ABSTRACT
Objective@#To evaluate the cost-benefit and cost-effectiveness of current strategy for preventing mother-to-child transmission (PMTCT) of hepatitis B virus.@*Methods@#A decision tree model with the Markov process was developed and simulated over the lifetime of a birth cohort in Zhejiang Province in 2016. The current PMTCT strategy was compared with universal vaccination and non-vaccination. Costs were assessed from social perspective. Benefits were the savings from reduced costs associated with disease and effectiveness were measured by quality-adjusted of life-years (QALY) gained. The net present value (NPV), cost-benefit ratio (BCR) and incremental cost-effectiveness ratio (ICER) were calculated. Univariate and Probabilistic Sensitivity Analyses (PSA) were performed to assess parameter uncertainties. The parameters of costs and utilities value of hepatitis B-related disease came from the results of the field survey, which were obtained by face-to-face questionnaire survey combined with inpatient medical records, including eight county and municipal hospitals in Jinhua, Jiaxing and Taizhou. A total of 626 outpatients and 523 inpatient patients were investigated. The annual total costs of infection was calculated by combining the costs of outpatient and inpatient.@*Results@#The PMTCT strategy showed a net-gain as 38 323.78 CNY per person, with BCR as 21.10, which was higher than 36 357.80 CNY per person and 13.58 respectively of universal vaccination. Compared with universal vaccination, the PMTCT strategy would save 2 787.07 CNY per additional QALY gained for every person, indicating that PMTCT would be cost-saving. The most important parameters that could affect BCR and ICER were the vaccine coverage rate and costs of hepatitis B related diseases respectively. The PSA showed the PMTCT strategy was preferable as it would gain more QALY and save costs.@*Conclusions@#The PMTCT strategy appeared as highly cost-beneficial and highly cost-effective. High vaccination rate was a key factor of high economic value.
ABSTRACT
Objective@#To evaluate the post-marketing safety of inactivated Enterovirus type 71 (EV-A71) vaccine (human diploid cell) .@*Methods@#A total of 20 191 healthy children aged 6 to 59 months were invited to receive 2 doses of EV-A71 vaccine in Zhejiang Province from September 2016 to December 2017. Child caregivers were followed up on the 4th or 5th day after each EV-A71 vaccination, and the incidence of local, systemic, and other adverse events within 3 days after vaccination was recorded to assess vaccine safety. Describe the differences in adverse events among children with different characteristics.@*Results@#A total of 32 230 doses were observed in this study, of which 20 191 and 12 039 were vaccinated for the first and the second dose, respectively; and the incidence of adverse events within 3 days was 2.045% (413 doses) and 1.611% (194 doses), respectively. After the first and the second dose, the number of systemic adverse events was the highest, 371 and 175 cases, respectively, with an incidence of 1.837% and 1.454%, respectively; the number of local adverse events was the lowest, 14 and 2 doses, respectively, with an incidence of 0.069% and 0.017%. Local adverse events occurred after vaccination were generally mild, and only 2 patients had level of 3; among the systemic adverse events, 39 patients had a fever level of 3 or higher, accounting for 8.2% of the total fever. Most of the symptoms in the local adverse events did not require treatment, only 3 cases of vaccination site rash and 2 cases of pruritus were self-purchased drugs or outpatient treatment; except for 5 cases of fever, the other symptoms were not hospitalized in the case of systemic adverse events.@*Conclusion@#The incidence of adverse events within 3 days after vaccination with EV-A71 vaccine was low in children, mainly systemic adverse events, and the prognosis was good.
ABSTRACT
Objective To evaluate the immunogenicity and safety of a booster dose of live attenua-ted measles-mumps-rubella (MMR) vaccine for 4-year-old children and to provide references for reasonable arrangement of MMR immunization schedule. Methods Children aged 4 years (54-60 months) old were recruited and divided into three groups as follows: Group 8 months MR [receiving live attenuated measles and rubella(MR) vaccination at 8 months and MMR vaccination at 18 months],Group 8 months MMR(re-ceiving MMR vaccination at both 8 and 18 months) and Group 12 months MMR(receiving MMR vaccination at both 12 and 22 months). Active follow-up was conducted for safety evaluation after immunization of all subjects with the booster dose of MMR vaccine. Blood samples were collected before and 35 days after vacci-nation and analyzed by ELISA to detect serum antibodies to measles,mumps and rubella. Results A total of 514 subjects were enrolled in this study of safety evaluation and 469 of them received serologic detection of antibodies twice. The rate of adverse reactions following vaccination was 17.12% (general reactions accoun-ted for 94.21%) and no severe adverse reactions were reported. No significant difference in the rates of ad-verse reactions was found among the three groups (χ2=4.82, P=0.090). Subjects who were seropositive for measles, mumps and rubella increased after immunization with MMR vaccine, accounting for 100%, 99.79% and 99.79%,respectively. Geometric mean concentrations (GMC) against measles, mumps and rubella in all subjects were 1.35,3.05 and 2.13 times higher than what they were before the immunization. Levels of antibodies to measles,mumps and rubella were all increased significantly in the three groups after immunization with the booster dose of MMR vaccine (Fisher Exact Test, P=0.000). Conclusion The booster dose of MMR vaccine increases the levels of serum antibodies in children aged 4 years old with high safety. It suggests that two doses of MMR vaccine should be encouraged in the immunization program in China.
