1,721,498 research outputs found
Indications for healthcare surge capacity in European countries facing an exponential increase in coronavirus disease (COVID-19) cases, March 2020
No full textEuropean healthcare systems face extreme pressure from coronavirus disease (COVID-19). We relate country-specific accumulated COVID-19 deaths (intensity approach) and active COVID-19 cases (magnitude approach) to measures of healthcare system capacity: hospital beds, healthcare workers and healthcare expenditure. Modelled by the intensity approach with a composite measure for healthcare capacity, the countries experiencing the highest pressure on 25 March 2020 - relative to Italy on 11 March - were Italy, Spain, the Netherlands and France (www.covid-hcpressure.org).This work is funded by the Epipose project from the European Union's SC1- PHE-CORONAVIRUS-2020 programme, project number 101003688.0Verelst, F (reprint author), Univ Antwerp, Vaccine & Infect Dis Inst VAXINFECTIO, CHERMID, Antwerp, Belgium.
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Determinants of COVID-19 vaccination coverage in European and Organisation for Economic Co-operation and Development (OECD) countries
No full textIntroduction In relatively wealthy countries, substantial between-country variability in COVID-19 vaccination coverage occurred. We aimed to identify influential national-level determinants of COVID-19 vaccine uptake at different COVID-19 pandemic stages in such countries.Methods We considered over 50 macro-level demographic, healthcare resource, disease burden, political, socio-economic, labor, cultural, life-style indicators as explanatory factors and coverage with at least one dose by June 2021, completed initial vaccination protocols by December 2021, and booster doses by June 2022 as outcomes. Overall, we included 61 European or Organisation for Economic Co-operation and Development (OECD) countries. We performed 100 multiple imputations correcting for missing data and partial least squares regression for each imputed dataset. Regression estimates for the original covariates were pooled over the 100 results obtained for each outcome. Specific analyses focusing only on European Union (EU) or OECD countries were also conducted.Results Higher stringency of countermeasures, and proportionately more older adults, female and urban area residents, were each strongly and consistently associated with higher vaccination rates. Surprisingly, socio-economic indicators such as gross domestic product (GDP), democracy, and education had limited explanatory power. Overall and in the OECD, greater perceived corruption related strongly to lower vaccine uptake. In the OECD, social media played a noticeable positive role. In the EU, right-wing government ideology exhibited a consistently negative association, while cultural differences had strong overall influence.Conclusion Relationships between country-level factors and COVID-19 vaccination uptake depended on immunization stage and country reference group. Important determinants include stringency, population age, gender and urbanization, corruption, government ideology and cultural context.The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study received funding from the Research Foundation Flanders (FWO project number G0D5917N) and the European Union’s Horizon 2020 research and innovation programme (Project EpiPose – project number 101003688, 2020 and Project ESCAPE – project number 101095619). The sponsors had no role in the study design;
in the collection, analysis and interpretation of data; in writing the article; and in the decision to submit it for publication. This work reflects only the authors’ views. The European Commission is not responsible for any use that may be made of the information it contains
Clustering of susceptible individuals within households can drive measles outbreaks: an individual-based model exploration
No full textWhen estimating important measures such as the herd immunity threshold, and the corresponding efforts required to eliminate measles, it is often assumed that susceptible individuals are uniformly distributed throughout populations. However, unvaccinated individuals may be clustered in a variety of ways, including by geographic location, by age, in schools, or in households. Here, we investigate to which extent different levels of within-household clustering of susceptible individuals may impact the risk and persistence of measles outbreaks. To this end, we apply an individual-based model, Stride, to a population of 600,000 individuals, using data from Flanders, Belgium. We construct a metric to estimate the level of within-household susceptibility clustering in the population. Furthermore, we compare realistic scenarios regarding the distribution of susceptible individuals within households in terms of their impact on epidemiological measures for outbreak risk and persistence. We find that higher levels of within-household clustering of susceptible individuals increase the risk, size and persistence of measles outbreaks. Ignoring within-household clustering thus leads to underestimations of required measles elimination and outbreak mitigation efforts.EK, LW and PB acknowledge support of the Antwerp Study Centre for Infectious Diseases (ASCID) at the University of Antwerp, and the Research Foundation Flanders (FWO) (research project G043815N and a postdoctoral fellowship 1234620N (LW)). NH acknowledges funding received from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement 682540-TransMID).
