Cost-effectiveness and programmatic benefits of maternal vaccination against pertussis in England.

: Maternal pertussis immunisation was introduced during the pertussis resurgence in England in 2012 as a temporary measure to protect infants too young to be vaccinated. The programme was shown to be safe and highly effective. However, continuation of maternal vaccination as a routine programme requires a cost-effectiveness analysis. : The estimated prevented disease burden among mothers and their infants was obtained assuming 89% (95% CI: 19%-99%) vaccine efficacy for mothers and 91% (95% CI: 84%-95%) for infants. Future incidence was projected based on the disease rates in 2010-2012, including the four-year cycle of low and high incidence years. Full probabilistic sensitivity analysis was performed for different scenarios. : Assuming a vaccine coverage of 60%, there were 1650 prevented hospitalisations in infants (3.5% discounting, the first 10 years), including 55-60 deaths and ∼20,500 cases among mothers, of which around 1800 would be severe. The annual costs of the programme are £7.3 million assuming a price of £10 per dose and £9.4 million assuming £15 per dose. Using discounting of 3.5%, a 200 year time horizon and a price of £10 per dose (+£7.5 administration costs) only 25% of the iterations were below £30,000 per QALY. Using a 35% higher incidence resulted in 88% of the scenarios below this threshold. Assuming that the incidence remains at the level at the height of 2012, then the programme would be highly cost effective, with an ICER of £16,865 (£12,209-£25,976; price of £10 and 3.5%/3.5% discounting). : Maternal vaccination is effective in preventing severe illness and deaths in infants but the cost-effectiveness of the programme is highly dependent on future incidence which is necessarily uncertain. However, the duration and magnitude of protection against transmission afforded by the current acellular vaccines is also uncertain as are the associated effects on future herd immunity. The direct protection offered by the maternal dose provides the only certain way of protecting vulnerable infants from birth.<br/

Infant hospitalisations and fatalities averted by the maternal pertussis vaccination programme in England, 2012-2017: Post-implementation economic evaluation

In October 2012, a maternal pertussis vaccination programme was implemented in England following an increased incidence and mortality in infants. We evaluated the cost-effectiveness of the programme by comparing pertussis-related infant hospitalisations and deaths in 2012-2017 with non-vaccination scenarios. Despite considerable uncertainties, findings support the cost-effectiveness of the programme

'Unable to have a proper conversation over the phone about my concerns': a multimethods evaluation of the impact of COVID-19 on routine childhood vaccination services in London, UK

Objectives Investigating the completion rate of 12-month vaccinations and parental perspectives on vaccine services during COVID-19. Study-design Service evaluation including parental questionnaire. Methods Uptake of 12-month vaccinations in three London general practices during three periods: pre-COVID (1/3/2018–28/2/2019, n = 826), during COVID (1/3/2019–28/2/2020, n = 775) and post-COVID first wave (1/8/2020–31/1/2021, n = 419). Questionnaire of parents whose children were registered at the practices (1/4/2019–1/22/2021, n = 1350). Results Comparing pre-COVID and both COVID cohorts, the completion rates of 12-month vaccines were lower. Haemophilus influenzae type B/meningococcal group C (Hib/MenC) vaccination uptake was 5.6% lower (89.0% vs 83.4%, P=<0.001), meningococcal group B (MenB) booster uptake was 4.4% lower (87.3% vs 82.9%, P = 0.006), pneumococcal conjugate vaccine (PCV) booster uptake was 6% lower (88.0% vs 82.0%, P < 0.001) and measles, mumps and rubella (MMR) vaccine uptake was 5.2% lower (89.1% vs 83.9%, P = 0.003). Black/Black-British ethnicity children had increased odds of missing their 12-month vaccinations compared to White ethnicity children (adjusted odds ratio 0.43 [95% confidence interval 0.24–0.79, P = 0.005; 0.36 [0.20–0.65], P < 0.001; 0.48 [0.27–0.87], P = 0.01; 0.40 [0.22–0.73], P = 0.002; for Hib/MenC, MenB booster, PCV booster and MMR. Comparing pre-COVID and COVID periods, vaccinations coded as not booked increased for MMR (10%), MenB (7%) and PCV booster (8%). Parents reported changes to vaccination services during COVID-19, including difficulties booking and attending appointments and lack of vaccination reminders. Conclusion A sustained decrease in 12-month childhood vaccination uptake disproportionally affected Black/Black British ethnicity infants during the first wave of the pandemic. Vaccination reminders and availability of healthcare professionals to discuss parental vaccine queries are vital to maintaining uptake

Rubella infection in pregnancy and congenital rubella in United Kingdom, 2003 to 2016

