Invasive meningococcal disease epidemiology and control measures: a framework for evaluation

<p>Abstract</p> <p>Background</p> <p>Meningococcal disease can have devastating consequences. As new vaccines emerge, it is necessary to assess their impact on public health. In the absence of long-term real world data, modeling the effects of different vaccination strategies is required. Discrete event simulation provides a flexible platform with which to conduct such evaluations.</p> <p>Methods</p> <p>A discrete event simulation of the epidemiology of invasive meningococcal disease was developed to quantify the potential impact of implementing routine vaccination of adolescents in the United States with a quadrivalent conjugate vaccine protecting against serogroups A, C, Y, and W-135. The impact of vaccination is assessed including both the direct effects on individuals vaccinated and the indirect effects resulting from herd immunity. The simulation integrates a variety of epidemiologic and demographic data, with core information on the incidence of invasive meningococcal disease and outbreak frequency derived from data available through the Centers for Disease Control and Prevention. Simulation of the potential indirect benefits of vaccination resulting from herd immunity draw on data from the United Kingdom, where routine vaccination with a conjugate vaccine has been in place for a number of years. Cases of disease are modeled along with their health consequences, as are the occurrence of disease outbreaks.</p> <p>Results</p> <p>When run without a strategy of routine immunization, the simulation accurately predicts the age-specific incidence of invasive meningococcal disease and the site-specific frequency of outbreaks in the Unite States. 2,807 cases are predicted annually, resulting in over 14,000 potential life years lost due to invasive disease. In base case analyses of routine vaccination, life years lost due to infection are reduced by over 45% (to 7,600) when routinely vaccinating adolescents 12 years of age at 70% coverage. Sensitivity analyses indicate that herd immunity plays an important role when this population is targeted for vaccination. While 1,100 cases are avoided annually when herd immunity effects are included, in the absence of any herd immunity, the number of cases avoided with routine vaccination falls to 380 annually. The duration of vaccine protection also strongly influences results.</p> <p>Conclusion</p> <p>In the absence of appropriate real world data on outcomes associated with large-scale vaccination programs, decisions on optimal immunization strategies can be aided by discrete events simulations such as the one described here. Given the importance of herd immunity on outcomes associated with routine vaccination, published estimates of the economic efficiency of routine vaccination with a quadrivalent conjugate vaccine in the United States may have considerably underestimated the benefits associated with a policy of routine immunization of adolescents.</p

Calculating total health service utilisation and costs from routinely collected electronic health records using the example of patients with irritable bowel syndrome before and after their first gastroenterology appointment

INTRODUCTION: Health economic models are increasingly important in funding decisions but most are based on data, which may therefore not represent the general population. We sought to establish the potential of real-world data available within the Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) to determine comprehensive healthcare utilisation and costs as input variables for economic modelling. METHODS: A cohort of patients with irritable bowel syndrome (IBS) who first saw a gastroenterologist in 2008 or 2009, and with 3 years of data before and after their appointment, was created in the CPRD. Primary care, outpatient, inpatient, prescription and colonoscopy data were extracted from the linked CPRD and HES. The appropriate cost to the NHS was attached to each event. Total and stratified annual healthcare utilisation rates and costs were calculated before and after the gastroenterology appointment with distribution parameters. Absolute differences were calculated with 95 % confidence intervals. RESULTS: Total annual healthcare costs over 3 years increase by £935 (95 % CI £928–941) following a gastroenterology appointment for IBS. We derived utilisation and cost data with parameter distributions stratified by demographics and time. Women, older patients, smokers and patients with greater comorbidity utilised more healthcare resources, which generated higher costs. CONCLUSIONS: These linked datasets provide comprehensive primary and secondary care data for large numbers of patients, which allows stratification of outcomes. It is possible to derive input parameters appropriate for economic models and their distributions directly from the population of interest