Acknowledgements
EK, LW and PB acknowledge support of the Antwerp Study Centre for Infectious Diseases (ASCID) at the
University of Antwerp, and the Research Foundation Flanders (FWO) (research project G043815N and a postdoctoral fellowship 1234620N (LW)). NH acknowledges funding received from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement
682540-TransMID).Kuylen, E (corresponding author), Univ Antwerp, Ctr Hlth Econ Res & Modelling Infect Dis CHERMID, Vaccine & Infect Dis Inst, Antwerp, Belgium ; Hasselt Univ, Data Sci Inst DSI, Hasselt, Belgium.
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Exploring the impact of population ageing on the spread of emerging respiratory infections and the associated burden of mortality
No full textBackgroundIncreasing life expectancy and persistently low fertility levels have led to old population age structures in most high-income countries, and population ageing is expected to continue or even accelerate in the coming decades. While older adults on average have few interactions that potentially could lead to disease transmission, their morbidity and mortality due to infectious diseases, respiratory infections in particular, remain substantial. We aim to explore how population ageing affects the future transmission dynamics and mortality burden of emerging respiratory infections.MethodsUsing longitudinal individual-level data from population registers, we model the Belgian population with evolving age and household structures, and explicitly consider long-term care facilities (LTCFs). Three scenarios are presented for the future proportion of older adults living in LTCFs. For each demographic scenario, we simulate outbreaks of SARS-CoV-2 and a novel influenza A virus in 2020, 2030, 2040 and 2050 and distinguish between household and community transmission. We estimate attack rates by age and household size/type, as well as disease-related deaths and the associated quality-adjusted life-years (QALYs) lost.ResultsAs the population is ageing, small households and LTCFs become more prevalent. Additionally, families with children become smaller (i.e. low fertility, single-parent families). The overall attack rate slightly decreases as the population is ageing, but to a larger degree for influenza than for SARS-CoV-2 due to differential age-specific attack rates. Nevertheless, the number of deaths and QALY losses per 1,000 people is increasing for both infections and at a speed influenced by the share living in LTCFs.ConclusionPopulation ageing is associated with smaller outbreaks of COVID-19 and influenza, but at the same time it is causing a substantially larger burden of mortality, even if the proportion of LTCF residents were to decrease. These relationships are influenced by age patterns in epidemiological parameters. Not only the shift in the age distribution, but also the induced changes in the household structures are important to consider when assessing the potential impact of population ageing on the transmission and burden of emerging respiratory infections.The results reported herein correspond to specifc aims of grant 682540-TransMID to investigator Niel Hens from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program
Inferring rubella outbreak risk from seroprevalence data in Belgium
No full textRubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with
high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid
future outbreaks.This work was supported by the Research Fund of Hasselt University (grant BOF11NI31 to SA). NH and PB acknowledge support from the Scientific Chair in Evidence-based Vaccinology, financed by a gift from Pfizer, and the Antwerp Study Centre for Infectious Diseases (ASCID), both at the University of Antwerp
Cost‑Efectiveness Analysis of Herpes Zoster Vaccination in 50‑ to 85‑Year‑Old Immunocompetent Belgian Cohorts: A Comparison between No Vaccination, the Adjuvanted Subunit Vaccine, and Live‑Attenuated Vaccine
No full textBackground A new adjuvanted subunit vaccine (HZ/su), with higher vaccine efficacy than live-attenuated vaccine (ZVL), has been licensed in Europe since March 2018. Therefore, Belgian decision-makers might need to re-assess their recommendations for vaccination against herpes zoster (HZ). Methods We conducted a cost-effectiveness analysis, using a Markov decision tree, of vaccinating 50- to 85-year-old immunocompetent Belgian cohorts with no vaccination, HZ/su, ZVL, and ZVL with booster after 10 years. Due to the uncertainty in vaccine waning of HZ/su vaccine beyond 4 years, we used a logarithmic and 1-minus-exponential function to model respectively a long and short duration of protection. We used a lifetime time horizon and implemented the health care payer perspective throughout the analysis. Results HZ/su had the greatest impact in avoiding health and economic burden. However, it would never become cost-effective at a willingness-to-pay threshold of euro40,000 per quality-adjusted life year (QALY) gained at its market price set by the manufacturer in the USA. Depending on the waning function assumed for HZ/su, the price per dose needs to drop 60% or 83% such that vaccination with HZ/su, assuming respectively a long or short duration of protection, would become cost-effective in 50- and 80-year-old individuals. At euro40,000 per QALY gained, ZVL or ZVL with booster was never found cost-effective compared with HZ/su, even if only administration cost was considered. Conclusion HZ/su is cost-effective in the 50-year-old age cohort at the unofficial Belgian threshold of euro40,000 per QALY gained, if its price drops to euro55.40 per dose. This result is, however, very sensitive to the assumed duration of protection of the vaccine, and the assumed severity and QALY loss associated with HZ and post-herpetic neuralgia (PHN).This work was supported in part by Research Foundation-Flanders (JB), the Methusalem financing program of the Flemish government (ZP). The funding agreements ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.
We would like to thank the colleagues from the SIMID group for their input during our monthly meetings
Optimizing influenza vaccine allocation by age using cost-effectiveness analysis: A comparison of 6720 vaccination program scenarios in children and adults in Belgium
No full textBackground: Many European countries prioritize groups for annual influenza vaccination based on risk of severe disease and death. This has resulted in relatively high influenza vaccination coverage in older adults in Belgium. However, coverage is much lower in younger adults and negligible in children. Children and young adults are known to play a major role in the transmission dynamics of influenza. Thus, an important policy question is how influenza vaccines can be optimally allocated across age groups, taking indirect effects into account. Methods: We adapted a dynamic transmission model to reproduce influenza seasonality in Belgium comparing 6720 mutually exclusive vaccination options, including current practice. Vaccination options were defined by different combinations of coverage level changes in nine age groups. We performed an economic evaluation comparing all options from a healthcare payer perspective. Quality-adjusted life-years (QALYs) were the primary health outcome. We expressed parametric uncertainty using the Incremental Net Monetary Benefits (INMB) approach. Results: Of all the vaccination options considered, over 90 % dominated the current Belgian vaccination strategy in terms of cost-effectiveness. Children were estimated to contribute a substantial indirect protective effect to the overall population. The most cost-effective program increases vaccination coverage rates for children to 90 %, 50-64 years old to 48 %, and 65-74 years old to 75 %. Discussion: Overall QALY gains can be maximized in seasonal influenza vaccination programs at acceptable costs by achieving high vaccination coverage in childhood age groups. Programmatic and ethical concerns towards such an implementation in the Belgian context need to be separately considered.This work was funded by the interdisciplinary Extraordinary Research Fund in Flanders (iBOF) DESCARTES project (reference: iBOF21-027). PB, JB and NH acknowledge funding by the Federal Healthcare Knowledge Centre (KCE) for previous work on which this study builds. NH acknowledges support by the Research Foundation Flanders (FWO) (reference G0A4624N)
Determinants of life-expectancy and disability-adjusted life years (DALYs) in European and Organisation for Economic Co-operation and Development (OECD) countries: A longitudinal analysis (1990–2019)
No full text•We relate 68 factors to population health observed in 61 countries over 30 years.•Using random forests, multiple imputation and generalized estimating equations.•GDP per capita and demographics are key; income inequality is not.•Health and social expenditure are more influential than freedom and corruption.•On the macro-level, life-style effects appear to be mediated by cultural context.This study was funded by the Research Foundation Flanders (FWO project number G0D5917N) and the European Union’s Horizon 2020 research and innovation programme (Project EpiPose – project number 101003688, 2020). The sponsors had no role in the study design; in the collection, analysis and interpretation of data; in writing the article; and in the decision to submit it for publication
Workplace influenza vaccination to reduce employee absenteeism: An economic analysis from the employers' perspective
