Childhood pneumococcal disease burden in Argentina Carga por enfermedad neumocócica en niños de Argentina

OBJECTIVES: To understand the disease burden of pneumococcal disease (PD), a major cause of childhood morbidity and mortality in Argentina, and to draw a baseline against which the need for and effectiveness of vaccination with pneumococcal conjugate vaccines might be measured. METHODS: A Markov model was constructed to estimate incidence and mortality rates of PD-meningitis (MEN), bacteremia/septicemia (BACT), pneumonia (PNEU), acute otitis media (AOM)-among a hypothetical, birth cohort of 750 000 Argentine infants born in 2006-2015. A systematic review of the literature was performed to select and incorporate input parameters. Life years and costs in 2006 US$were expressed as both undiscounted and discounted. RESULTS: The number of PD episodes estimated to occur over a 10-year period in the hypothetical birth cohort were: MEN, 225; BACT, 2 841; PNEU, 2 628; and AOM, 2 066 719. Chronic sequelae of MEN could be expected to cause neurological damage in 43 children and severe hearing issues in 28. Results indicate that there would be 78 PD-related deaths in the cohort (29$ 167 (US$151 discounted), imposing a total, cohort cost-burden of more than US$ 126 million (US$113 million discounted). CONCLUSIONS: The study shows that PD imposes a significant health and economic burden on the Argentine population. This information is essential for assessing the potential health and economic impact of introducing pneumococcal conjugate vaccine into the national immunization schedule.OBJETIVOS: Analizar la carga que provoca la enfermedad neumocócica (EN), una importante causa de morbimortalidad infantil en Argentina y establecer una línea de base a partir de la cual se pueda medir la necesidad y la eficacia del uso de vacunas antineumocócicas conjugadas. MÉTODOS: Se elaboró un modelo de Markov para estimar las tasas de incidencia y mortalidad por meningitis (MEN), bacteremia/septicemia (BACT), neumonía (PNEU) y otitis media aguda (AOM) asociadas con la EN, en una cohorte hipotética de 750 000 niños nacidos en Argentina entre 2006 y 2015. Se realizó una revisión sistemática para seleccionar los parámetros de entrada y utilizarlos en el modelo. Los resultados se expresaron en años de vida y costos en dólares estadounidenses (US$), con descuento y sin descuento. RESULTADOS: Los episodios de EN que se estima ocurrirían en un período de 10 años en la cohorte hipotética serían 225 MEN, 2 841 BACT, 2 628 PNEU y 2 066 719 AOM. Las secuelas crónicas de las MEN podrían causar daños neurológicos en 43 niños y trastornos auditivos graves en 28. Estos resultados indican que en esta cohorte habría 78 muertes asociadas con la EN (29% por MEN, 54% por BACT y 17% por PNEU). La esperanza de vida sin descuento estimada para los niños de la cohorte fue de 72,4 años (con descuento de 29,9 años). Los costos promedio sin descuento atribuidos a la EN por cada niño de la cohorte durante toda la vida fueron de US$167 (con descuento de US$ 151), lo que provocaría un costo total para la cohorte de más de US$126 millones (con descuento de US$ 113 millones). CONCLUSIONES: Estos resultados demuestran que la EN impone una carga sanitaria y económica significativa a la población argentina. Esta información es esencial para evaluar el posible impacto sanitario y económico de la introducción de la vacuna conjugada antineumocócica en el programa nacional de vacunación

The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection.

$\textbf{INTRODUCTION}$: The 2015 Global Meningococcal Initiative (GMI) meeting discussed the global importance of meningococcal disease (MD) and its continually changing epidemiology. $\textbf{Areas covered}$: Although recent vaccination programs have been successful in reducing incidence in many countries (e.g. $\textit{Neisseria meningitidis}$ serogroup [Men]C in Brazil, MenA in the African meningitis belt), new clones have emerged, causing outbreaks (e.g. MenW in South America, MenC in Nigeria and Niger). The importance of herd protection was highlighted, emphasizing the need for high vaccination uptake among those with the highest carriage rates, as was the need for boosters to maintain individual and herd protection following decline of immune response after primary immunization. $\textbf{Expert commentary}$: The GMI Global Recommendations for Meningococcal Disease were updated to include a recommendation to enable access to whole-genome sequencing as for surveillance, guidance on strain typing to guide use of subcapsular vaccines, and recognition of the importance of advocacy and awareness campaigns.The GMI is funded by an educational grant from Sanofi Pasteu

