ABSTRACT
BACKGROUND: Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. METHODS: The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. RESULTS: The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. CONCLUSION: Compared to no vaccination, routine vaccination against rotavirus in Argentina would be highly cost-effective with either vaccine. Health and economic benefits would be higher in the Northeast and Northwest regions, where the intervention would even be cost-saving.
Subject(s)
Rotavirus Infections/economics , Rotavirus Infections/prevention & control , Rotavirus Vaccines/economics , Rotavirus Vaccines/immunology , Vaccination/economics , Argentina/epidemiology , Child, Preschool , Cost-Benefit Analysis , Diarrhea/economics , Diarrhea/epidemiology , Diarrhea/mortality , Diarrhea/prevention & control , Health Policy , Humans , Immunization Programs , Infant , Infant, Newborn , Models, Statistical , Rotavirus Infections/epidemiology , Rotavirus Infections/mortality , Rotavirus Vaccines/administration & dosage , Vaccination/methods , Vaccines, Attenuated/administration & dosage , Vaccines, Attenuated/economics , Vaccines, Attenuated/immunologyABSTRACT
As a consequence of YF outbreaks that hit Brazil, Argentina, and Paraguay in 2008-2009, a significant demand for YF vaccination was subsequently observed in Argentina, a country where the usual vaccine recommendations are restricted to provinces that border Brazil, Paraguay, and Bolivia. The goal of this paper is to describe the adverse events following immunization (AEFI) against YF in Argentina during the outbreak in the northeastern province of Misiones, which occurred from January 2008 to January 2009. During this time, a total of nine cases were reported, almost two million doses of vaccine were administered, and a total of 165 AEFI were reported from different provinces. Case study analyses were performed using two AEFI classifications. Forty-nine events were classified as related to the YF vaccine (24 serious and 1 fatal case), and 12 events were classified as inconclusive. As the use of the YF 17D vaccine can be a challenge to health systems of countries with different endemicity patterns, a careful clinical and epidemiological evaluation should be performed before its prescription to minimize serious adverse events.
Subject(s)
Vaccination/adverse effects , Yellow Fever Vaccine/adverse effects , Adolescent , Adult , Adverse Drug Reaction Reporting Systems/statistics & numerical data , Aged , Aged, 80 and over , Argentina , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: After a country wide outbreak occurred during 2003-2004, 1 dose of hepatitis A vaccine was introduced into Argentinian regular immunization schedule for all children aged 12 months in June 2005. The aim of this study was to assess the impact of this novel intervention. METHODS: A longitudinal analysis was done of hepatitis A virus (HAV) infection rates reported to the National Epidemiological Surveillance System from 2000 to 2011. Occurrence of fulminant hepatic failure (FHF) and liver transplantation cases up to 2011 were also assessed. Incidence rates and clinical impact were compared between pre- and postvaccination periods (2000-2002 vs. 2006-2011). Notification rates were also compared by age groups and geographical regions. RESULTS: Since 2006, an abrupt decline was observed in HAV infection rates, as well as in FHF and liver transplantation cases. The mean incidence rate of 7.9/100,000 in the postvaccination period represents a reduction of 88.1% (P < 0.001) when compared with the prevaccination period. Neither FHF nor liver transplantation due to HAV infection were observed since March 2007. Decline in incidence rates was evident in all geographical regions and all age groups but was higher in the prevaccination most affected areas and in young children. Although an absolute decrease was observed for cases and rates in all age groups, since 2006, a higher proportion of cases was observed in people >14 years of age. CONCLUSIONS: The single-dose vaccination strategy has been highly effective for controlling HAV infection in all age groups till now in Argentina. Long-term surveillance will be critical to document the sustained success of this unique intervention.
Subject(s)
Hepatitis A Vaccines/administration & dosage , Hepatitis A/epidemiology , Hepatitis A/prevention & control , Adolescent , Adult , Argentina/epidemiology , Child , Child, Preschool , Humans , Incidence , Infant , Longitudinal Studies , Middle Aged , Young AdultABSTRACT
OBJECTIVE: Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule. METHODOLOGY: The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization's ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3+1 (three doses+booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines. RESULTS: Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate. CONCLUSION: Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system.
Subject(s)
Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/economics , Pneumococcal Vaccines/immunology , Argentina/epidemiology , Child, Preschool , Cost-Benefit Analysis , Humans , Infant , Infant, Newborn , Models, Statistical , Pneumococcal Infections/economicsABSTRACT
En 2003, la tasa de mortalidad infantil (TMI) de la provincia de Tucumán era una de las más altas del país. En 2004 se implementaron dos estrategias para reducirla: el fortalecimiento del primer nivel de atención y la optimización de los servicios neonatales de alta complejidad. OBJETIVO: evaluar el impacto sobre la mortalidad infantil de estas estrategias luego de 4 años de implementación. MÉTODO: se comparó la evolución de tres indicadores entre 2003 y 2007 y entre cuatrienios 2000-03 y 2004-07: 1) Proporción de recién nacidos por intervalo de peso del total de nacidos vivos en el periodo, para evaluar las mejoras del control prenatal; 2) Cambios en la tasa de mortalidad posneonatal, para estimar el efecto del fortalecimiento del control del niño sano; y 3) Proporción de niños fallecidos por intervalo de peso al nacer del total de nacidos vivos en ese intervalo y periodo, para medir el efecto de las mejoras de los servicios neonatales de alta complejidad. El análisis estadístico se realizó con χ2 y regresión segmentada. RESULTADOS: La proporción de neonatos con menos de 1.500 g descendió de 1,33 por ciento en 2003 a 1,26 en 2007 (p = 0,44; OR preintervención =1,02; OR postintervención = 0,93). La tasa de mortalidad posneonatal se redujo de 6,4 en 2003 a 3,8 en 2007. La proporción de niños fallecidos en el intervalo de peso de menos de 1.500 g bajó de 91,30 por ciento en 2003 a 46,40 por ciento en 2007 (p =0,00). En 2003, la tasa de mortalidad infantil fue de 22,9 , en 2007 fue 12,9 . CONCLUSIÓN: Ambas estrategias tuvieron resultados positivos según el objetivo buscado, aunque la mejora de los servicios neonatales de alta complejidad mostró un impacto más significativo.
