Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model

Seasonal influenza infection is primarily caused by circulation of two influenza A strain subtypes and strains from two B lineages that vary each year. Trivalent influenza vaccine (TIV) contains only one of the two B-lineage strains, resulting in mismatches between vaccine strains and the predominant circulating B lineage. Quadrivalent influenza vaccine (QIV) includes both B-lineage strains. The objective was to estimate the cost-utility of introducing QIV to replace TIV in Germany. An individual-based dynamic transmission model (4Flu) using German data was used to provide realistic estimates of the impact of TIV and QIV on age-specific influenza infections. Cases were linked to health and economic outcomes to calculate the cost-utility of QIV versus TIV, from both a societal and payer perspective. Costs and effects were discounted at 3.0 and 1.5 % respectively, with 2014 as the base year. Univariate and probabilistic sensitivity analyses were conducted. Using QIV instead of TIV resulted in additional quality-adjusted life-years (QALYs) and cost savings from the societal perspective (i.e. it represents the dominant strategy) and an incremental cost-utility ratio (ICUR) of a,not sign14,461 per QALY from a healthcare payer perspective. In all univariate analyses, QIV remained cost-effective (ICUR <a,not sign50,000). In probabilistic sensitivity analyses, QIV was cost-effective in > 98 and > 99 % of the simulations from the societal and payer perspective, respectively. This analysis suggests that QIV in Germany would provide additional health gains while being cost-saving to society or costing a,not sign14,461 per QALY gained from the healthcare payer perspective, compared with TIV

Vaccination programs for older adults in an era of demographic change

Objectives Populations are aging worldwide. This paper summarizes some of the challenges and opportunities due to the increasing burden of infectious diseases in an aging population. Results Older adults typically suffer elevated morbidity from infectious disease, leading to increased demand for healthcare resources and higher healthcare costs. Preventive medicine, including vaccination can potentially play a major role in preserving the health and independence of older adults. However, this potential of widespread vaccination is rarely realized. Here, we give a brief overview of the problem, discuss concrete obstacles and the potential for expanded vaccination programs to promote healthy aging. Conclusion The increasing healthcare burden of infectious diseases expected in aging populations could, to a large extent, be reduced by achieving higher vaccination coverage among older adults. Vaccination can thus contribute to healthy aging, alongside healthy diet and physical exercise. The available evidence indicates that dedicated programs can achieve substantial improvements in vaccination coverage among older adults, but more research is required to assess the generalizability of the results achieved by specific interventions (see Additional file 1)

Tuberkulose in Einrichtungen der Kindertagesbetreuung – zwei Erfahrungsberichte aus Bayern

Im Juni 2019 und Juni 2020 wurden gemäß § 6 Infektionsschutzgesetz (IfSG) jeweils ein Fall von offener Lungentuber¬kulose beim Betreuungspersonal in Kindertagesstätten an die zuständigen Gesundheitsbehörden gemeldet. Entsprechende Infektionsschutzmaßnahmen und Umgebungsuntersuchungen wurden eingeleitet. In einem der Fälle konnten durch die frühzeitige Diagnose der Lun¬gentuberkulose beim Indexfall und wirksame Infektionsschutzmaßnahmen weitere Folgeinfektionen unterbunden werden. Der zweite Fall schildert ein umfassendes Infektionsgeschehen, mit Exposition zahlreicher Kon¬taktpersonen gegenüber einem vermutlich über ei¬nen längeren Zeitraum infektiösen Indexfall. Wie das Epidemiologische Bulletin 11/2021 ausführt, zeigen diese Erfahrungen die Bedeutung ei¬ner frühzeitigen Tuberkulose-Diagnostik bei Ver¬dachtsfällen und der konsequenten Umsetzung von Infektionsschutz- und Präventionsmaßnahmen in besonders vulnerablen Bereichen

Influence of social contact patterns and demographic factors on influenza simulation results

