The psychology of unbelief

xx, 67 p.; 19 cm

Psychiatrie. Door I. Inleiding

xvi, 374 p.; 23 cm

Influenza bij kinderen.

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Influenza bij kinderen.

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Pneumococcal vaccines: an update on current strategies.

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Combination vaccine against invasive meningococcal B and pneumococcal infections - Potential epidemiological and economic impact in The Netherlands

Background: Streptococcus pneumoniae and Neisseria meningitidis group B are among the main causes of invasive bacterial meningitis infections in infants. Worldwide, these diseases lead to significant mortality, morbidity and costs. The societal impact is especially severe since the majority of cases occur in very young infants. A combination vaccine consisting of 9-valent conjugated pneumococcal and meningococcal B components is currently being developed. The aim of this study was to estimate the potential impact and cost effectiveness from the societal perspective of vaccinating infants in The Netherlands with this combination pneumococcal and meningococcal B vaccine versus no vaccination. Methods: A Markov cycle model was developed using epidemiological and healthcare resource use data from 1996 to 2001. This model was used to project the annual costs, benefits and health gains associated with vaccinating all newborns. The base year for the costing was 2003 and all costs and health effects were discounted at 4%. The results of the analysis are expressed in costs per QALY and both probabilistic and univariate sensitivity analyses were used to identify the robustness of the results. Results: Annually, an average of 755 cases of invasive pneumococcal and meningococcal B infection occurred in infants aged 0-10 years in The Netherlands. Introduction of the combination vaccine would prevent 201 cases of meningococcal B meningitis and 165 cases of invasive pneumococcal disease per year. Additionally, 3410 cases of pneumococcal pneumonia and 46 350 cases of otitis media would be prevented. Vaccination would save 35 lives per year and prevent 71 cases of severe sequelae. This translates into 860 life-years gained, or 1128 QALYs gained. Alongside these health gains, vaccination would prevent E 17 681 370 of direct medical and indirect costs attributable to meningococcal and pneumococcal infections in The Netherlands. Depending on vaccine price, cost effectiveness varied from EURO3160 (vaccine price per dose EURO20) to EURO32 170 (vaccine price EURO60 per dose) per QALY. Base-case cost effectiveness (vaccine price 4640) was EURO17 700 per QALY. The model was most sensitive to changes in incidence, vaccine price and duration of protective efficacy. Conclusion: Our results suggest that the introduction of a combination meningococcal B and pneumococcal vaccine into the Dutch infant vaccination programme is potentially cost effective compared with no vaccination

No epidemiological evidence gor infant vaccination to cause allergic disease.

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Reactogenicity of acellular pertussis vaccine in four-year-olds in the Netherlands.

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Primary vaccination of adults with reduced antigen-content diphtheria-tetanus-acellular pertussis or dTpa-inactivated poliovirus vaccines compared to diphtheria-tetanus-toxoid vaccines.

Item does not contain fulltextOBJECTIVE: To evaluate immunogenicity and reactogenicity of primary vaccination with reduced-antigen-content diphtheria-tetanus-acellular pertussis (dTpa) or dTpa-inactivated poliovirus (dTpa-IPV) vaccine compared to diphtheria-tetanus-toxoid vaccines (Td) in adults > or = 40 years of age without diphtheria or tetanus vaccination for 20 years or with an unknown vaccination history. RESEARCH DESIGN AND METHODS: Double-blind, randomized, controlled clinical trial. Primary vaccination with either three doses of dTpa, one dose of dTpa-IPV followed by two doses of Td, or three doses of Td vaccine (control) administered in a 0-1-6-month schedule. MAIN OUTCOME MEASURES: Blood samples were collected before commencement and 1 month after each dose. Local and general symptoms were solicited for 15 days after each dose. RESULTS: A total of 460 adults were enrolled, of whom over 48% did not have protective antibody concentrations against diphtheria and tetanus. One month after dose 3 > 99% had seroprotective anti-diphtheria and tetanus antibodies. Three doses were required to maximize anti-diphtheria seroprotection rates. A vaccine response to pertussis antigens was observed in > 92% of dTpa and dTpa-IPV recipients after dose 1. One month after dTpa-IPV, > 98.4% had seroprotective anti-polio titres. No statistically significant differences in local or general symptoms between groups were observed. CONCLUSIONS: dTpa and dTpa-IPV can provide primary vaccination of adults. Combinations of dTpa or dTpa-IPV can be used to replace Td and provide booster vaccination against pertussis and polio simultaneously with diphtheria and tetanus, even in situations where the primary vaccination history is unknown

Do costs of varicella justify routine infant vaccination? Pharmacoeconomic and clinical considerations.

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