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Cost-effectiveness analysis of switching from a bivalent to a nonavalent HPV vaccination programme in China: a modelling study.
Get PDFBACKGROUND: Several domestically-manufactured nonavalent HPV vaccine candidates are in phase III clinical trials and their future availability may address the current dilemma of insufficient supply and high price of the overseas-manufactured nonavalent HPV vaccine in China. We compare the population-level effectiveness and cost-effectiveness of switching to nonavalent HPV vaccination in China.
METHODS: We used a previously validated transmission model to project the lifetime costs and effectiveness of five same-vaccine and two mixed-vaccine strategies. Nonavalent HPV vaccines were assumed to be available and meet the production requirements for national vaccination between 2030 and 2050. All women living or projected to be born in China during 2023-2100 were considered. We adopted a societal perspective and determined optimal strategies using cost-effectiveness efficiency frontiers.
FINDINGS: Under our pricing assumptions, switching to nonavalent vaccination was always cost-saving compared with maintaining the current bivalent vaccination programme, irrespective of the screening scenarios and the year when nonavalent vaccine was assumed to become available (status quo screening: net cost saving 1852-3789 million). In the same-vaccine strategies, the optimal strategy changed from "routine nonavalent HPV vaccination with catch-up to age 18" to "switching from bivalent to nonavalent HPV vaccination" if nonavalent vaccination is available after 2035. Compared with the optimal same-vaccine strategy, adopting mixed schedules with bivalent and nonavalent vaccines would further save $1336-4280 million net costs and gain 87,000-833,000 QALYs, depending on the screening scenario and the year when nonavalent vaccine becomes available.
INTERPRETATION: Switching from bivalent to nonavalent HPV vaccination is likely to be cost-saving and have a significant impact on reducing the cervical cancer burden in China.
FUNDING: Bill & Melinda Gates Foundation (INV-031449 and INV-003174) and CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-004)
Valuing an Index of Sanitation-Related Quality of Life in Urban Mozambique: A Discrete Choice Experiment.
Get PDFObjectives: A total of 1.5 billion people live without basic sanitation. A 5-attribute index of sanitation-related quality of life (SanQoL-5) has been applied in 9 countries. SanQoL-5 attributes and their levels require weighting (valuation), with the resulting index ranging from 0 to 1. To date, SanQoL-5 valuation applied simple methods such as rank sum, not robust methods such as discrete choice experiment (DCE). We aimed to value SanQoL-5 using a DCE in urban Mozambique.
Methods: We enrolled 601 adults in the cities of Maputo and Dondo, sampling women and men equally. The DCE task was a choice of which was "better" among 2 combinations of SanQoL-5 attribute levels (always, sometimes, never). Each respondent completed 10 tasks and a dominance test. After fitting a mixed logit model, we rescaled coefficients to derive the index.
Results: The highest-valued attribute was disgust ("never feel disgusted while using the toilet") at 0.25. The other attributes had similar values (ranging 0.18-0.19). People valued "sometimes" levels at approximately 60% of "never" levels. Therefore, moving from the middle level to the worst involves a larger decrement than moving from the best to the middle. Mean SanQoL-5 by toilet type followed a gradient with Sustainable Development Goal 6 categories: "open defecation" 0.30, "unimproved" 0.45, "limited" 0.60, and "at least basic" 0.70.