In 2003, the infant mortality rate in Tucuman was one of the high est in the country. In 2004, two strategies were implemented in order to reduce it: Strengthening the first level of care and optimization of tertiaryneonatal care. OBJECTIVE: To evaluate the impact on the infant mortality of both strategies after 4 years of implementation. METHOD: The changes of three indicators were compared between 2003 and 2007 and by 4-years periods 2000-03 and 2004-07: 1) Proportion of newborns by birthweigh interval of total live births in the period in order to assess the strengthening of prenatal controls; 2) Changes in post-neonatal mortality rate, to estimate the effect of strengthening the healthy child controls; 3) Proportion of child deaths by birthweightinterval of total live births in that interval in the period to measure the effect of improving the high complexity neonatal care services. The statistical analysis was performed with x2 and segmented regression. RESULTS:The proportion of infants with less than 1,500 g fell from 1.33 percent in 2003 to 1.26 percent in 2007 (p = 0.44). The posneonatal mortality rate fell from 6.4 in 2003 to 3.8 in 2007. The proportion of dead children in the range of less than 1,500 g was reduced from 91.30 percent in 2003 to 46.40 percent in 2007 (p = 0.00). The infant mortality ratewas 22.9 in 2003 and 12.9 in 2007. CONCLUSION:Both strategies had a positive result in accordance to their objectives, although the improvement of tertiarycare services showed a more signifficant impact.
Subject(s)
Humans , Infant, Newborn , Infant , Child , Primary Health Care/organization & administration , Quality of Health Care/statistics & numerical data , Quality of Health Care/organization & administration , Infant MortalityABSTRACT
La enfermedad de Kawasaki en menores de 60 días de vida representa el 0,23 por ciento en las series internacionales más grandes.Reportamos un lactante de 54 días de vida con clínica típica.El niño se presentó con síndrome febril prolongado,adenopatía cervical y eritema polimorfo,a los que se agregaron los demás signos de la enfermedad.Fue medicado con gammaglobulina E.V con buena evolución.Se relata el seguimiento a un año del diagnóstico
Subject(s)
Infant , Mucocutaneous Lymph Node Syndrome , PediatricsABSTRACT
La enfermedad de Kawasaki en menores de 60 días de vida representa el 0,23 por ciento en las series internacionales más grandes.Reportamos un lactante de 54 días de vida con clínica típica.El niño se presentó con síndrome febril prolongado,adenopatía cervical y eritema polimorfo,a los que se agregaron los demás signos de la enfermedad.Fue medicado con gammaglobulina E.V con buena evolución.Se relata el seguimiento a un año del diagnóstico
Subject(s)
Infant , Mucocutaneous Lymph Node Syndrome , PediatricsSubject(s)
Infant, Newborn , Infant , Catheters, Indwelling , Catheterization , Needles , Intensive Care Units, Pediatric , PediatricsSubject(s)
Infant, Newborn , Infant , Catheterization , Catheters, Indwelling , Intensive Care Units, Pediatric , Needles , PediatricsABSTRACT
El estreptococo beta hemolítico del grupo A ha presentado un cambio en su agresividad en estos últimos años,generando infecciones más severas.Se relatan tres pacientes internados entre octubre de 1997 y enero de 1998 en una UCIP polivalente en San Miguel de Tucuman.Un niño con fascitis necrotizante y compromisohemodinámico,otro con shock séptico y fallo mmultiorgánico y un lactante de 10 meses que ingresó en paro cardiorespiratorio por shock séptico.Se discuten las causas de este cambio en la agresividad,los signos de alarma,los criterios diagnósticos y terapéuticos actuales
Subject(s)
Infant , Child , Shock, Septic/diagnosis , Shock, Septic/therapy , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/therapyABSTRACT
El estreptococo beta hemolítico del grupo A ha presentado un cambio en su agresividad en estos últimos años,generando infecciones más severas.Se relatan tres pacientes internados entre octubre de 1997 y enero de 1998 en una UCIP polivalente en San Miguel de Tucuman.Un niño con fascitis necrotizante y compromisohemodinámico,otro con shock séptico y fallo mmultiorgánico y un lactante de 10 meses que ingresó en paro cardiorespiratorio por shock séptico.Se discuten las causas de este cambio en la agresividad,los signos de alarma,los criterios diagnósticos y terapéuticos actuales
