Effect and cost-effectiveness of pneumococcal conjugate vaccination: a global modelling analysis

by Cynthia Chen, PhD; Francisco Cervero Liceras, MSc; Stefan Flasche, PhD; Sucitro Sidharta, MSc; Joanne Yoong, PhD; Neisha Sundaram, PhD; and Prof Mark Jit, PhD

Published in The Lancet Global Health, January 2019. DOI: https://doi.org/10.1016/S2214-109X(18)30422-4

 

 

Introduction of pneumococcal conjugate vaccines (PCVs) has substantially reduced disease burden due to Streptococcus pneumoniae, a leading cause of childhood morbidity and mortality globally. However, PCVs are among the most expensive vaccines, hindering their introduction in some settings and threatening sustainability in others. Researchers aimed to assess the effect and cost-effectiveness of introduction of 13-valent PCV (PCV13) vaccination globally. Researchers assessed the incremental cost-effectiveness ratio of PCV13 introduction by integrating two models: an ecological model (a parsimonious, mechanistic model validated with data from post-seven-valent PCV introduction in 13 high-income settings) to predict the effect of PCV on childhood invasive pneumococcal disease, and a decision-tree model to predict a range of clinical presentations and economic outcomes under vaccination and no-vaccination strategies. The models followed 30 birth cohorts up to age 5 years in 180 countries from 2015 to 2045. One-way scenario and probabilistic sensitivity analyses were done to explore model uncertainties. Researchers estimate that global PCV13 use could prevent 0·399 million child deaths and 54·6 million disease episodes annually. Global vaccine costs (in 2015 international dollars) of $15·5 billion could be partially offset by health-care savings of $3·19 billion (2·62 billion to 3·92 billion) and societal cost savings of $2·64 billion (2·13 billion to 3·28 billion). PCV13 use is probably cost-effective in all six UN regions. The 71 countries eligible for support from Gavi, the Vaccine Alliance, account for 83% of PCV13-preventable deaths but only 18% of global vaccination costs. The expected cost of PCV vaccination globally is around $16 billion per year. Study findings highlight the value of Gavi's support for PCV introduction in low-income countries and of efforts to improve the affordability of PCVs in countries not eligible for, or transitioning from, Gavi support. This study was funded by the World Health Organization; Gavi, the Vaccine Alliance; and the Bill & Melinda Gates Foundation.  Access the full article here.  
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Lessons From California’s Discipline of a Popular Physician for Vaccination Exemptions Without Medical Cause

by Ross D. Silverman, JD, MPH and Y. Tony Yang, ScD, LLM, MPH3

Published in JAMA Pediatrics, 10 December 2018. doi:10.1001/jamapediatrics.2018.3835

 

 

In June 2018, the Medical Board of California placed an American Academy of Pediatrics fellow and leading vaccine skeptic, Robert “Dr Bob” Sears, MD, on 35 months’ probation for substandard care in writing a medical report exempting a boy from all childhood vaccinations. The medical board’s action represents a novel and important development in how states protect the public’s health from vaccine-preventable illnesses. It also reveals concerns about exploitable loopholes in many states’ vaccination exemption policies, whether the state permits religious and philosophical exemptions or even if, as California has since 2015, it only accepts medical grounds for exemption.

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New York City Childcare Influenza Vaccine Mandate

by Tony Yang, ScD, LLM, MPH and James Colgrove, PhD, MPH

Published in JAMA Pediatrics, 03 December 2018. doi:10.1001/jamapediatrics.2018.4220

 

 

In December 2013, the New York City Board of Health amended its requirements to mandate annual influenza vaccination for infants and children aged 6 months to 59 months, before they may be admitted to city-regulated childcare and educational institutions. The Board of Health already required vaccinations against 11 other diseases, such as measles, mumps, rubella, pertussis, and pneumococcal disease. The amended requirements authorized denial of admission to any child who lacks proof of receiving the influenza vaccine, established an appeal process for children who have been denied admission, and subjected fines to childcare and educational institutions for not maintaining documentation of influenza vaccination status. The amended requirements also provided vaccination exemptions based on medical need and religious belief. Parents of these children challenged this regulation in court. Although the New York lower courts twice ruled in favor of the parents, the highest court in New York upheld the regulation on June 28, 2018.

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Influenza and pertussis vaccination in pregnancy: Portrayal in online media articles and perceptions of pregnant women and healthcare professionals

by Christopher R Wilcox, Kathryn Bottrell, Pauline Paterson, William S Schulz, Tushna Vandrevala, Heidi J Larson, Christine E Jones

Published in Vaccine, 29 November 2018. https://doi.org/10.1016/j.vaccine.2018.10.092

 

 

Online media may influence women’s decision to undergo vaccination during pregnancy. The aims of this mixed-methods study were to: (1) examine the portrayal of maternal vaccination in online media and (2) establish the perceived target of vaccine protection as viewed by pregnant women and maternity healthcare professionals (HCPs).

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The changing epidemiology of invasive pneumococcal disease after PCV13 vaccination in a country with intermediate vaccination coverage

by Pilar Ciruela, Conchita Izquierdo, Sonia Broner, Carmen Muñoz-Almagro, Sergi Hernández, Carmen Ardanuy, Roman Pallarés, Angela Domínguez, Mireia Jané and The Catalan Working Group on Invasive Pneumococcal Disease

Published in Vaccine, 29 November 2018. https://doi.org/10.1016/j.vaccine.2018.05.026

 

Researchers studied the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the incidence of invasive pneumococcal disease (IPD) and serotype distribution in a region with intermediate levels of vaccination (around 64% in children aged <2 years).

 

Surveillance data on IPD cases reported by microbiologists participating in the Microbiological Reporting System of Catalonia during 2006–2014 were analysed. Researchers compared estimated incidence rate (IR) ratios for serotypes included in PCV7, PCV10non7, PCV13non10 and non-PCV13 between the PCV7 (2006–2009) and PCV13 periods (2010–2014). IR were corrected for missing serotypes according to year and age groups: <2 years, 2–4 years, 5–64 years and ≥65 years.

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