RESUMEN
Tracheal pooling for Mycoplasma hyopneumoniae (M. hyopneumoniae) DNA detection allows for decreased diagnostic cost, one of the main constraints in surveillance programs. The objectives of this study were to estimate the sensitivity of pooled-sample testing for the detection of M. hyopneumoniae in tracheal samples and to develop probability of M. hyopneumoniae detection estimates for tracheal samples pooled by 3, 5, and 10. A total of 48 M. hyopneumoniae PCR-positive field samples were pooled 3-, 5-, and 10-times using field M. hyopneumoniae DNA-negative samples and tested in triplicate. The sensitivity was estimated at 0.96 (95% credible interval [Cred. Int.]: 0.93, 0.98) for pools of 3, 0.95 (95% Cred. Int: 0.92, 0.98) for pools of 5, and 0.93 (95% Cred. Int.: 0.89, 0.96) for pools of 10. All pool sizes resulted in PCR-positive if the individual tracheal sample Ct value was < 33. Additionally, there was no significant decrease in the probability of detecting at least one M. hyopneumoniae-infected pig given any pool size (3, 5, or 10) of tracheal swabs. Furthermore, this manuscript applies the probability of detection estimates to various real-life diagnostic testing scenarios. Combining increased total animals sampled with pooling can be a cost-effective tool to maximize the performance of M. hyopneumoniae surveillance programs.
Asunto(s)
Mycoplasma hyopneumoniae , Neumonía Porcina por Mycoplasma , Tráquea , Mycoplasma hyopneumoniae/aislamiento & purificación , Mycoplasma hyopneumoniae/genética , Animales , Tráquea/microbiología , Porcinos , Neumonía Porcina por Mycoplasma/diagnóstico , Neumonía Porcina por Mycoplasma/microbiología , Reacción en Cadena de la Polimerasa/métodos , ADN Bacteriano/análisis , Sensibilidad y Especificidad , Manejo de Especímenes/métodos , ProbabilidadRESUMEN
BACKGROUND: Antimicrobial resistance (AMR) is among the gravest threats to human health and food security worldwide. The use of antimicrobials in livestock production can lead to emergence of AMR, which can have direct effects on humans through spread of zoonotic disease. Pigs pose a particular risk as they are a source of zoonotic diseases and receive more antimicrobials than most other livestock. Here we use a large-scale genomic approach to characterise AMR in Streptococcus suis, a commensal found in most pigs, but which can also cause serious disease in both pigs and humans. RESULTS: We obtained replicated measures of Minimum Inhibitory Concentration (MIC) for 16 antibiotics, across a panel of 678 isolates, from the major pig-producing regions of the world. For several drugs, there was no natural separation into 'resistant' and 'susceptible', highlighting the need to treat MIC as a quantitative trait. We found differences in MICs between countries, consistent with their patterns of antimicrobial usage. AMR levels were high even for drugs not used to treat S. suis, with many multidrug-resistant isolates. Similar levels of resistance were found in pigs and humans from regions associated with zoonotic transmission. We next used whole genome sequences for each isolate to identify 43 candidate resistance determinants, 22 of which were novel in S. suis. The presence of these determinants explained most of the variation in MIC. But there were also interesting complications, including epistatic interactions, where known resistance alleles had no effect in some genetic backgrounds. Beta-lactam resistance involved many core genome variants of small effect, appearing in a characteristic order. CONCLUSIONS: We present a large dataset allowing the analysis of the multiple contributing factors to AMR in S. suis. The high levels of AMR in S. suis that we observe are reflected by antibiotic usage patterns but our results confirm the potential for genomic data to aid in the fight against AMR.
