Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model

Objectives Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. Design Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. Setting National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. Participants Hypothetical cohorts of people aged 12 months and 65-years at baseline. Interventions Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies. Main outcome measures Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). Results It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million. Conclusions The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective–the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.

COVID-19 vaccination acceptability in the UK at the start of the vaccination programme: a nationally representative cross-sectional survey (CoVAccS wave 2)

Aim: To investigate factors associated with intention to have the COVID-19 vaccination following initiation of the UK national vaccination programme. Methods: 1,500 adults completed an online cross-sectional survey (13th to 15th January 2021). Linear regression analyses were used to investigate associations between intention to be vaccinated for COVID-19 and sociodemographic factors, previous influenza vaccination, attitudes and beliefs about COVID-19, attitudes and beliefs about COVID-19 vaccination and vaccination in general. Participants main reasons for likely vaccination uptake/decline were also solicited. Results: 73.5% of participants (95% CI 71.2%, 75.7%) reported being likely to be vaccinated against COVID-19, 17.3% were unsure (95% CI 15.4%, 19.3%), and 9.3% (95% CI 7.9%, 10.8%) reported being unlikely to be vaccinated. The full regression model explained 69.8% of the variance in intention. Intention was associated with having been/intending to be vaccinated for influenza last winter/this winter, and with stronger beliefs about social acceptability of a COVID-19 vaccine; the need for vaccination; adequacy of information about the vaccine; and weaker beliefs that the vaccine is unsafe. Beliefs that only those at serious risk of illness should be vaccinated and that the vaccines are just a means for manufacturers to make money were negatively associated with vaccination intention. Conclusions: Most participants reported being likely to get the COVID-19 vaccination. COVID-19 vaccination attitudes and beliefs are a crucial factor underpinning vaccine intention. Continued engagement with the public with a focus on the importance and safety of vaccination is recommended.

Mexico’s vaccination plan faces significant challenges

Significance A national vaccination programme revealed on December 8 aims to cover 75% of over-16s within 18 months. Pfizer, whose vaccine is being administered, will supply 34.4 million doses in total. The government has also reached agreements with other suppliers: the World Health Organisation’s Covax vaccine alliance (51.5 million doses), AstraZeneca (77.4 million) and CanSino Biologics (35 million). Impacts Demand for hospital beds in Mexico City looks set to exceed supply in the coming weeks, despite renewed restrictions on activities. With no suggestion of increased government support to mitigate the pandemic’s economic impacts, joblessness and poverty will increase. Claims that the federal government is controlling vaccination for political reasons will increase ahead of this year’s mid-term elections. The arrival or emergence of new virus strains could greatly exacerbate contagion rates, seeing infections far outstrip vaccinations.

Pneumococcal and meningococcal vaccines - A significant reduction of pediatric admissions and deaths

Background Mortality rates associated with paediatric inpatient stays in mainland Portuguese Hospitals have decreased approximately 50%, between 2000 and 2016, despite the majority of deaths occurring in hospitals. During this timeframe meningococcal and pneumococcal vaccines were introduced in the National Vaccination Programme (NVP). In this study, the authors analyzed admission and mortality rates associated with vaccine preventable diseases such as pneumococcal and meningococcal disease. Methods A sequential cross-sectional retrospective study was performed, from 2000 and 2016, to assess the hospitalizations for meningitis, sepsis and pneumonia of children and adolescents at the SNS (National Health Service) hospitals in mainland Portugal. An administrative Portuguese database that contains all the public hospital admissions to mainland Portugal hospitals was utilized and diagnoses were coded per ICD9. National Institute Of Statistics (INE) data was accessed as reference. All admissions of individuals 17 years old and younger were analysed. Results A 10-fold reduction of admissions and deaths for pneumococcal pneumonia and a 3-fold reduction of meningococcal sepsis were observed after the introduction of the antipneumococcal and antimeningococcal vaccine in the NVP, respectively. Conclusions These results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children and can provide evidence to educate the public towards vaccination. Key messages The results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children. The results show a 10x reduction in pneumococcal pneumonia hospital admission and deaths and a 3x in meningococcal meningitis.

Ocena wiedzy studentów kierunków medycznych na temat szczepień dla dzieci

Introduction. Vaccinations are the most important element in the prevention of infectious diseases. Parents’ decisions about vaccinations, including especially non-obligatory (recommended) ones, are influenced by the knowledge and opinions provided by medical personnel. Aim. The aim of the study was to assess the knowledge of students of the medical university about vaccines for children, with special regard to recommended vaccinations. Material and methods. The study was conducted from January to April 2017 among 116 students of the Medical University of Warsaw. The research method used in the work was a diagnostic survey. The author’s questionnaire was used as a research tool. Results. Based on answers provided by the respondents, their attitude, knowledge and evaluation of information provided during university education on vaccination were analyzed with particular emphasis on vaccinations recommended for children. Classes conducted during studies and/or scientific literature according to respondents provide the most reliable knowledge about recommended vaccinations (59%). Respondents agreed that the knowledge provided in the course of vaccinations on recommended vaccinations is insufficient (85%) and this material should be broadened. The lack of providing the latest vaccination guidelines was statistically significantly more often declared in the direction of Nursing, while Midwifery students were the best-rated education group about vaccinations received during the course of studies and had the best knowledge about recommended vaccinations for children. Importantly, students declaring sufficient knowledge about vaccination and at the same time lack of trust in vaccination and reluctance to vaccinate their own children, answered incorrectly the questions regarding the recommended vaccinations. Conclusions. It is necessary to broaden education about vaccinations at medical studies so that medical doctors, nurses, and midwives can shape correct attitudes towards immunization in parents group. In the medical university course of education, particular attention should be paid to the need to update information in the field of vaccinology with the annual National Vaccination Programme and with the guidelines of National Consultants.

The erosion of public sector vaccine production: the case of the Netherlands

A century ago, state institutes of public health played an important role in the production of sera and vaccines. In The Netherlands and the Scandinavian countries they continued to do so until after World War II. Focusing in particular on The Netherlands, this chapter examines their withdrawal from vaccine production in the past 20 years. In the 1980s the Dutch government was still committed to maintaining the state’s ability to produce the vaccines needed by the national vaccination programme. A series of legal and institutional changes sought to protect the public sector vaccine producer against the threat of privatisation. These changes ultimately proved inadequate. Not only was the Institute’s ability to meet demand for new vaccines being eroded by global developments, but policy makers were increasingly convinced that vaccination practices should be harmonised with those of other European countries. The decision to sell off the Dutch state’s vaccine production facilities, taken in 2009, has to be understood in historical context. It was the outcome of globalisation processes that for two decades had worked simultaneously on both the supply and the demand sides