Acellular pertussis vaccine efficacy: An updated systematic review and meta-analysis

Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. Methods: We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package. Results: Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55-0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60-0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85-0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64-0.93) in highrisk group. Conclusion: The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended

Rotavirus infection in children with acute gastroenteritis in Iran: A systematic review and meta-analysis

© 2014, Isfahan University of Medical Sciences(IUMS). All rights reserved. Background: The recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data.Methods: We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea (and 95% confidence intervals [CI]). Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests.Results: A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rotavirus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 (95% CI, 0.28-0.41). Pooled estimates for hospitalized children and outpatient subgroups were 0.39 (95% CI, 0.30-0.48), and 0.31 (95% CI, 0.23-0.38), respectively.Conclusions: This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran

Educational Needs Assessment of General Practitioners Working in Health Centers Affiiated to Shahid Beheshti University of Medical Sciences in Tehran on the State of Tuberculosis Care System

Background and objectives: Tuberculosis is a global health problem and one of the top ten causes of mortality in the world. Therefore, the purpose of this study was to assess the educational needs of general practitioners working in health centers of Shahid Beheshti University of Medical Sciences in Tehran about tuberculosis. Material and Methods: This descriptive cross-sectional study was performed with the participation of all general practitioners working in health centers of Shahid Beheshti University of Medical Sciences in Tehran. Sampling method was census and 83 of the 97 doctors participated in the study. A needs assessment was performed using selfassessment and knowledge assessment questionnaires that were classifid into fie areas of general information about tuberculosis, detection, diagnosis, treatment and prevention. Data were entered into the SPSS-21 software and analyzed using one-way ANOVA. Results: In this study, 35 (42.2%) of the participants were from the Shargh Health Center, 31 (37.3%) from the Shomal Health Center and 17 (20.5%) of them were from the Shemiranet Health Network. Among the participants, 50 (60.2%) had participated in TB training course, and 79 (95.2%) had followed the DOTS strategy for treating patients. About 58 (69.9%) of them declared that workshop is the most effective method for learning. The mean (SD) level of general knowledge of physicians in the Shomal Health Center was 8.22 (6.4), the Shargh Health Center was 22.8 (6.5) and the Shemiranat Health. Network was 22.1 (7.5) out of 40. One-way analysis of variance didnot show a signifiant difference between mean scores of groups, but weakness of knowledge in the fild of treatment was observed according to the knowledge test and self-assessment. Conclusion: The study showed that the physicians’ knowledge was weak in all areas and was more signifiant in the fild of treatment than other areas

Epidemiology of animal bite in Iran: A Systematic review and meta-analysis

Background: Despite a lot of efforts made in the rabies health-care system, Iran is still in an endemic region and millions are spent annually to prevent rabies. Materials and Methods: Searching in national and international databases has been performed. The preferred reporting items for systematic reviews and meta-analyses protocol were followed. To assess heterogeneity, the I-index was calculated. In addition, sensitivity analysis was performed by the remove-one method. The publication bias was also investigated by Egger's regression test, and the trim and fill method. To perform a meta-analysis, CMA version 2 software was used. Results: Totally, 33 studies with 250,980 animal-bite cases were meta-analyzed. A summary estimate of the incidence of 1200 per 100,000 population (95% CI 1000, 1500) with a mean age of 29.97±15.13years (95%CI: 29.33, 30.61) was estimated. The rate in men was higher 76.7% (95%CI 74.7%, 78.8%) than in women and in the rural 49.7% (95%CI: 42.8%, 58.6%) was equal in the urban. Most bites occurred in the spring and summer 20.5% (95%CI: 16.1%, 25.9%). The highest of job-related bites was in students 20.1% (95%CI: 19%, 23%). The highest rate of bite location and the animal type were estimated in the order of lower limbs and by dogs respectively. The rate of complete vaccination 61% (95%CI: 43%, 76%) and immunoglobulin injection 39% (95%CI: 22%, 59%), were estimated respectively. Conclusion: Estimates reveal that there has been little change in the animal bites over the years. It is necessary to take special actions to control the disease at the national and international levels

Immunization against Haemophilus Influenzae Type b in Iran; Cost-utility and Cost-benefit Analyses

Background: Haemophilus Influenzae type b (Hib) is an important cause of morbidity and mortality in children. Although its burden is considerably preventable by vaccine, routine vaccination against Hib has not been defined in the National Immunization Program of Iran. This study was performed to assess the cost-benefit and cost-utility of running an Hib vaccination program in Iran. Methods: Based on a previous systematic review and meta-analysis for vaccine efficacy, we estimated the averted DALYs (Disability adjusted life years) and cost-benefit of vaccination. Different acute invasive forms of Hib infection and the permanent sequels were considered for estimating the attributed DALYs. We used a societal perspective for economic evaluation and included both direct and indirect costs of alternative options about vaccination. An annual discount rate of 3% and standard age-weighting were used for estimation. To assess the robustness of the results, a sensitivity analysis was performed. Results: The incidence of Hib infection was estimated 43.0 per 100000, which can be reduced to 6.7 by vaccination. Total costs of vaccination were estimated at US$15,538,129. Routine vaccination of the 2008 birth cohort would prevent 4079 DALYs at a cost per averted-DALY of US$ 4535. If we consider parents′ loss of income and future productivity loss of children, it would save US$ 8,991,141, with a benefit-cost ratio of 2.14 in the base-case analysis. Sensitivity analysis showed a range of 0.78 to 3.14 for benefit-to-cost ratios. Conclusion: Considering costs per averted DALY, vaccination against Hib is a cost-effective health intervention in Iran, and allocating resources for routine vaccination against Hib seems logical

The Novel Coronavirus Disease (COVID-19): A PRISMA Systematic Review and Meta-Analysis of Clinical and Paraclinical Characteristics

An outbreak of pneumonia, caused by a novel coronavirus (SARS-CoV-2), was identified in China in December 2019. This virus expanded worldwide, causing global concern. Although clinical, laboratory, and imaging features of COVID-19 are characterized in some observational studies, we undertook a systematic review and meta-analysis to assess the frequency of these features. We did a systematic review and meta-analysis using three databases to identify clinical, laboratory, and computerized tomography (CT) scanning features of rRT-PCR confirmed cases of COVID-19. Data for 3420 patients from 30 observational studies were included. Overall, the results showed that fever (84.2%, 95% CI 82.6-85.7), cough (62%, 95% CI 60-64), and fatigue (39.4%, 95% CI 37.2-41.6%) are the most prevalent symptoms in COVID-19 patients. Increased CRP level, decreased lymphocyte count, and increased D-dimer level were the most common laboratory findings. Among COVID-19 patients, 92% had a positive CT finding, most prevalently ground-glass opacification (GGO) (60%, 95% CI 58-62) and peripheral distribution opacification (64%, 95% CI 60-69). These results demonstrate the clinical, paraclinical, and imaging features of COVID-19

Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran.

BACKGROUND: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. METHODS: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. RESULTS: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. CONCLUSION: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran