中小学校学生流感疫苗接种效果评估和卫生经济学评价

目的评估中小学校学生流感疫苗接种效果,开展疫苗接种的卫生经济学评价,为制定流感疫苗接种策略提供依据。方法采用易感者-潜伏者-显性感染者/隐性感染者-移出者/恢复者(susceptible-exposed-infectious/asymptomatic-removed/recovered,SEIARR)动力学模型对既往疫情数据进行模拟,计算累计罹患率评估疫苗接种效果,计算成本-效果和成本-效益进行卫生经济学评价。结果当流感疫苗接种率为0%、50%、70%和90%时,疫情平均累积罹患率为99.79%(99.75%,99.82%)、70.84%(70.58%,71.09%)、56.81%(56.17%,57.45%)和34.29%(32.46%,36.20%),流感疫苗接种率越高,累计罹患率越低;当疫苗接种率为50%、70%和90%时,疫苗的成本-效果比为:141.03(139.86,142.19)元、133.16(131.34,135.08)元和112.90(110.03,116.11)元,疫苗的成本-效益比为:6.27(6.22,6.32)元、6.65(6.56,6.74)元和7.88(7.66,8.09)元;流感疫苗接种率越高,疫苗的成本-效果越好,成本-效益越高。结论接种流感疫苗能有效降低疫情的累计罹患率,提高接种率能有效增加疫苗接种的卫生经济学效应。     

甲型H1N1流感暴发疫情处置的卫生经济学评价

目的 从卫生经济学角度评价南宁市2009～2011年学校甲型H1N1流感暴发疫情处置的效果和效益,探索传染病暴发疫情处置的卫生经济学评价方法.方法 采用成本-效果和成本-效益分析方法对南宁市2009～2011年学校甲型H1N1流感暴发疫情处置过程中的投人情况及相关资料进行分析.结果 通过采取疫情防控措施减少了41 899人发病,减少了35 882 303.60元的损失,效果-成本比为18.91,效益-成本比为161.93.按照疫情发生时间划分为3个阶段,不同阶段疫情处置措施的经济学效果不同,效果-成本比和效益-成本比均以第三阶段为最高,其次是第二阶段,第一阶段最低.结论 疫情处置措施的实施取得了显著的社会效益和经济效益,但是防控措施的应用应强调以科学为依据.     

一起乡镇小学乙型流感暴发疫情调查

目的调查某乡镇小学一起乙型流感暴发疫情流行特征,为制定学校传染病暴发疫情预防控制措施提供依据。方法采用描述流行病学方法对瑞安市某乡镇小学学生乙型流感发病情况进行调查分析。结果某乡镇1879名小学生中共发生44例乙型流感病例,罹患率2．34％,涉及3个班级,发病学生均未接种流感疫苗;采集10份新发病例咽拭子标本,乙型流感病毒核酸阳性率70．00％。经隔离传染源、晨检和健康教育等措施,疫情得到控制。结论加强晨检、隔离传染源和接种流感疫苗是预防控制流感暴发的重要措施。     

上海市长宁区某医院流感样病例的经济负担分析

目的了解流感样病例单次就诊的经济负担情况。方法收集长宁区某医院2010年7—12月发热门诊就诊的流感样病例资料并进行问卷调查,收集患者就医的直接费用及误工、陪护造成的间接费用。结果共调查流感样病例288人,直接经济支出57109.27元,间接经济损失达16930.00元。人均门诊支出(191.48±9.26)元,其中甲型H1N1流感病例(239.70±59.81)元,季节性流感病例(188.50±21.08)元,普通感冒病例(189.99±9.98)元,甲型H1N1流感病例花费高于季节性流感和普通感冒病例,但无统计学显著性差异(χ2=4.293,P=0.117)。结论流感样病例的就诊费用对低收入人群的经济负担重,可通过扩大流感疫苗接种人群减少发病,降低负担。     