Conclusions: To our knowledge, this is the first DCE-based valuation of any index of sanitation-related quality of life, enabling SanQoL-5 to be used in economic evaluation. Identifying sanitation service transitions associated with the greatest quality of life gains could inform more efficient resource allocation
Impacts of discretionary universal free school meal schemes on primary school children’s education attainment and school absence: A natural experiment study in England
Get PDFDiscretionary Universal Free School Meal (UFSM) schemes for 4-11-year-olds were implemented in four local authorities with high child poverty levels in London, UK. The schemes were initiated between 2009/10 and 2014/15. The first scheme was evaluated as part of a national 2-year pilot. The present study concerns the first six years of all four schemes. In addition, we report on the longer-term effects (7+ years) for two of the schemes while the others were interrupted by COVID-19. The intention-to-treat impacts on z-score standardised attainment scores (reading, mathematics) and school absence in 10-11-year-olds were studied in a natural experiment design. We used a dynamic difference-in-differences approach with matched controls in sociodemographically similar neighbourhoods elsewhere in London. UFSM provision was on average not significantly associated with attainment nor absence during the initial six years of the schemes. However, scheme effects differed by local authority with the two longest running schemes showing positive results for reading and mathematics as secondary outcomes. Further studies are needed to better understand the mechanisms, how the schemes impact on the school environments, and how they may be improved
Protection and Containment: Surviving <scp>COVID</scp> ‐19 in Palabek Refugee Settlement, Northern Uganda
Get PDFABSTRACT
Humanitarian assistance is framed around ‘protection’. Deciding whom to protect and against what is not straightforward, particularly during a pandemic. In Uganda, policies to protect against COVID‐19 embraced containment through the reduction of movement and the securitisation of borders. Refugees in Uganda were described as particularly vulnerable to COVID‐19 and therefore in need of protection, whilst simultaneously perceived to be a health security threat. This article critically explores containment and protection by focusing on refugee self‐protection. Ethnographic research was carried out during COVID‐19 in Palabek refugee settlement in northern Uganda, amongst refugees from South Sudan. In contrast to containment policies that curtailed mobility in order to ‘protect’, research findings demonstrate that self‐protection included dynamic social boundaries around the settlement, and harnessed mobility. The latter drew on social, political, and historical borderland dynamics between (South) Sudan and Uganda. Effective social boundaries around Palabek were only created when policies of containment had legitimacy. Boundaries were circumvented when legitimacy waned and wider socio‐economic challenges, particularly regarding food insecurity, came to the fore. If humanitarians and the Ugandan government had understood the essential need to consider self‐protection, they might have paid more attention to ensuring the long‐lasting legitimacy of COVID‐19 containment policies amongst refugees
Impact of Primary Health Care Data Quality on Infectious Disease Surveillance in Brazil: Case Study.
Get PDFBACKGROUND: The increase in emerging and re-emerging infectious disease outbreaks underscores the need for robust early warning systems (EWSs) to guide mitigation and response measures. Administrative health care databases provide valuable epidemiological insights without imposing additional burdens on health services. However, these datasets are primarily collected for operational use, making data quality assessment essential to ensure an accurate interpretation of epidemiological analysis. This study focuses on the development and implementation of a data quality index (DQI) for surveillance integrated into an EWS for influenza-like illness (ILI) outbreaks using Brazil's a nationwide Primary Health Care (PHC) dataset.
OBJECTIVE: We aimed to evaluate the impact of data completeness and timeliness on the performance of an EWS for ILI outbreaks and establish optimal thresholds for a suitable DQI, thereby improving the accuracy of outbreak detection and supporting public health surveillance.
METHODS: A composite DQI was established to measure the completeness and timeliness of PHC data from the Brazilian National Information System on Primary Health Care. Completeness was defined as the proportion of weeks within an 8-week rolling window with any register of encounters. Timeliness was calculated as the interval between the date of encounter and its corresponding registry in the information system. The backfilled PHC dataset served as the gold standard to evaluate the impact of varying data quality levels from the weekly updated real-time PHC dataset on the EWS for ILI outbreaks across 5570 Brazilian municipalities from October 10, 2023, to March 10, 2024.
RESULTS: During the study period, the backfilled dataset recorded 198,335,762 ILI-related encounters, averaging 8,623,294 encounters per week. The EWS detected a median of 4 (IQR 2-5) ILI outbreak warnings per municipality using the backfilled dataset. Using the real-time dataset, 12,538 (65%) warnings were concordant with the backfilled dataset. Our analysis revealed that 100% completeness yielded 76.7% concordant warnings, while 80% timeliness resulted in at least 50% concordant warnings. These thresholds were considered optimal for a suitable DQI. Restricting the analysis to municipalities with a suitable DQI increased concordant warnings to 80.4%. A median of 71% (IQR 54%-71.9%) of municipalities met the suitable DQI threshold weekly. Municipalities with ≥60% of weeks achieving a suitable DQI demonstrated the highest concordance between backfilled and real-time datasets, with those achieving ≥80% of weeks showing 82.3% concordance.