ABSTRACT
The process of globalization increases the risk of global transmission of infectious diseases,resulting in pressure for country's prevention and control of imported infectious disease.Based on the risk assessment of disease importation and local transmission,a strategy that conducting importation prevention and routine prevention and control before the importation of disease and taking emergency control measures after the importation of disease was developed.In addition,it is important to take part in global infectious disease response action,aid the countries with outbreak or epidemic to actively decrease the risk of disease importation.
ABSTRACT
Objective To investigate the epidemiological characteristics of measles outbreak caused by genotype D8 virus in Pinghu city of Zhejiang province,and provide evidence for the control of the outbreak.Methods The measles outbreak data were collected through National Measles Surveillance System.The outpatient records and admission records were checked,field investigation and outbreak response were conducted.Blood samples in acute phase and swab specimens were collected from the patients for laboratory testing,including serology test,RNA extraction and amplification,measles virus isolation and genotype identification.Software SPSS 17.0 and Excel 2016 were used for data analysis.Results A total of 10 confirmed measles cases were reported in Pinghu city,and 8 cases were aged ＞40 years.Six blood samples were collected,in which 5 were measles D8 virus positive and 1 was negative in measles virus detection.There were epidemiological links among 10 cases which occurred in a factory,a hospital and a family at the same time.There was no statistical difference in symptoms among cases caused by D8 virus and H1a virus.After the emergent measles vaccination,the measles outbreak was effectively controlled.Conclusion Untimely response due to the uneasy detection of measles cases in the early stage,nosocomial infection and weak barrier of measles immunity in adults might be the main reasons for this outbreak.Measles vaccination is effective in the prevention of measles D8 virus infection.It is necessary to strengthen measles genotype monitoring for the tracing of infection source and control of outbreaks.
ABSTRACT
The process of globalization increases the risk of global transmission of infectious diseases,resulting in pressure for country's prevention and control of imported infectious disease.Based on the risk assessment of disease importation and local transmission,a strategy that conducting importation prevention and routine prevention and control before the importation of disease and taking emergency control measures after the importation of disease was developed.In addition,it is important to take part in global infectious disease response action,aid the countries with outbreak or epidemic to actively decrease the risk of disease importation.
ABSTRACT
Objective To investigate the epidemiological characteristics of measles outbreak caused by genotype D8 virus in Pinghu city of Zhejiang province,and provide evidence for the control of the outbreak.Methods The measles outbreak data were collected through National Measles Surveillance System.The outpatient records and admission records were checked,field investigation and outbreak response were conducted.Blood samples in acute phase and swab specimens were collected from the patients for laboratory testing,including serology test,RNA extraction and amplification,measles virus isolation and genotype identification.Software SPSS 17.0 and Excel 2016 were used for data analysis.Results A total of 10 confirmed measles cases were reported in Pinghu city,and 8 cases were aged ＞40 years.Six blood samples were collected,in which 5 were measles D8 virus positive and 1 was negative in measles virus detection.There were epidemiological links among 10 cases which occurred in a factory,a hospital and a family at the same time.There was no statistical difference in symptoms among cases caused by D8 virus and H1a virus.After the emergent measles vaccination,the measles outbreak was effectively controlled.Conclusion Untimely response due to the uneasy detection of measles cases in the early stage,nosocomial infection and weak barrier of measles immunity in adults might be the main reasons for this outbreak.Measles vaccination is effective in the prevention of measles D8 virus infection.It is necessary to strengthen measles genotype monitoring for the tracing of infection source and control of outbreaks.