No full textBackground: Each year, up to 10% of unvaccinated adults contracts seasonal influenza, with half of this proportion developing symptoms. As a result, employers experience significant economic losses in terms of employee absenteeism. Influenza vaccines can be instrumental in reducing this burden. Workplace vaccination is expected to reduce employee absenteeism more than linearly as a result of positive externalities. It remains unclear whether workplace influenza vaccination yields a positive return on investment. Methods: We simulated the spread of influenza in the seasons 2011-12 up to 2017-18 in Belgium by means of a compartmental transmission model. We accounted for age-specific social contact patterns and included reduced contact behavior when symptomatically infected. We simulated the impact of employer-funded influenza vaccination at the workplace and performed a cost-benefit analysis to assess the employers' return on workplace vaccination. Furthermore, we look into the cost-benefit of rewarding vaccinated employees by offering an additional day off. Results: Workplace vaccination reduced the burden of influenza both on the workplace and in the population at large. Compared to the current vaccine coverage - 21% in the population at large - an employee vaccine coverage of 90% could avert an additional 355 000 cases, of which about 150 000 in the employed population and 205 000 in the unemployed population. While seasonal influenza vaccination has been cost-saving on average at about (SIC)10 per vaccinated employee, the cost-benefit analysis was prone to between-season variability. Conclusions: Vaccinated employees can serve as a barrier to limit the spread of influenza in the population, reducing the attack rate by 78% at an employee coverage of 90%. While workplace vaccination is relatively inexpensive (due to economies of scale) and convenient, the return on investment is volatile. Government subsidies can be pivotal to encourage employers to provide vaccination at the workplace with positive externalities to society as a whole. (C) 2021 Elsevier Ltd. All rights reserved.We thank Sciensano for providing the ILI + data in order to fit our model. We are indebted to Esther Kissling and her colleagues at the I-MOVE study for providing the vaccine effectiveness data. We acknowledge support from the Antwerp Study Center for Infectious Diseases (ASCID), methusalem's VAX-IDEA and the Flemish Research Foundation (FWO, project no. G043815N and postdoctoral fellowship no. 1234620 N). NH acknowledges support from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant number 682540 - TransMID project).Verelst, F (corresponding author), Univ Antwerp, Ctr Hlth Econ Res & Modelling Infect Dis, Vaccine & Infect Dis Inst, Univ Pl 1, B-2610 Antwerp, Belgium.
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Identifying indicators of “success” in managing the COVID-19 pandemic in Europe: insights from an interdisciplinary expert consultation
No full textBackground Reflecting on what we have been through and learned during the COVID-19 pandemic can help prepare for similar challenges in the future. A quintessential question is what may indicate "success" in pandemic management. We aimed to establish a workable set of indicators for success over different distinct pandemic stages, as well as cumulatively from pandemic emergence to epidemic control. Methods First, using an iterative brainstorm and a pilot survey process, we developed a set of indicators of success for the entire pandemic (from late 2019 to date) and for six distinct COVID-19 pandemic stages: (1) pre-pandemic, (2) rising virus prevalence outside Europe, (3) rising virus prevalence in other countries or regions within Europe, (4) within-country first wave of virus, (5) subsequent virus waves pre-vaccination, (6) post-vaccination. Secondly, these indicators were validated by COVID-19 experts from different fields through an online survey. Experts were asked to rank the proposed indicators according to importance, along with answering two open-ended questions and five background questions. Results The developed indicator lists differed according to the pandemic stages. A total number of 45 experts completed the survey (29% response rate). All 50 indicators were ranked by at least 70% of the respondents as important. Notably, experts from all disciplines agreed that mortality was the most important indicator over the entire pandemic, during the first wave and subsequent waves pre-vaccination, while vaccination coverage was considered the most important indicator post-vaccination. Experts had different ranking preferences for the remaining indicators. Conclusion Reflecting on the COVID-19 pandemic, this list could serve as a valuable resource to point towards which indicators are most crucial to monitor, informing future pandemic response strategies. Meanwhile, as this study currently only relied on input from European experts, it could serve as a validation set for experts outside Europe as well as the general public
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