Potential impact of vaccination for a scenario with cross-protection only (A–D) and a scenario combining cross-protection & cross-enhancement (E–H).

<p>The two scenarios are those which calibration results are reported <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051244#pone-0051244-g004" target="_blank">Figure 4</a> (Model S2.2C, S2.4C).</p

Simulated and observed evolution of annual dengue incidence for different scenarios of serotype interactions: Model simulation with short term cross-protection only (A,B), Model simulation with cross-enhancement only (C,D), Model simulation with cross-protection & cross-enhancement (E,F).

<p>Wavelet analysis for observed data (G) and observed annual DHF/DSS incidence corrected for under-reporting (H). Footnotes of panels A, C, E: 1. Increased susceptibility and severity in case of secondary infection 2. Dominant period assessed using Fourier power spectrum over 36 consecutive years, 3. Median, minimum and maximum 4. The basic reproduction number reported is the annual average (average vector density and daily biting rates). In Wavelet analysis for observed data (G), the power has been scaled by the global wavelet spectrum. The cross-hatched region is the cone of influence, where zero padding has reduced the variance. Black contour is the 10% significance level <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051244#pone.0051244-Torrence1" target="_blank">[41]</a>. The 36 years of available data were duplicated to improve comparability with model results (H).</p

Results of dengue surveillance in Southern Vietnam.

<p>a. Reported DHF incidence from 1972 to 2007 (per 100,000 inhabitants). b. Reported dengue incidence for <15 years old and 15+ years old individual per level of severity (per 100,000 inhabitants) c. based on reported incidence and serotype distribution of isolated virus (about 1% of reported cases are subject to virus isolation) d. Seasonality in vector (Aedes Aegypti) density and monthly DHF incidence. Seasonality was assessed through locally weighted scatterplot smoothing <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051244#pone.0051244-Cleveland1" target="_blank">[61]</a>. Data derived from the surveillance system of dengue in Southern Vietnam coordinated by the Pasteur Institute in Ho Chi Minh.</p

Results of a prospective cohort study in Long Xuen [<b>34</b>].

<p>a. Age and serotype specific seroprevalence rate observed in a prospective cohort study performed in An Giang from (2004–2007) b. DF, DHF and DSS incidence observed in 3–15 year-old children.</p

Flow diagram of the infection and vaccination process.

<p>Rounded rectangles correspond to compartments and ellipses to factors influencing the transition from one compartment to another. For clarity, the representation in human hosts is limited to serotype 1 but each individual is characterized by their status for each of the four serotypes.</p

Vaccinating Women Previously Exposed to Human Papillomavirus: A Cost-Effectiveness Analysis of the Bivalent Vaccine

<div><p>Recent trials have indicated that women with prior exposure to Human papillomavirus (HPV) subtypes 16/18 receive protection against reinfection from the HPV vaccines. However, many of the original models investigating the cost effectiveness of different vaccination strategies for the protection of cervical cancer assumed, based on the trial results at that time, that these women received no protection. We developed a deterministic, dynamic transmission model that incorporates the vaccine-induced protection of women with prior exposure to HPV. The model was used to estimate the cost effectiveness of progressively extending a vaccination programme using the bivalent vaccine to older age groups both with and without protection of women with prior exposure. We did this under a range of assumptions on the level of natural immunity. Our modelling projections indicate that including the protection of women with prior HPV exposure can have a profound effect on the cost effectiveness of vaccinating adults. The impact of this protection is inversely related to the level of natural immunity. Our results indicate that adult vaccination strategies should potentially be reassessed, and that it is important to include the protection of non-naive women previously infected with HPV in future studies. Furthermore, they also highlight the need for a more thorough investigation of this protection.</p> </div

Cost Effectiveness Acceptability Curves for Extending the Vaccination Catch-up to (A) 19 year olds and (B) 24 year olds.

<p>Different durations of vaccine induced immunity; Life (Δ), 20 years (○), 10 years (□). Thick lines represent presence of protection to HPV non-naive women and thin the absence. The results presented assumed the vaccine cost is £20 per dose (not including the cost of administering the vaccine) a 100 year time horizon and 3.5% discount rate for costs and benefits. QALY: Quality adjusted life year.</p

Baseline census and training of pharmacy/botica workers, physicians and midwives in private practice in the 10 intervention cities.

*<p>Certification required attendance at all four seminars and passing the peer evaluation test and at least 60% correct answers to the written test.</p>**<p>Certification required attendance at two seminars, completion of homework and at least 60% correct answers to the written test.</p

Number of cases of STDs reported by PREVEN Network.

<p>The number of cases of urethral discharge, vaginal discharge, genital ulcer disease, and pelvic inflammatory disease reported by the PREVEN Network of pharmacies or boticas for 2004, 2005, and 2006 was substantially higher than the numbers reported by Network physicians and midwives, especially for urethral discharge, less so for suspected PID.</p

Results of evaluations by Simulated Patients.

<p>Evaluations to pharmacy workers at baseline both at intervention and control cities showed no significant differences in STD management or referral, or in recommendations for use of condoms or partner treatment. Subsequent evaluations at three, six and 18 months showed significantly better performance for all measures in intervention cities.</p