ABSTRACT
<p><b>OBJECTIVE</b>To determine measles antibody levels and influencing factors among children aged 6 to 15 years in Zhejiang province.</p><p><b>METHODS</b>Blood samples were collected from 2069 children aged 6 to 15 years in Changxing county (Huzhou) and Liandu district (Lishui) of Zhejiang province. Serum level of measles IgG antibody was measured using ELISA, and 800 mIU/mL was applied as the cut-off point of high antibody level. Chi-square or trend Chi-square test was used to analyze difference in positive rates of high antibody level among children with different characters, and the factors related to high antibody level in the vaccinated children were analyzed using multivariate logistic regression.</p><p><b>RESULTS</b>Among 2069 subjects, positive rate of high measles antibody level was 36.06% (746/2069). Multivariate logistic regression showed that the high measles antibody level was significantly associated with age of children and the age of first measles vaccine inoculation. The positive rate of high measles antibody level decreased with age(=0.866, 95%:0.830-0.904, <0.01), and the positive rate in children whose first vaccination at ≥ 12 months of age was higher than those whose first vaccination at 8 months of age(=0.633, 95%:0.498-0.805, <0.01).</p><p><b>CONCLUSIONS</b>In order to obtain high measles antibody level and to maintain high levels of population immune barrier, it is suggested that first dose of vaccination can be appropriately delayed in low epidemic areas, and elder children should have timely catch-up vaccination.</p>
Subject(s)
Adolescent , Child , Humans , Male , Antibodies, Viral , Enzyme-Linked Immunosorbent Assay , Immunoglobulin G , Measles , Measles Vaccine , VaccinationABSTRACT
Objective@#To assess the 3-year antibody persistence after vaccination of domestic measles, mumps and rubella combined attenuated live vaccine (MMR) with different program.@*Methods@#Children from three different vaccination strategies (Group 8 m MR: 8 months and 18 months vaccinated with measles-rubella combined attenuated live vaccine and domestic MMR,respectively; Group 8 m MMR: 8 months and 18 months both vaccinated with domestic MMR; Group 12 m MMR: 12 months and 22 months both vaccinated with domestic MMR ) were followed up in Zhejiang province in July 2015. There were 170 participants in Group 8 m MR, 171 participants in Group 8 m MMR and 173 participants in Group 12 m MMR selected by simple random sampling method .Blood samples (venous blood 2-3 ml) were collected 1 month after the first dose vaccination of MMR (only in Group 8 m MMR and Group 12 m MMR) and 3 years (36-38 months) after the last dose vaccination of MMR and tested for antibody IgG against Measles, Mumps and Rubella using ELISA. Seropostive rate and Geometric mean concentration (GMC) were calculated and compared among different groups by Chi-square test or Fisher exact test and Kruskal-Wallis H test.@*Results@#A total of 514 participants (8 m MR: 170; 8 m MMR:171; 12 m MMR:173) were enrolled. The overall seropositivity rate of measles, mumps and rubella was 98.1% (504), 93.4% (480) and 88.1% (453), respectively, with corresponding GMC was 1 012.33 mU/ml, 502.87 U/ml and 50.53 U/ml respectively. There was no significant difference of seropositivity rate for measles among three groups (all groups were>97%). The highest seropositivity rate for mumps was found in the Group 12 m MMR with the rate of 98.8% (171/173), followed by Group 8 m MMR and Group 8 m MR with 93.0% (159/171) and 88.2%(150/170) respectively (Fisher exact test, P<0.001). The highest seropositivity rate for rubella was also found in the Group 12 m MMR with the rate of 94.8% (164/173), followed by Group 8 m MMR and Group 8 m MR with 86.6%(148/171) and 82.9%(141/170) respectively (Fisher exact test, P=0.002). The highest GMC of antibody against measles, mumps and rubella were all found in Group 12 m MMR, with 1 217.30 (1 119.35-1 323.82) mU/ml, 717.07 (643.83-798.65) U/ml and 62.54(56.21-69.58) U/ml respectively. The lowest GMC of antibody against measles and mumps were both in Group 12 m MR with 812.01 (734.52-897.67) mU/ml and 363.28 (305.42-432.11) U/ml respectively. The lowest GMC of antibody against rubella was in Group 8 m MMR with 44.10 (39.08-49.76) U/ml. These differences of GMCs among three groups were all reach significant means (P<0.05).@*Conclusion@#High level seropostive rates and GMCs were exist against measles and rubella after 3-year vaccination of domestic MMR among different program. Higher antibody level against mumps were found in those children with two doses vaccination of MMR.
ABSTRACT
Objective To study the spatial-temporal dynamical features of measles in Zhejiang province.Methods Data was from the China Disease Surveillance Information System and China Immunization Program Information Management System.Power-law method on spatial-temporal-multicomponent model was used to analyze the epidemic characteristics of measles in the districts of Zhejiang province.Results The incidence of measles in Zhejiang province was 2.72/ 100 000 (1 494 cases) in 2013.Compared to the first order adjacent matrix,Power-law method showed a lower value of Akaike information criterion.The follow-up impact from the previous measles epidemic was strong to the Keqiao,Xiaoshan and Yuecheng districts with the autoregressive component as 1.39,0.88 and 0.77,respectively.Local risk of measles seemed high in Keqiao,Qujiang and Xiaoshan districts with the endemic component as 4.06,3.74 and 3.55,respectively.Impact of the epidemic to the nearby districts was large in Keqiao,Shangyu districts and Jiande city with epidemic components as 3.08,2.54 and 2.21,respectively.Conclusion The spatial-temporal feature of measles in several districts of Zhejiang province appeared heterogeneous,suggesting the specific strategies should be taken to control the epidemics of measles.