中国 2005 — 2013年流感暴发疫情的流行病学特征分析

  目的  基于最新提出的成本效益指标净增效益值（INB）比较评价预防接种四价流感疫苗（QIV）与三价流感疫苗（TIV）的成本效益。  方法  检索中国知网数据库、万方数据知识服务平台、PubMed数据库和Web of science数据库,收集1998 年1月1日 — 2018 年8月7日公开发表的关于QIV与TIV成本效益比较的相关文献,应用Stata/SE 12.0软件进行meta分析,估计总增量净效益（TINB）。  结果  最终纳入5 篇英文文献,累计研究对象96 727 891人;meta分析结果显示,QIV与TIV比较,合并的TINB为308（95 % CI = 303～313）;在剔除权重系数较小的1个研究后合并的TINB为307（95 % CI = 302～313）,剔除前后研究的合并效益值比较接近,纳入的文献结果较为可靠。发表偏倚结果显示本研究所纳入文献可能存在发表偏倚,但因纳入的文献较少,发表偏倚的检验仍需作进一步研究。  结论  接种QIV与TIV相比更具有成本效益。     

西宁市学龄儿童接种流感疫苗效果与效益评价

目的 评价西宁市学龄儿童接种流感疫苗的效果与效益.方法 随机招募215名儿童作为接种组,接种三价流感裂解疫苗,同时选取同期进行体检的215名健康儿童(未上报已知疾病及既往史,未接种疫苗)作为对照组,除了进行基本人口信息学调查,还进行了为期1年的随访.结果 接种组和对照组儿童的人口信息学特征差异无统计学意义,具有可比性(...     

江苏省流感和流感样病例暴发疫情流行病学分析

目的:摸清江苏省流感或流感样病例暴发的特征。方法:对流感或流感样病例暴发的时间、地区、人群和暴发规模以及实验室检测的情况进行描述。结果:2004年4月~2007年3月度全省共报告流感或流感样病例暴发61起,累计发病8116人,2005年流感暴发强度大。所有事件发生在每年的12月份至次年4月份。农村地区的暴发起数与发病数均高于城市,暴发事件全部发生在学校。发病数在50人以上的暴发占86.89%。2004年~2006年度,暴发事件采样检测率达95.08%,3年来,H3N2、B、H3N2型先后成为优势循环株。结论:江苏省流感暴发具有明显的季节性,循环优势株变化频繁,应及时加强对流感暴发疫情的监测。     

2006年广州市145起流感样病例暴发疫情分析

目的了解广州市流感样病例暴发流行及毒株变异情况,分析流行特征以及所采取的防制措施,为控制暴发提供科学依据。方法对流感样病例暴发疫情进行现场调查分析,采集流感样病例咽拭子标本进行病毒分离与鉴定。结果2006年广州市报告疑似流感暴发疫情145起,波及全市12个区县,报告流感样病例5 350例,罹患率介于0.40%～16.97%。疫情主要发生在3-4月,共发生126起,占总数的86.90%,全部暴发疫情均发生在学校。进行标本采集的124起疫情中72起分离出流感病毒,其中BV型51起,H1N1型13起,未分型8起。结论广州市局部地区存在流感的暴发流行,流行优势毒株为BV型,未发现流行毒株变异情况;针对目前流行特点,应加强学校流感监测。     

2003-2007年广州市流感样病例暴发疫情分析

目的 了解广州市流感样病例暴发流行及毒株变异情况,分析流行特征及影响因素,为防控策略的制定提供科学依据.方法 对2003-2007年广州市流感样病例暴发疫情进行流行病学分析.结果 2003-2007年广州市共报告流感样病例暴发疫情371起,波及全市12个区(市),累计发病13 290例,罹患率介于0.40%～34.27%之间.疫情主要发生在3-6月(占92.45%),学校累计报告353起,占95.15%.371起流感样病例暴发疫情中有223起(占60.11%)最终被确认为流感暴发,其中H3N2型138起(占61.88%).首例发病到信息报告时间与整个事件持续时间Pearson相关系数为0.562,P<0.01.结论 3-6月是广州市流感样病例暴发疫情的高发季节,以局部暴发为主要特征,流行毒株以H3N2型为主,学校是高发场所.加强疾病监测,落实防控措施,积极开展健康教育,及早报告有利于疫情及时控制.     

