Evaluación económica de vacunas neumocócicas conjugadas para Chile

Objective: To determine the cost-effectiveness of conjugated pneumococcal vaccines, PHiD-CV and PCV-13, for Chile. Materials and methods: We evaluated the cost effectiveness of both vaccines for Chile. Community acquired pneumonias (CAP; hospitalized and outpatients), invasive pneumococcal diseases (IPD; hospitalized bacteremia, meningitis and its sequelae) acute otitis media (AOM; medical visits and myringotomies), and PAHO revolving fund 2012 vaccine prices were considered in the analysis. The model assesses the medical and economic impact of both vaccines over a newborn cohort during a lifetime. Univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of our cost effectiveness result were performed. Results: We estimate that these vaccines can prevent 15,000 CAPs, 92-96 pneumococcal meningitis, 101-105 hospitalized pneumococcal bacteraemias and 21,000-28,000 AOMs per vaccinated cohort. PCV-13 showed additional benefits on IPD, while PHiD-CV showed additional benefits on AOM. PHiD-CV prevents 142 million pesos more than PCV-13 on treatment costs, and the vaccine costs 745 million pesos less. The cost utility analysis shows that both vaccines are cost effective for Chile. PHiD-CV generates 19 more quality adjusted life years (QALYs) than PCV-13 at a lower cost (-849 million pesos), being dominant in the deterministic analysis. PSA shows PHiD-CV is less costly than PCV-13 in 100% of the replicas, confirming the robustness of our estimations. Conclusions: In our analyses, both vaccines demonstrate reduction in the burden of pneumococcal disease, as well as cost effectiveness for Chile. PHiD-CV appears more cost effective, saving 849 million pesos per vaccinated cohort versus PCV-13.Objetivo: Evaluar costo-efectividad (CE) de las vacunas conjugadas neumocóccicas, PHiD-CV y PCV-13 para Chile. Material y método: Se evaluó la CE de ambas vacunas. Se consideraron la neumonía adquirida en la comunidad (hospitalizadas y ambulatorias), enfermedad neumocóccica invasiva (ENI; bacteremia hospitalizada, meningitis y sus secuelas) otitis media aguda (OMA; ambulatorias y miringotomías), y precios por dosis del fondo rotatorio de OPS 2012. Se determinó el impacto médico y económico de ambas vacunas siguiendo una cohorte chilena por toda la vida. Se realizó un análisis de sensibilidad univariado y probabilístico (ASP) para evaluar la robustez de las estimaciones de CE generadas. Resultados: Se estimó que estas vacunas pueden prevenir unas 15 mil neumonías, 92-96 meningitis neumocóccicas, 101-105 bacteremias neumocóccicas hospitalizadas y 21 mil a 28 mil OMAs por cohorte vacunada. PCV-13 mostró beneficios adicionales en ENI mientras que PHiD-CV presentó beneficios en OMAs. PHiD-CV previno 142 millones de pesos más que PCV-13 en tratamientos médicos y la vacuna costó 745 millones menos. El análisis de costo-utilidad mostró que ambas vacunas son CE para Chile. PHiDCV generó 19 AVACs más que PCV-13 a un menor costo (-849 millones de pesos), siendo dominante en el análisis determinístico. El ASP mostró que PHiD-CV fue menos costosa que PCV-13 en 100% de las replicas, respectivamente, confirmando que los resultados generados fueron robustos. Conclusiones: Ambas vacunas reducirían la carga por enfermedad neumocóccica significativamente y serían altamente CE para Chile. PHiD-CV sería más CE y ahorraría 849 millones por cohorte vacunada versus PCV-13

HPV genotyping from invasive cervical cancer in Chile

Objective: To determine the prevalence rates of the different HPV types in cervical cancer lesions in Chile to facilitate the development of prophylactic human papillomavirus (HPV) vaccines effective for that country. Method: Biopsy samples of 312 cervical cancer lesions were assessed for HPV type by reverse-line blotting assay. Results: HPV DNA was found in 94.2% of the lesions, 67.2% harboring 1 viral type and the remainder harboring more than 1 type. HPV-16 was the most frequent type in single infections (50.5%), followed by HPV-18 (7.8%), HPV-31 (2.4%), and HPV-45 (2.0%). HPV-16 was also present in 98.7% of dual and multiple infections, its most frequent association being with HPV-18. Conclusions: HPV types 16, 18, 31, and 45, alone or combined with other types, were observed in the biopsy samples of up to 80.5% of cervical cancer lesions. © 2008 International Federation of Gynecology and Obstetrics

CASOS GRAVES DE VÍRUS SINCICIAL RESPIRATÓRIO EM ANOS DE PANDEMIA: UMA ANÁLISE RETROSPECTIVA DA BASE DE DADOS DO SIVEP-GRIPE NO BRASIL (2020-2022)