CONCLUSIONS: Our findings highlight the critical role of data quality in improving the EWS' performance based on PHC data for detecting ILI outbreaks. The proposed framework for real-time DQI monitoring is a practical approach and can be adapted to other surveillance systems, providing insights for similar implementations. We demonstrate that optimal completeness and timeliness of data significantly impact the EWS' ability to detect ILI outbreaks. Continuous monitoring and improvement of data quality should remain a priority to strengthen the reliability and effectiveness of surveillance systems
Description of four cases of male genital schistosomiasis (MGS) in children and adolescents, with a scoping review.
Get PDFWe present four cases of male genital schistosomiasis (MGS) within children and adolescents opportunistically encountered as part of a wider screening programme for imported schistosomiasis in Germany and community outreach screening in Mali. Such genital manifestations in young children and adolescents are often overlooked but can include hydrocele, hypogonadism, varicocele, cutaneous granulomata on the penis and scrotum, echogenic spots in the prostate and the epididymis, alongside testicular masses. Though these cases appear sporadic, from our scoping literature review, they draw fresh attention on MGS in young children and highlight wider confusion with other congenital, neoplastic and infectious disease. These might include an insufficient closure of the tunica vaginalis, malignancies or lymphatic filariasis. Frequently haematuria is not present. One typical sign indicating MGS in adults, i.e. haematospermia is not present before puberty. Another reason of missing MGS cases may be that screening with scrotal or transabdominal ultrasonography are not easily accepted unless the reason for it is not extensively explained beforehand and that transabdominal ultrasonography is less sensitive for revealing prostatic lesions than transrectal ultrasonography
Identifying vaccine-hesitant subgroups in the Western Pacific using latent class analysis.
Get PDFVaccine hesitancy seriously compromised the COVID-19 vaccine roll-out across the Western Pacific with limited evidence-based recommendations for diverse populations across the region. This study investigates the profile of the vaccine-hesitant populations by using fixed-effect latent class analysis and multi-country survey data collected in 12 countries in 2021 and 2022: Cambodia, Viet Nam, Lao PDR, Japan, Republic of Korea, Malaysia, Philippines, Mongolia, Fiji, Solomon Islands, Tonga and Vanuatu. The analysis identified 9 latent classes: Stay-at-home mothers, High-school-educated employees, High-school-educated older adults, High-school-educated young adults, University-educated employees, University-educated older adults, University-educated young adults, Unemployed, Non-compliant employees. The probabilities of COVID-19 vaccine acceptance and booster uptake were significantly lower in most of these latent classes, compared to University-educated older adults, as the reference group. While each country had unique compositions of latent classes among vaccine-hesitant people, there were also some shared risk groups, such as High-school-educated employees and High-school-educated young adults, across the countries. The study findings demonstrate the benefits of subgroup analysis in unpacking the complex interplay of characteristics within vaccine-hesitant populations, highlighting the need for customised strategies tailored to each country's unique profile of vaccine hesitancy
One Health investigation of the first human rabies death linked to a clinically suspected rabid bull calf in Bangladesh.