Varicella Seroprevalence and Molecular Epidemiology of Varicella-Zoster Virus in Argentina, 2002

There is limited data on immunity against varicella-zoster virus (VZV) in adults in different parts of Argentina, and it is not known which VZV strains are circulating in Argentina. The objectives of this study were as follows: (i) to evaluate seroprevalence of varicella among adults, assessing the accuracy of clinical history and determining the sociodemographic factors associated with seropositivity; and (ii) to determine the VZV strains circulating in Argentina. A cross-sectional serological survey enrolling 2,807 women aged 15 to 49 years attending public health-care settings in four cities in Argentina (i.e., Buenos Aires, Salta, Mendoza, and Rosario) and one rural area was conducted from August to November 2002. Specimens for identification of VZV strains were obtained from vesicular lesions from 13 pediatric patients with varicella from different areas of the country. PCR amplification was used for genotyping. The overall seroprevalence of varicella antibodies was 98.5% (95% confidence interval, 98.0 to 98.9), ranging from 97.2% in central Buenos Aires to 99.3% in southern Buenos Aires and Salta. Varicella seroprevalence increased with age. Crowding and length of residence in the same place were associated with seropositivity. The positive predictive value of varicella history for immunity to varicella was 99.4%; however, the negative predictive value was 2.5%. The European genotype was identified in all viral specimens. In Argentina, seroprevalence in women more than 15 years old was high regardless of the area of residence. Negative or uncertain varicella history was not a good predictor of immunity. VZV genotype was stable in all areas of the country

Varicella epidemiology in Latin America and the Caribbean

Introduction: The Latin American Society of Pediatric Infectious Diseases (SLIPE), with the support of the Americas Health Foundation (AHF), has developed a position paper on varicella prevention in Latin America and Caribbean countries (LAC). This article summarizes the most relevant aspects of varicella in LAC, and emphasizes the need to include the varicella vaccine in the national immunization programs in the Region and evaluate its impact disease burden. Areas covered: A systematic review was conducted of the medical evidence published and presented at various regional medical conferences on the disease burden in LAC, the advances made by prevention programs, the available vaccines in the Region, and their immunogenicity, efficacy, effectiveness, and safety. The different national varicella-prevention vaccination programs were reviewed, as was available information regarding the impact of these programs on the epidemiology of varicella in those countries implementing a varicella vaccine strategy. Following that initial publication, an update was conducted, including data from additional countries in the Region. Expert commentary: Varicella is a vaccine-preventable infectious disease, considered a ‘benign disease’ because of lower complication rates when compared with measles, pertussis. The incorporation of a two-dose varicella vaccine in national immunization schedules in all countries throughout LAC would be of great benefit to the health of the children

The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection.

International audienceThe 2015 Global Meningococcal Initiative (GMI) meeting discussed the global importance of meningococcal disease (MD) and its continually changing epidemiology. Areas covered: Although recent vaccination programs have been successful in reducing incidence in many countries (e.g. Neisseria meningitidis serogroup [Men]C in Brazil, MenA in the African meningitis belt), new clones have emerged, causing outbreaks (e.g. MenW in South America, MenC in Nigeria and Niger). The importance of herd protection was highlighted, emphasizing the need for high vaccination uptake among those with the highest carriage rates, as was the need for boosters to maintain individual and herd protection following decline of immune response after primary immunization. Expert commentary: The GMI Global Recommendations for Meningococcal Disease were updated to include a recommendation to enable access to whole-genome sequencing as for surveillance, guidance on strain typing to guide use of subcapsular vaccines, and recognition of the importance of advocacy and awareness campaigns