Objetivo: O vírus sincicial respiratório (VSR) pode causar síndrome respiratória aguda grave (SRAG) em indivíduos de todas as idades. Durante a pandemia da COVID-19, recomendações de saúde foram adotadas para impedir a propagação do SARS-CoV-2, o que influenciou na transmissão de outros vírus respiratórios como o VSR. Avaliamos a carga do VSR em todas as faixas etárias no Brasil. Métodos: Realizou-se uma análise retrospectiva de dados publicamente disponíveis na base SIVEP-Gripe (2020 a 2022). Os casos de VSR-SRAG foram definidos como: códigos CID-10 J09 a J18 e confirmados com RT-PCR ou imunofluorescência. Os resultados foram calculados como frequências absolutas e relativas, incluindo número de casos de VSR-SRAG, taxas de letalidade e mortalidade. Resultados: De Jan/2020 a Dez/2022 foram notificados 30.934 casos de VSR-SRAG. Em 2020, 1.681 casos foram relatados com um pico na semana epidemiológica (SE) 12 (15-21 de março; 178 casos). Em 2021, foram notificados 12.478 casos; o pico ocorreu durante a SE 11 (14-20 de março; 433 casos), seguido por um segundo pico na SE 46 (14-20 de novembro; 352 casos). Em 2022, 16.775 casos foram relatados com o pico na SE 16 (17 a 23 de abril; 800 casos) e outra tendência crescente a partir da SE 37 (11 a 17 de setembro). Durante o período do estudo, 2.718 (8,8%) casos foram relatados em adultos ≥20 anos e 8.760 pacientes (28,3%) precisaram de internação na unidade de terapia intensiva, proporção semelhante entre as faixas etárias. Um total de 852 mortes por VSR-SRAG foram relatadas, levando a uma taxa de letalidade geral de 2,75%. As taxas anuais de letalidade foram de 6,66% (2020), 2,74% (2021) e 2,37% (2022). As taxas de letalidade aumentaram com a idade, variando de 20,77% (2022) a 32,45% (2020) em adultos ≥60 anos versus 0,96% (2022) a 1,86% (2020) em crianças ≤9 anos. As taxas de mortalidade de 60-69 anos foram semelhantes às observadas em crianças (0-9 anos) e aumentaram com a idade de 0,09/1.000 habitantes em 60-69 anos para 0,74 em ≥90 anos (2020), de 0,24 em 60-69 anos para 2,34 em ≥90 (2021) e de 0,24 em 60-69 anos para 3,12 em ≥90 em 2022. Conclusão: A ocorrência de um segundo pico de casos no final de 2021 e 2022 pode indicar uma diferença de sazonalidade durante a pandemia de COVID-19. Os resultados evidenciaram que a frequência de VSR-SRAG é maior em crianças no Brasil. No entanto, observa-se maior letalidade em adultos mais velhos, resultando em taxas de mortalidade comparáveis em extremos de faixa etária

Yellow fever in Brazil: epidemiological aspects and implications for travelers.

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Federal do Pará. Faculdade de Medicina. Belém, PA, Brazil.Hospital de Infecciosas F. Muñíz. Buenos Aires, Argentina.Scientific Affairs and Public Health Medical Director for GSK Vaccines inLatin America. Buenos Aires, Argentina.Hospital de Trauma y Emergencias. Federico Abete, Buenos Aires, Argentina.Hospital Británico de Buenos Aires´. Buenos Aires, Argentina.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela.Pontificia Universidad Católica de Chile. School of Medicine. Department of Pediatric Infectious Diseases and Immunology. Santiago de Chile, Chile.Hospital de Infecciosas F. Muñíz. Buenos Aires, ArgentinaUniversidad Tecnológica de Pereira. Faculty of Health Sciences. Public Health and Infection Research Group. Pereira, Risaralda, Colombia / UniFranz. Faculty of Health Sciences. Medical School. Cochabamba, Bolivia.Hospital de Infecciosas F. Muñíz. Buenos Aires, Argentina

Efficacy of pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in young Latin American children: A double-blind randomized controlled trial.

The relationship between pneumococcal conjugate vaccine-induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed.This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15-18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n = 10,295; control, n = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization-defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28-30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n = 10,211; control, n = 10,140) and AOM (n = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: -1.1%, 30.4%; one-sided p = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (n = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases.Efficacy was demonstrated against a broad range of pneumococcal diseases commonly encountered in young children in clinical practice.www.ClinicalTrials.gov NCT00466947

Efficacy of Pneumococcal Nontypable <i>Haemophilus influenzae</i> Protein D Conjugate Vaccine (PHiD-CV) in Young Latin American Children: A Double-Blind Randomized Controlled Trial

<div><p>Background</p><p>The relationship between pneumococcal conjugate vaccine–induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable <i>Haemophilus influenzae</i> protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed.</p><p>Methods and Findings</p><p>This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15–18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, <i>n</i> = 10,295; control, <i>n</i> = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided <i>p</i> = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization–defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28–30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, <i>n</i> = 10,211; control, <i>n</i> = 10,140) and AOM (<i>n</i> = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: −1.1%, 30.4%; one-sided <i>p</i> = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (<i>n</i> = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (<i>n</i> = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases.</p><p>Conclusions</p><p>Efficacy was demonstrated against a broad range of pneumococcal diseases commonly encountered in young children in clinical practice.</p><p>Trial registration</p><p><a href="http://www.ClinicalTrials.gov" target="_blank">www.ClinicalTrials.gov</a><a href="http://www.clinicaltrials.gov/ct2/show/NCT00466947" target="_blank">NCT00466947</a></p><p><i>Please see later in the article for the Editors' Summary</i></p></div