Although rubella is usually a mild, sometimes asymptomatic illness in childhood, the consequences of rubella infection in pregnancy can be devastating. In 2010, the Pan American Health Organisation announced that the Region of the Americas had eliminated rubella and congenital rubella syndrome (CRS) [1,2]. In the same year all 53 Member States of the World Health Organization (WHO) European Region committed to the goal of eliminating endemic transmission of measles and rubella, initially by 2015 and later revised to 2020. For the elimination of rubella and congenital rubella, high coverage of a two-dose childhood vaccination programme of a rubella-containing vaccine must be sustained [3]. Rubella can be easily mistaken for a number of other viral infections, and in order to monitor progress towards elimination it is essential that countries across Europe have robust surveillance systems in place to identify all suspected cases and reliably confirm or exclude rubella and congenital rubella infection (CRI) using appropriate laboratory methods [4]. Surveillance systems and laboratory confirmation of rubella and congenital rubella cases vary across Europe. Despite the elimination goals set for the WHO European Region, three of 28 European Union (EU) countries do not have national surveillance systems for all rubella cases [5,6]. In 2016, only 5% of all cases reported to the European Centre for Disease Prevention and Control (ECDC) were laboratory-confirmed. The United Kingdom (UK) vaccination strategy and programme surveillance is very similar to other western European countries and is based on laboratory-confirmed cases. It is, however, the only country to perform routine IgM confirmatory testing of oral fluid of notified cases (since 1994), which has strengthened surveillance and improved ascertainment [7-9]. The consequences of rubella infection in the first 20 weeks of pregnancy, and the relationship between gestational week of exposure and likelihood of fetal loss or features of congenital rubella syndrome, have been well documented [10,11]. With the introduction of effective vaccination strategies in the UK, the incidence of rubella has decreased dramatically and the last large outbreak of rubella occurred in 1995–96. Most clinicians who have qualified in this country in the past 20 years will never have seen a case of rubella, rubella infection in pregnancy or congenital rubella. Before routine vaccination was introduced, rubella was a common childhood disease in the UK with 80% of adults having evidence of prior infection [12]. Rubella vaccination was introduced for susceptible women and girls aged 11–14 years in 1970 with the aim of allowing most girls to acquire natural immunity in earlier childhood [13,14]. Non-immune women of child-bearing age were also targeted following the introduction of antenatal screening for rubella susceptibility based on rubella IgG testing throughout the UK in the early 1970s. The main programme aim was to ensure women of childbearing age were immune to rubella and thus prevent primary infection in pregnancy. This strategy successfully increased the proportion of women with antibodies to rubella from 85–90% in 1970 to 97–98% in 1987 [15]. Surveillance of CRS and CRI infections was established in the UK in 1971 to monitor the effectiveness of the vaccination programme [16]. While programmes to directly protect women of childbearing age against rubella successfully reduced cases of congenital rubella and terminations following rubella infection in pregnancy [16,17], the disease continued to circulate among young children, who were a potential source of infection to any women who remained susceptible. In 1988, a combined measles-mumps-rubella (MMR) vaccination was introduced into the routine childhood schedule at 12–15 months of age. The rubella component of MMR vaccine is highly effective and a single dose of a rubella-containing vaccine confers around 95–100% protection; the measles and mumps components require two doses to reach high levels of effectiveness [10,18]. A successful mass school-based measles-rubella immunisation campaign targeting all children aged 5–16 years was conducted in 1994 to prevent a predicted measles epidemic and to address continuing high levels of rubella susceptibility in school-aged children, particularly among boys [15]. To ensure continued high population protection, a routine second dose of MMR for 3–4-year-olds was introduced from 1996, when selective immunisation of schoolgirls ended. Uptake of the two-dose schedule by fifth birthday in the UK reached 75% by June 2005 [19] and was 88.5% in October to December 2016 [20]. MMR first-dose coverage by fifth birthday reached the 95% WHO elimination target for the first time in 2016. Determination of rubella susceptibility is not straightforward. The widespread use of an ELISA cut-off value of 10IU/ml, generally accepted as evidence of immunity, is based on levels following vaccination [21]. Vaccine-induced rubella antibody levels, while protective, appear to be lower at a population level than those resulting from naturally acquired infection. With an increasing proportion of UK-born women acquiring immunity through vaccination rather than natural infection and the absence of circulating rubella in the UK, reported antenatal susceptibility rates have increased in recent years based on this cut-off value [9]. In 2013, 27% of all births in England were to women born outside the UK, with geographical variation peaking in London at 58% [22]. Many of these women are likely to have come from rubella-endemic countries, with no or disrupted routine immunisation against rubella. A higher proportion of non-UK-born mothers, particularly those from sub-Saharan Africa and south-east Asia were more likely to be seronegative than UK-born women or white British women [23], [24] and analysis of antenatal rubella susceptibility data from London suggested that between 16% and 65% of non-UK-born women were susceptible in 2007 [25]. This paper summarises cases of laboratory-confirmed rubella infection in pregnancy (IIP), CRI and CRS reported to Public Health England (PHE) and other national surveillance programmes in the UK between 2003 and 2016