Economic burden of seasonal influenza in the United States

BackgroundSeasonal influenza is responsible for a large disease and economic burden. Despite the expanding recommendation of influenza vaccination, influenza has continued to be a major public health concern in the United States (U.S.). To evaluate influenza prevention strategies it is important that policy makers have current estimates of the economic burden of influenza.ObjectiveTo provide an updated estimate of the average annual economic burden of seasonal influenza in the U.S. population in the presence of vaccination efforts.MethodsWe evaluated estimates of age-specific influenza-attributable outcomes (ill-non medically attended, office-based outpatient visit, emergency department visits, hospitalizations and death) and associated productivity loss. Health outcome rates were applied to the 2015 U.S. population and multiplied by the relevant estimated unit costs for each outcome. We evaluated both direct healthcare costs and indirect costs (absenteeism from paid employment) reporting results from both a healthcare system and societal perspective. Results were presented in five age groups (<5 years, 5–17 years, 18–49 years, 50–64 years and ≥65 years of age).ResultsThe estimated average annual total economic burden of influenza to the healthcare system and society was $11.2 billion ($6.3–$25.3 billion). Direct medical costs were estimated to be $3.2 billion ($1.5–$11.7 billion) and indirect costs $8.0 billion ($4.8–$13.6 billion). These total costs were based on the estimated average numbers of (1) ill-non medically attended patients (21.6 million), (2) office-based outpatient visits (3.7 million), (3) emergency department visit (0.65 million) (4) hospitalizations (247.0 thousand), (5) deaths (36.3 thousand) and (6) days of productivity lost (20.1 million).ConclusionsThis study provides an updated estimate of the total economic burden of influenza in the U.S. Although we found a lower total cost than previously estimated, our results confirm that influenza is responsible for a substantial economic burden in the U.S.     

2017—2018年南昌市城区流感病例经济负担和影响因素分析

目的 调查南昌市城区流感病例的经济负担,分析其影响因素,为制定传染病防控策略提供依据。 方法 将分层整群抽样抽取的南昌市城区6个街道2017—2018年报告的141例流感确诊病例作为调查对象,通过回顾性调查,收集其直接经济负担和间接经济负担数据,采用Spearman秩相关和logistic回归模型,对流感病例经济负担的影响因素进行分析。 结果 南昌城区流感门诊病例和住院病例平均经济负担分别为946元和8561元。直接医疗费用、直接非医疗费用和间接经济负担分别占门诊病例的经济负担的48.11%、18.20%和33.68%,直接医疗费用、直接非医疗费用分别和间接经济负担分别占住院病例的经济负担的76.74%、15.78%和7.48%。病例年龄在5岁以下（OR=4.662, 95%CI=1.295~16.785）和60岁及以上（OR=9.171, 95%CI=1.353~62.173）、延误抗病毒治疗（OR=3.957, 95%CI=1.989~7.871）为流感病例直接经济负担增高的危险因素,病例年龄在5岁以下（OR=17.453, 95%CI=4.485~67.918）和60岁及以上（OR=16.844, 95%CI=2.884~98.395）为流感病例间接经济负担增高的危险因素,流感疫苗接种既是流感病例直接经济负担增高的保护性因素（OR=0.119, 95%CI=0.026~0.539）,也是间接经济负担增高的保护性因素（OR=0.224, 95%CI=0.067~0.746）,P均<0.05。 结论 应将5岁以下儿童、60岁以上老年人作为流感防控的重点人群,促进公众接种流感疫苗,引导流感病例及早就医接受抗病毒治疗,以降低流感给病例造成的经济损失。     