Abstract Background The demographic composition and the frequency and nature of social contacts may affect the spread of influenza virus in a population, resulting in distinct age-dependent immunity patterns. As demography and social contact rates differ strongly between European countries, this may impact infection incidence and vaccine effectiveness and thus limit the extent to which conclusions derived from observations in one country can be generalized to others. In the current study, we aimed to decipher the impact of social contact patterns and demographic factors on simulation results and, thus, to determine to what extent vaccination results can be generalized. Methods We simulated the transmission of four influenza strains (A(H1N1), A(H3N2), B/Victoria, B/Yamagata) in Belgium, Finland, Germany, GB, Italy, Luxembourg, Netherlands and Poland, using the simulation tool 4Flu. Individuals were connected in a dynamically evolving age-dependent contact network based on the POLYMOD study. Results When averaged over 20 years, simulation results without vaccination ranged from annually 20,984 (Germany) to 31,322 infections (Italy) per 100,000 individuals. QIV annually prevented 1758 (Poland) to 7720 infections (Germany) per 100,000. Variability of prevented cases remained high when the country-specific vaccination was replaced by unified coverage, but was reduced considerably if the same demography was used for all countries, or even more so when the same contact matrix was used. Conclusions Contact matrix and demography strongly influence the age-dependent incidence of influenza and the success of vaccination. Projecting simulation results from one country to another can, therefore, lead to erroneous results

Improved Serological Diagnosis Stresses the Major Role of Campylobacter jejuni in Triggering Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is a postinfectious autoimmune polyradiculoneuropathy. The most frequent antecedent pathogen is Campylobacter jejuni, followed by cytomegalovirus. However, more than 40% of GBS cases currently cannot be attributed to triggering events. This might be due to the shortcomings of the serological assays used for diagnosing infections, in particular for C. jejuni. In our study investigating 36 patients with acute GBS, standard serological methods identified the triggering viral or bacterial etiology in only 25% of cases. However, using a highly specific enzyme-linked immunosorbent assay based on two recombinant outer antigens encoded by C. jejuni genes Cj0017 (P39) and Cj0113 (P18), we found serological evidence of a preceding C. jejuni infection in 80.6% of the patients but in only 3.5% of the controls. We conclude that the role of C. jejuni in triggering GBS has been greatly underestimated

Additional file 1: of Influence of social contact patterns and demographic factors on influenza simulation results

The online available file “Supporting_Material_4Flu.pdf” explains (1) the extension and smoothing of the original POLYMOD matrix (2) the translation of the resulting matrix into a contact network (3) the occurrence of super-spreaders in the simulation tool 4Flu (PDF 930 kb

Sustaining Vaccine Confidence in the 21st Century

vaccine

Impact of herpes zoster and postherpetic neuralgia on the quality of life of Germans aged 50 or above

Abstract Background Herpes zoster (HZ) is a painful dermatomal rash caused by reactivation of latent varicella zoster virus surviving in the patient’s sensory ganglia after a previous episode of varicella. The incidence of HZ increases markedly with age as does the proportion of HZ patients who develop postherpetic neuralgia (PHN) with often severe and debilitating pain persisting for months and even years. This prospective study aimed to assess the impact of HZ and PHN on the quality of life (QoL) of individuals aged ≥ 50 years in Germany. Methods Patients were recruited when consulting primary care physicians for a first HZ episode. PHN was defined as a ‘worst’ pain score ≥ 3 on the Zoster Brief Pain Inventory (ZBPI) scale persisting or appearing 90 days or more after rash onset. PHN-cases were followed for up to nine months after rash onset. The interference of pain with patients’ ability to carry out normal activities was assessed by the ZBPI activities of daily living (ADL) scale and QoL by the EuroQoL five-dimension scale (EQ-5D) utility score. Results Of 513 patients enrolled, 61 (11.9%) developed PHN. At HZ onset, the mean ZBPI worst pain score of all patients was 5.1, the least square (LS)means estimates of the ZBPI ADL and EQ-5D utility scores were 2.970 and 0.740, respectively. Over three months follow-up, the pain scores decreased and the QoL increased monotonically across all age groups. At Day 90, the mean ZBPI worst pain score of the PHN patients was 4.4, while the LSmeans estimates of the ZBPI ADL and EQ-5D utility scores were 2.899 and 0.826, respectively. For patients with PHN persisting at nine months, the pain scores and QoL remained unchanged over the six months following the development of PHN. Conclusion HZ and PHN had a substantial impact on the patients’ QoL and ability to function in their normal activities. There was a clear association in time between the evolution of pain and estimated QoL. The impact on ADL and QoL did not vary with age