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Objective:To understand the reported incidence level, change of the trend, epidemic characteristics and spatial clustering of scrub typhus in Nanjing, to explore key seasons, populations and areas for prevention and control, and to guide formulation of scientific and precise prevention and control strategies and measures.Methods:The reported data of scrub typhus in Nanjing from January 1, 2011 to December 31, 2020 were collected in the "Infectious Disease Surveillance System" from Chinese Center for Disease Control and Prevention. The reported incidence level and change of the trend were analyzed, and the seasonal, population and spatial distribution characteristics were described. Global spatial autocorrelation analysis was carried out by ArcGIS 10.3 software, and the spatial clustering scanning was carried out by using FleXScan 3.1.2 software.Results:A total of 192 cases of scrub typhus were reported in Nanjing from 2011 to 2020. Median annual reported incidence was 0.21/100 000 (0.12/100 000 - 0.49/100 000). Totally 87.5% (168/192) of cases were reported from October to November, and the peak occurred in November (57.8%, 111/192). Among these cases, males accounted for 64.1% (123/192); and the median age was 59 years old (6 - 84 years old). The groups ≥60 years old and 45 - 59 years old accounted for 47.9% (92/192) and 31.2% (60/192), respectively, which accounted for 79.2% (152/192) in all groups. Farmers accounted for 43.8% (84/192), household chores and unemployed people accounted for 16.7% (32/192), retired persons accounted for 15.6% (30/192) and workers accounted for 6.8% (13/192), which accounted for 82.8% (159/192) in all occupations. The top four areas in the total number of reported cases were Jiangning District (23.4%, 45/192), Luhe District (22.9%, 44/192), Gulou District (10.4%, 20/192) and Jiangbei New Area (8.9%, 17/192), which accounted for 65.6% (126/192) in all districts. According to global spatial autocorrelation analysis, Moran's I = 0.34 ( Z = 5.90, P < 0.001). FlexScan 3.1.2 software scanned and detected two spatial clusters areas, the first-class of cluster area covered three streets in Jiangning District, one street in Yuhuatai District and two streets in Pukou District [restricted log likelihood ratio ( RLLR) = 26.91, P < 0.001]. The second-class of cluster area included six townships/streets in Luhe District and four streets in Jiangbei New Area ( RLLR = 26.48, P < 0.001). All the cluster areas were agriculture-related. Conclusions:The reported incidence level of scrub typhus in Nanjing is low and stable which belongs to a typical autumn epidemic area. The middle-aged and elderly population is the key population and the agriculture-related area is key area. It is suggested that scrub typhus should be included in the management of statutory or regional key infectious diseases in Nanjing. Additionally, training on diagnosis and treatment technology and information report management of scrub typhus need to be carried out, and comprehensive prevention and control interventions such as health education, personal protection, rodent prevention and control and vector control should be strengthened and implemented in the high incidence season.
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Objective To evaluate the cost-utility of different hepatitis E vaccination strategies in women aged 15 to 49.Methods The Markov-decision tree model was constructed to evaluate the cost-utility of three hepatitis E virus vaccination strategies.Parameters of the models were estimated on the basis of published studies and experience of experts.Both methods on sensitivity and threshold analysis were used to evaluate the uncertainties of the model.Results Compared with non-vaccination group,strategy on post-screening vaccination with rate as 100％,could save 0.10 quality-adjusted life years per capital in the women from the societal perspectives.After implementation of screening program and with the vaccination rate reaching 100％,the incremental cost utility ratio (ICUR) of vaccination appeared as 5 651.89 and 6 385.33 YuaWQALY,respectively.Vaccination post to the implementation of a screening program,the result showed better benefit than the vaccination rate of 100％.Results from the sensitivity analysis showed that both the cost of hepatitis E vaccine and the inoculation compliance rate presented significant effects.If the cost were lower than 191.56 Yuan (RMB) or the inoculation compliance rate lower than 0.23,the vaccination rate of 100％ strategy was better than the post-screening vaccination strategy,otherwise the post-screening vaccination strategy appeared the optimal strategy.Conclusion Post-screening vaccination for women aged 15 to 49 from social perspectives seemed the optimal one but it had to depend on the change of vaccine cost and the rate of inoculation compliance.
RESUMO
Objective To evaluate the cost-utility of different hepatitis E vaccination strategies in women aged 15 to 49.Methods The Markov-decision tree model was constructed to evaluate the cost-utility of three hepatitis E virus vaccination strategies.Parameters of the models were estimated on the basis of published studies and experience of experts.Both methods on sensitivity and threshold analysis were used to evaluate the uncertainties of the model.Results Compared with non-vaccination group,strategy on post-screening vaccination with rate as 100％,could save 0.10 quality-adjusted life years per capital in the women from the societal perspectives.After implementation of screening program and with the vaccination rate reaching 100％,the incremental cost utility ratio (ICUR) of vaccination appeared as 5 651.89 and 6 385.33 YuaWQALY,respectively.Vaccination post to the implementation of a screening program,the result showed better benefit than the vaccination rate of 100％.Results from the sensitivity analysis showed that both the cost of hepatitis E vaccine and the inoculation compliance rate presented significant effects.If the cost were lower than 191.56 Yuan (RMB) or the inoculation compliance rate lower than 0.23,the vaccination rate of 100％ strategy was better than the post-screening vaccination strategy,otherwise the post-screening vaccination strategy appeared the optimal strategy.Conclusion Post-screening vaccination for women aged 15 to 49 from social perspectives seemed the optimal one but it had to depend on the change of vaccine cost and the rate of inoculation compliance.