Get PDFRabies is a fatal and neglected zoonotic disease that remains endemic in Bangladesh. Most human cases result from dog bites, and it is not uncommon for livestock to be bitten by dogs. This report presents the first known clinically diagnosed human rabies case in Bangladesh associated with exposure to infected livestock. The case involved a 65-year-old male farmer from rural Bangladesh who died of clinically diagnosed rabies after a minor, unrecognized exposure to a bull calf suspected of having rabies. The man suffered very little hand injuries while feeding the calf, which had been showing progressive neurological symptoms consistent with rabies. Despite medical advice, he did not receive post-exposure prophylaxis (PEP), largely due to negligence. Thirty-four days after the exposure, the man began to exhibit early symptoms of rabies, including limb weakness, neck and back pain, anxiety, and early signs of hydrophobia. The illness quickly progressed to the classic features of furious rabies, such as severe hydrophobia, aerophobia, confusion, and agitation. He died 41 days after the initial exposure. This case triggered fear and panic in the local community, reflecting a broader lack of awareness about rabies, particularly its transmission from non-traditional hosts like livestock. The incident highlights the severe consequences of inadequate awareness and delayed or missed PEP following potential rabies exposure. It emphasizes the urgent need to raise public awareness about all possible transmission routes, ensure timely access to PEP for both humans and animals, stray dog vaccination and strengthen public-veterinary health collaboration in Bangladesh
Non-cancer risks among female breast cancer survivors: a matched cohort study in Japan.
Get PDFBACKGROUND: The number of breast cancer (BC) survivors has increased worldwide, but the landscape of their non-cancer disease risks remains unclear, especially among Asian women. METHODS: In the JMDC claims database, which covers company employees and their family members in Japan, women aged 18-74 years with and without an incident BC were matched in a 1:4 ratio for age and entry timing to the database between January 2005 and December 2019. The risks for six cardiovascular diseases (myocardial infarction, heart failure, atrial fibrillation/flutter, ischaemic stroke, intracranial haemorrhage, and pulmonary embolism) and six non-cardiovascular diseases (major osteoporotic fractures, other fractures, gastrointestinal bleeding, urinary tract infection, infectious pneumonia, and anxiety/depression) were compared between the groups. FINDINGS: Comparing 24,017 BC survivors and 96,068 matched women (mean age, 50.5 years, standard deviation, 8.7 years), the incidence rates of heart failure, atrial fibrillation/flutter, and all non-cardiovascular diseases were higher in the BC survivor group. The highest adjusted hazard ratio (HR) was noted for heart failure (3.99 [95% confidence interval 2.58-6.16]), followed by gastrointestinal bleeding (3.55 [3.10-4.06]), and anxiety/depression (3.06 [2.86-3.28]). The HRs in the first year were larger than those for 1-10 years for most outcomes, whereas the HRs for fracture outcomes were larger for 1-10 years. INTERPRETATION: BC survivors in Japan showed an increased risk of many non-cancer diseases compared to women without BC. Most risks increased more steeply during the first year following diagnosis, whereas the risk of fractures increased later. FUNDING: Competitive research funding from Pfizer Health Research Foundation in Japan
Use of geocoding techniques for epidemiological surveillance in the Federal District, Brazil: a case study using dengue.
No full textThis study aimed to compare different address geocoding services and their applicability to epidemiological surveillance using dengue as an example. We applied a cross-sectional, descriptive study based on case notifications in the Notifiable Diseases Information System (SINAN) for the Brazilian capital in 2014 that includes complete postal code (CEP) information identified in the National Address Database for Statistical Purposes (CNEFE), which is considered the 'gold standard' for accuracy analysis. For records without CEP, georeferencing was performed through linkage of the original database with four geocoding tools: Google Maps, CNEFE, OpenStreetMap (OSM) and ArcGIS. Variables used for georeferencing were 'street name', 'code for municipality/ city of residency' and 'State' using accuracy rate estimate and mean spatial error (MSE) of case locations. The two most accurate models were used for kernel density (KD) analysis which is valuable for identifying priority areas for intervention. There were 18,206 dengue cases, 109 (0.6%) of which had correct CEP information and geocoded using CNEFE bases. The linkage results showed that Google Maps application programming interface (API) had an accuracy of 17.6% (MSE: 178.89km), CNEFE 9.0% (MSE: 17.24km), OSM 7.1% (MSE: 564.19km), and ArcGIS 3.7% (MSE: 2001.33km). Although overall accuracy values were modest, the best two models proven to be effective for KD analysis revealed similar patterns between Google Maps and CNEFE results but choosing the preferable geocoding technique should also financial resources. This study recommends the use of Google Maps API for georeferencing, followed by CNEFE