proveedor no se ahorra dinero, pero las razones coste-efectividad son de niveles muy razonables (5,8 euros por caso de enfermedad respiratoria febril aguda prevenido y 6,87 euros por visita pediatrica evitada).

Prevención de enfermedades en viajeros desde la atención primaria. A propósito de un caso de cólera importado

Resumen Se describe un caso de colera en una paciente de turismo por la India (Delhi, Agra y Jaipur). La mujer tuvo vomitos y diarrea severos durante el vuelo de regreso de Delhi a Londres. Necesito cuidados intensivos debido a la deshidratacion, la profunda acidosis metabolica y la insuficiencia renal. Fue recuperandose poco a poco con los cuidados de su medico de familia en el centro de atencion primaria del distrito en Barcelona (Espana). Durante el viaje permanecio en hoteles de alta calidad. No es usual que los turistas de esos hoteles contraigan el colera. Se discute la oportunidad para la educacion sanitaria y la informacion a viajeros dadas por los medicos de atencion primaria ayudando a los centros de vacunaciones internacionales y a las autoridades de salud publica. Los medicos generales conocen muy bien a sus pacientes y pueden facilitarles informacion apropiada sobre prevencion de enfermedades importadas. Proponemos en situaciones especiales, en turistas con factores de riesgo, realizar la educacion sanitaria y la posibilidad de utilizar las vacunas anticolericas para prevenir el colera y la diarrea del viajero por Escherichia coli .