Seroprevalence of SARS-CoV-2 among Blood Donors and Changes after Introduction of Public Health and Social Measures, London, UK

We describe results of testing blood donors in London, UK, for severe acute respiratory disease coronavirus 2 (SARS-CoV-2) IgG before and after lockdown measures. Anonymized samples from donors 17–69 years of age were tested using 3 assays: Euroimmun IgG, Abbott IgG, and an immunoglobulin receptor-binding domain assay developed by Public Health England. Seroprevalence increased from 3.0% prelockdown (week 13, beginning March 23, 2020) to 10.4% during lockdown (weeks 15–16) and 12.3% postlockdown (week 18) by the Abbott assay. Estimates were 2.9% prelockdown, 9.9% during lockdown, and 13.0% postlockdown by the Euroimmun assay and 3.5% prelockdown, 11.8% during lockdown, and 14.1% postlockdown by the receptor-binding domain assay. By early May 2020, nearly 1 in 7 donors had evidence of past SARS-CoV-2 infection. Combining results from the Abbott and Euroimmun assays increased seroprevalence by 1.6%, 2.3%, and 0.6% at the 3 timepoints compared with Euroimmun alone, demonstrating the value of using multiple assays

Study on Web-Site Attributes and Predatory Efficiency of Dark Tetragnathid Spider in Point Calimere Wildlife and Bird Sanctuary

Abstract. Spiders represent one of the most abundant components of the predatory arthropods in terrestrial ecosystem. Their effectiveness at restricting pest populations, both alone and as part of natural enemy complex has well demonstrated in many countries. The web, web-site attributes and predatory efficiency of Dark Tetragnathid Spider Tetragnatha mandibulata were assessed in Point Calimere Wildlife and Bird Sanctuary between August 2015 and March 2016. In the present study, the spiders used limited number of plants species. The relationship between web architecture and web-site attributes was estimated using Pearson&apos;s correlation. Number of spiders recorded in the web showed the positive correlation with web horizontal and vertical length of the capture areas (p&lt;0.05). Similarly, the web circumference showed the positive interaction with plant height and canopy width (p&lt;0.05), which clearly indicated the importance of vegetations across the webs of Dark Tetragnathid Spider. Further, the microhabitat selection and utilization could also be impacted by non-trophic factors like structural features of plants that provide architectural supports to spiders. A total of 4620 insect pests comprising seven orders were entangled by the webs of dark tetragnathid spiders. Number of spiders in the web were positively correlated with number of insect pests (p&lt;0.05), which clearly explained that the Dark Tetragnathid spiders restricting pest populations and therefore they are considered as useful organism in biological control

Validity of a reported history of chickenpox in targeting varicella vaccination at susceptible adolescents in England

Introduction: In the UK, primary varicella is usually a mild infection in children, but can cause serious illness in susceptible pregnant women and adults. The UK Joint Committee on Vaccination and Immunisation is considering an adolescent varicella vaccination programme. Cost-effectiveness depends upon identifying susceptibles and minimising vaccine wastage, and chickenpox history is one method to screen for eligibility. To inform this approach, we estimated the proportion of adolescents with varicella antibodies by reported chickenpox history. Methods: Recruitment occurred through secondary schools in England from February to September 2012. Parents were asked about their child's history of chickenpox, explicitly setting the context in terms of the implications for vaccination. 247 adolescents, whose parents reported positive (120), negative (77) or uncertain (50) chickenpox history provided oral fluid for varicella zoster virus-specific immunoglobulin-G (VZV-IgG) testing. Results: 109 (90.8% [85.6-96.0%]) adolescents with a positive chickenpox history, 52 (67.5% [57.0-78.1%]) with a negative history and 42 (84.0% [73.7-94.3%]) with an uncertain history had VZV-IgG suggesting prior infection. Combining negative and uncertain histories, 74% had VZV-IgG (best-case). When discounting low total-IgG samples and counting equivocals as positive (worst-case), 84% had VZV-IgG. We also modelled outcomes by varying the negative predictive value (NPV) for the antibody assay, and found 74-87% under the best-case and 84-92% under the worst-case scenario would receive vaccine unnecessarily as NPV falls to 50%. Conclusion: Reported chickenpox history discriminates between varicella immunity and susceptibility in adolescents, but significant vaccine wastage would occur if this approach alone were used to determine vaccine eligibility. A small but important proportion of those with positive chickenpox history would remain susceptible. These data are needed to determine whether reported history, with or without oral fluid testing in those with negative and uncertain history, is sufficiently discriminatory to underpin a cost-effective adolescent varicella vaccination programme. © 2013 The Authors