苏州市2011-2017年5岁以下儿童流感门诊病例临床特征及疾病负担

目的 了解2011-2017年苏州大学附属儿童医院<5岁儿童流感样病例（ILI）临床特征及疾病负担。方法 2011年3月至2017年2月于苏州市儿童医院监测因流感样疾病就诊的<5岁门诊病例,通过问卷调查和电话随访收集人口学信息、临床信息、疾病史及与医疗有关的直接和间接费用,比较ILI及不同流感亚型确诊病例的临床特征和社会经济负担。结果 共纳入6 310例,其中791例（12.9%）流感病毒检测阳性,其中A/H1N1阳性88例（11.1%）,A/H3N2阳性288例（36.4%）,B型415例（52.5%）。流感阳性儿童发生咳嗽、流涕、喘息、呕吐、抽搐的比例皆高;A/H1N1、A/H3N2、B型感染导致临床特征的主要差异为咳嗽（χ²=9.227,P=0.010）、喘息（χ²=7.273,P=0.026）和呕吐（χ²=8.163,P=0.017）。流感病毒阴性者治疗平均费用688.4（95%CI：630.1~746.7）元,流感病毒阳性者为768.0（95%CI：686.8~849.3）元。A/H1N1阳性者治疗总费用明显高于A/H3N2阳性和B型阳性者（χ²=7.237,P=0.028）。结论 儿童感染流感病毒更易发生咳嗽、流涕、喘息、呕吐、抽搐等临床症状,并造成严重的疾病负担,其中A/H1N1亚型感染造成的疾病负担高于其他2种亚型。     

流感大流行的疾病负担和经济影响研究进展

甲型流感病毒常以流行形式出现,能引起世界性流感大流行。流感大流行是指当甲型流感病毒出现新亚型或旧亚型重现,人群普遍缺乏相应免疫力,病毒在人群中快速传播,从而引起流感在全球范围的广泛流行。历史上每次流感大流行都给人类健康和社会经济带来灾难性打击。     

上海市关节炎疾病经济负担评价

目的：明确上海市关节炎疾病经济负担以及关节炎产生影响的相关费用。方法：病例对照研究，采用方差分析比较关节炎患者与对照的疾病经济负担。结果：上海市15岁及以上人群中，关节炎的年疾病经济负担为41．93亿元。总的疾病费用中，关节炎患者的门诊花费、门诊等候时间折合费用显著高于对照。结论：关节炎主要对门诊费用产生影响，还加重关节炎患者伴随慢性病的经济负担。     

流感在老年人、慢性基础性疾病患者和医务人员的疾病负担与疫苗预防

流行性感冒（简称流感）是由流感病毒引起的呼吸道传染病,主要造成鼻、喉、支气管及肺部感染,其传播迅速,很容易藉由咳嗽或喷嚏造成飞沫传染。大多数的健康成人在感染后的1~2个星期便能自行恢复。然而,对老年人和慢性基础性疾病患者而言,感染流感病毒可能会导致住院甚至死亡。每年定期接种流感疫苗是目前已知预防流感最好的方式。本文旨在对流感高危人群的疾病负担及疫苗预防做一描述。     

A preliminary study into the economic burden of cerebral palsy in China

OBJECTIVES: To measure the economic burden of cerebral palsy (CP) in China is to provide information on CP's societal impacts to policy-makers. METHODS: The economic burden of CP includes direct healthcare costs, direct non-healthcare costs, developmental costs and indirect costs such as productivity loss. The incidence approach is employed to estimate the lifetime economic burden of a new CP birth and that of all new cases in China in 2003. Caregivers of 319 CP patients were interviewed in specialty hospitals in five cities in 2004. Average expenditure and utilization rates for different services by age groups from this sample were obtained to estimate the economic burden of CP. Chinese CP patients' life expectancy and survival rate were simulated with reference to Australian data with Human Development Index adjustment. RESULTS: From the societal perspective, the average lifetime economic burden of a new CP case in China was US$ 67,044 in 2003, and the life-span total economic loss due to all new CP cases in 2003 amounted to US$ 2-4 billion. Indirect (productivity) costs are responsible for 93% of total economic loss, and direct healthcare and developmental costs make up 3% each. There are several factors which contribute to the extraordinarily high economic burden of CP, including productivity loss, reduced life expectancy, dependency, progressive deterioration of motor physical function, and recurrent use of rehabilitation services. CONCLUSION: The economic burden of CP in China is substantial for the family of a CP patient, as well as to society. Public provision and financing of necessary preventive and rehabilitative services is urgently needed to mitigate this heavy burden for patients and their families.     

