Cost-effectiveness analysis of domestic 13-valent pneumococcal conjugate vaccine for children under 5 years of age in mainland China

Background: The first Chinese domestic 13-valent pneumococcal conjugate vaccine (WoAnxin®, PCV-13) is available for children aged 2 months to 5 years and is more economical than import vaccine with equal safety and immunogenicity. However, the cost-effectiveness of this new PCV-13 for children <5 years in mainland China is not clear. Methods: In the present study, we developed a Markov model under societal perspective to evaluate the incremental cost-effectiveness ratios (ICERs) of five birth cohorts of 100,000 Chinese infants across four alternative vaccination programs:1) no vaccination; 2) vaccinate 4 doses of new PCV-13 for children aged 2 to 6 months; 3) vaccinate 3 doses of new PCV-13 for children aged 7 to 11 months; 4) vaccinate 2 doses of new PCV-13 for children aged 12 to 23 months; 5) vaccinate 1 dose of new PCV-13 for children aged 2 to 5 years. We conducted one-way and probability sensitivity analysis to determine the uncertainty of the model findings. Results: We found that with awillingness-to-pay (WTP) threshold of three-times Chinese per-capita gross domestic product (GDP) all vaccination programs were cost-effective compared to no vaccination and children aged 2 to 5 years received 1 dose of new PCV-13 would incur the lowest additional cost of US$2417 per quality-adjusted-life-years (QALYs) compare with other vaccination programs ($15394/QALYs for 4 doses program, $9292/QALYs for 3 doses program,$4445/QALYs for 2 doses program). Conclusions: According to our results, China should give priority to incorporating new PCV-13 into its national immunization program

High‐production dairy cattle exhibit different rumen and fecal bacterial community and rumen metabolite profile than low‐production cattle

Abstract Our aim was to simultaneously investigate the gut bacteria typical characteristic and conduct rumen metabolites profiling of high production dairy cows when compared to low‐production dairy cows. The bacterial differences in rumen fluid and feces were identified by 16S rDNA gene sequencing. The metabolite differences were identified by metabolomics profiling with liquid chromatography mass spectrometry (LC‐MS). The results indicated that the high‐production dairy cows presented a lower rumen bacterial richness and species evenness when compared to low‐production dairy cows. At the phylum level, the high‐production cows increased the abundance of Proteobacteria and decreased the abundance of Bacteroidetes, SR1, Verrucomicrobia, Euryarchaeota, Planctomycetes, Synergistetes, and Chloroflexi significantly (p < 0.05). At the genus level, the rumen fluid of the high‐production group was significantly enriched for Butyrivibrio, Lachnospira, and Dialister (p < 0.05). Meanwhile, rumen fluid of high‐production group was depleted for Prevotella, Succiniclasticum, Ruminococcu, Coprococcus,YRC22, CF231, 02d06, Anaeroplasma, Selenomonas, and Ruminobacter significantly (p < 0.05). A total of 92 discriminant metabolites were identified between high‐production cows and low‐production cows. Compared to rumen fluid of low‐production dairy cows, 10 differential metabolites were found up‐regulated in rumen fluid of high‐production dairy cows, including 6alpha‐Fluoropregn‐4‐ene‐3,20‐dione, 3‐Octaprenyl‐4‐hydroxybenzoate, disopyramide, compound III(S), 1,2‐Dimyristyl‐sn‐glycerol, 7,10,13,16‐Docosatetraenoic acid, ferrous lactate, 6‐Deoxyerythronolide B, vitamin D2, L‐Olivosyl‐oleandolide. The remaining differential metabolites were found down‐regulated obviously in high‐production cows. Metabolic pathway analyses indicated that most increased abundances of rumen fluid metabolites of high‐yield cows were related to metabolic pathways involving biosynthesis of unsaturated fatty acids, steroid biosynthesis, ubiquinone and other terpenoid‐quinone biosynthesis. Most down‐regulated metabolic pathways were relevant to nucleotide metabolism, energy metabolism, lipid metabolism and biosynthesis of some antibiotics

Long-term neurological sequelae and disease burden of Japanese encephalitis in Gansu Province, China

Background and objects: The study aimed to evaluate the long-term neurological sequelae and the disease burden of JE in Gansu, China. Methods: JE patients were included as study population from 2005–2011 in Gansu, and a follow-up survey was conducted in 2007–2014. Pair-matched healthy individuals were selected as controls. All subjects underwent a neurological examination and intelligence quotient (IQ) and memory quotient (MQ) assessments. Then, the disability-adjusted life years (DALYs), and direct and indirect medical expenses were systematic assessed. Results: Forty-four point seven percent of the JE patients had objective neurological deficits, compared with 2.4% of controls. Subnormal intelligence was found in 21.2% of JE subjects, compared with 1.2% control who exhibited a mildly reduced IQ. Abnormal MQ scores were noted in 56.3% JE subjects, compared with only 12.7% controls. Prevalence of each sequelae caused by JE were significantly higher in adults than in younger subjects. Furthermore, median DALY lost due to JE was 9.2 per subject. Median economic cost of JE was approximately $2776.6 per subject and significantly higher in adults than in younger subjects. Findings and Conclusions: JE patients suffered from severe neurological sequelae and high disease burden, resulting in a significant downstream burden for both the patients (especially adults) and the healthcare system.</p