Innate Immune Response to Rift Valley Fever Virus in Goats

Rift Valley fever (RVF), a re-emerging mosquito-borne disease of ruminants and man, was endemic in Africa but spread to Saudi Arabia and Yemen, meaning it could spread even further. Little is known about innate and cell-mediated immunity to RVF virus (RVFV) in ruminants, which is knowledge required for adequate vaccine trials. We therefore studied these aspects in experimentally infected goats. We also compared RVFV grown in an insect cell-line and that grown in a mammalian cell-line for differences in the course of infection. Goats developed viremia one day post infection (DPI), which lasted three to four days and some goats had transient fever coinciding with peak viremia. Up to 4% of peripheral blood mononuclear cells (PBMCs) were positive for RVFV. Monocytes and dendritic cells in PBMCs declined possibly from being directly infected with virus as suggested by in vitro exposure. Infected goats produced serum IFN-γ, IL-12 and other proinflammatory cytokines but not IFN-α. Despite the lack of IFN-α, innate immunity via the IL-12 to IFN-γ circuit possibly contributed to early protection against RVFV since neutralising antibodies were detected after viremia had cleared. The course of infection with insect cell-derived RVFV (IN-RVFV) appeared to be different from mammalian cell-derived RVFV (MAM-RVFV), with the former attaining peak viremia faster, inducing fever and profoundly affecting specific immune cell subpopulations. This indicated possible differences in infections of ruminants acquired from mosquito bites relative to those due to contact with infectious material from other animals. These differences need to be considered when testing RVF vaccines in laboratory settings

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Towards Transformational Leadership: The Nexus of Emergency Management Systems in Canada

This qualitative research study explores the leadership challenges in emergency management systems in Canada. Complex adaptive systems theory forms the theoretical paradigmatic perspective of emergency events, such as mass emergencies, disasters and catastrophes. Thematic analysis of a key informant study of emergency leaders identified twelve key leadership capabilities. From the grounded theory methodological approach, a theory of transformational emergency systems leadership emerged and is posited. The findings and implications are discussed in light of theoretical implications for humanistic and technologically driven leadership; inter-sectorial collaborative networks; adaptive learning and training of future emergency leaders; and future international emergency management research

Traumatic Brain Injury Care Systems: 2020 Transformational Challenges

Traumatic Brain Injury (TBI) care systems are those that deliver care services to reduce mortality and morbidity rates, risks and incalculable human suffering from neuro-traumatic events. These care systems seek positive cognitive, functional and physical outcomes and social reintegration for TBI patients. Current TBI care systems are fragmented and operate in silos, each with diverse clinical and resource priorities and supported through disparate information systems. Paradoxically as each silo attempts to sustain life and mitigate the impact of patho-physiological aspects of TBI, the systemic sustainability of the entire TBI care system is compromised. This paper explores the implications for the future systemic sustainability of TBI care through regionalization, intelligence systems, virtual environments and transformational leadership

Code Orange: Towards the Future of Strategic Leadership of Emergency Management Systems

Emergency management systems reflect require strategic leadership of an order not yet fully potentiated in Canada. When we ponder on past tragic events across Canada, what is the future role of strategic leaders in emergency management? A key informant study examines the perspectives of emergency, health care and IT leaders on the challenges of emergency management systems across Canada. The study underscores the eight unique strategic leadership challenges in this important specialization

Emergency intelligence support of regional emergency networks: visions and critical dimensions

Le texte intégral de ce document de travail n'est pas disponible en ligne. Une copie papier est disponible à l'Annexe de la bibliothéque. Effectuez une recherche par titre dans le catalogue pour réserver le document. // The full text of this working paper is not available online. A print copy is available in the Library Annex. Search by title in the catalogue to request the paper

Technostress coping strategies: the chaining of Prometheus

Le texte intégral de ce document de travail n'est pas disponible en ligne. Une copie papier est disponible à l'Annexe de la bibliothéque. Effectuez une recherche par titre dans le catalogue pour réserver le document. // The full text of this working paper is not available online. A print copy is available in the Library Annex. Search by title in the catalogue to request the paper