A systematic review of the social and economic burden of influenza in low- and middle-income countries

ObjectivesThe economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development.MethodsWe conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950–2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza.ResultsWe included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows.ConclusionThe economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components.     

Comparative immunogenicity evaluations of influenza A virus M2 peptide as recombinant virus like particle or conjugate vaccines in mice and monkeys

Immunization against M2 peptide, also called M2e, from influenza A virus is an innovative vaccine approach for induction of cross-strain protective immunity. Two promising M2 vaccine compositions reported to date are M2 peptide chemically conjugated to carrier proteins or M2 peptide recombinantly expressed on the surface of virus like particles (VLPs) of hepatitis B virus core antigen (HBVc). To conduct a head-to-head comparison of these approaches, we constructed two recombinant HBVc VLPs expressing M2 peptide and prepared two conjugate vaccines with M2 peptide chemically coupled to Neisseria meningitidis outer membrane complex (OMPC) or HBVc VLP, respectively. Here, we showed superior immunogenicity of M2 peptide conjugated to OMPC and M2 peptide expressed on the surface of HBVc antigen based on dose–titration responses in mice. Surprisingly, HBVc expressing M2 peptide was an inferior vaccine in rhesus monkeys, whether as a primary vaccine or as a booster vaccine, when compared with M2-OMPC conjugate vaccine.     

Economic burden of influenza illness among children under 5 years in Suzhou,China: Report from the cost surveys during 2011/12 to 2016/17 influenza seasons

BackgroundData are limited on the economic burden of seasonal influenza in China. We estimated the cost due to influenza illness among children < 5-year-old in Suzhou, China.MethodsThis study adopted a societal perspective to estimate direct medical cost, direct non-medical cost, and indirect cost related to lost productivity. Data to calculate costs and rates of three influenza illness outcomes (non-medically attended, outpatient and hospitalization) were collected from prospective community-based cohort studies and hospital-based enhanced laboratory-confirmed influenza surveillance in Suzhou during the 2011/12 to 2016/17 influenza seasons. We used mean cost-per-episode, annual incidence rates of episodes of each outcome, and annual population size to estimate the total annual economic burden of influenza illnesses among children < 5-year-old for Suzhou. All costs were reported in 2017 U.S. dollars.ResultsThe mean cost-per-episode (standard deviation) was $9.92 (13.26) for non-medically attended influenza, $161.05 (176.98) for influenza outpatient illnesses, and $1425.95 (603.59) for influenza hospitalizations. By applying the annual incidence rates to the population size, we estimated an annual total of 4,919 episodes of non-medically attended influenza, 21,994 influenza outpatient, and 2,633 influenza hospitalization. Total annual economic burden of influenza to society among children < 5-year-old in Suzhou was $7.37 (95% confidence interval, 6.9–7.8) million, with estimated costs for non-medically attended influenza of $49,000 (46,000–52,000), influenza outpatients $3.5 (3.3–3.8) million, and influenza hospitalizations $3.8 (3.6–3.9) million. Among outpatients, the indirect cost was 36.3% ($1.3 million) of total economic burden, accounting for 21,994 days of lost productivity annually. Among inpatients, the indirect cost was 22.1% ($829,000), accounting for 18,431 days of lost productivity annually.ConclusionsOur findings show that influenza in children < 5-year-oldcauses substantial societal economic burden in Suzhou, China. Assessing the potential economic benefit of increasing influenza vaccination coverage in this population is warranted.