Asunto(s)
Streptococcus suis , Animales , Antibacterianos/farmacología , Antiinfecciosos , Farmacorresistencia Bacteriana/genética , Genómica , Pruebas de Sensibilidad Microbiana , Preparaciones Farmacéuticas , Streptococcus suis/efectos de los fármacos , Streptococcus suis/genética , PorcinosRESUMEN
Streptococcus suis, a global zoonosis of pigs, shows regional differences in the prevalence of human-associated disease for Asian and non-Asian countries. The isolation rates and diversities of S. suis on tonsils of healthy slaughter pigs in China and the United Kingdom were studied for effects of geography, temperature, pig age, and farm type. Isolates underwent analysis of molecular serotype and multilocus sequence type and virulence-associated genotyping. Although we found no significant difference in positive isolation rates between Chinese and UK farms, the prevalences of serotypes previously associated with human disease were significantly greater in the Chinese collection (P = 0.003). A significant effect of temperature was found on the positive isolation rate of the Chinese samples and the prevalence of human disease-associated serotypes in the UK S. suis population (China, P = 0.004; United Kingdom, P = 0.024) and on the prevalence of isolates carrying key virulence genes in China (P = 0.044). Finally, we found marked diversity among S. suis isolates, with statistically significant temperature effects on detection of multiple strain types within individual pigs. This study highlighted the high carriage prevalence and diversity of S. suis among clinically healthy pig herds of China and the United Kingdom. The significant effect of temperature on prevalence of isolation, human disease-associated serotypes, and diversity carried by individual pigs may shed new light on geographic variations in human S. suis-associated disease.IMPORTANCEStreptococcus suis is a global zoonotic pathogen and also a normal colonizer mainly carried on the tonsil of pigs. Thus, it is important to study the effect of environmental and management-associated factors on the S. suis populations in clinically healthy pigs. In this research, we investigated the similarities and differences between the S. suis populations obtained from different pig ages, seasons, and farm management systems and discovered the relationship between high climatic temperature and the prevalence of S. suis.
Asunto(s)
Crianza de Animales Domésticos/métodos , Variación Genética , Infecciones Estreptocócicas/veterinaria , Streptococcus suis/fisiología , Enfermedades de los Porcinos/epidemiología , Factores de Edad , Animales , China/epidemiología , Genoma Bacteriano , Estudios Longitudinales , Prevalencia , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus suis/genética , Porcinos , Enfermedades de los Porcinos/microbiología , Temperatura , Reino Unido/epidemiologíaRESUMEN
Collection of abattoir data related to public health is common worldwide. Standardised on-going programmes that collect information from abattoirs that inform producers about the presence and frequency of disease that are important to them rather than public health hazards are less common. The three voluntary pig health schemes, implemented in the United Kingdom, are integrated systems which capture information on different macroscopic disease conditions detected in slaughtered pigs. Many of these conditions have been associated with a reduction in performance traits and consequent increases in production costs. The schemes are the Wholesome Pigs Scotland in Scotland, the British Pig Health Scheme in England and Wales and the Pig Regen Ltd. health and welfare checks in Northern Ireland. In this study, four post mortem conditions (pericarditis, milk spots, papular dermatitis and tail damage) were surveyed and analysed over a ten and half year period, with the aim to compare the prevalence, monthly variations, and yearly trends between schemes. Liver milk spot was the most frequently recorded condition while tail damage was the least frequently observed condition. The prevalence of papular dermatitis was relatively low compared to liver milk spot and pericarditis in the three schemes. A general decreasing trend was observed for milk spots and papular dermatitis for all three schemes. The prevalence of pericarditis increased in Northern Ireland and England and Wales; while Scotland in recent years showed a decreasing trend. An increasing trend of tail damage was depicted in Scotland and Northern Ireland until 2013/2014 followed by a decline in recent years compared to that of England and Wales with a decreasing trend over the full study period. Monthly effects were more evident for milk spots and papular dermatitis. Similarity of the modus operandi of the schemes made the comparison of temporal variations and patterns in gross pathology between countries possible over time, especially between countries with similar pig production profile. This study of temporal patterns enables early detection of prevalence increases and alerts industry and researchers to investigate the reasons behind such changes. These schemes are, therefore, valuable assets for endemic disease surveillance, early warning for emerging disease and also for monitoring of welfare outcomes.
Asunto(s)
Dermatitis/veterinaria , Hepatopatías/veterinaria , Pericarditis/veterinaria , Enfermedades de los Porcinos/epidemiología , Mataderos , Bienestar del Animal , Animales , Autopsia/veterinaria , Dermatitis/epidemiología , Hepatopatías/epidemiología , Pericarditis/epidemiología , Vigilancia de la Población , Prevalencia , Análisis de Regresión , Estaciones del Año , Porcinos , Enfermedades de los Porcinos/patología , Cola (estructura animal)/patología , Reino Unido/epidemiologíaAsunto(s)
Infecciones por Actinobacillus/veterinaria , Actinobacillus pleuropneumoniae/clasificación , Actinobacillus pleuropneumoniae/aislamiento & purificación , Serogrupo , Enfermedades de los Porcinos/microbiología , Infecciones por Actinobacillus/epidemiología , Infecciones por Actinobacillus/microbiología , Animales , Inglaterra/epidemiología , Porcinos , Enfermedades de los Porcinos/epidemiología , Gales/epidemiologíaRESUMEN
OBJECTIVES: Intraoral dental tomosynthesis and closely related tuned-aperture CT (TACT) are low-dose three-dimensional (3D) imaging modalities that have shown improved detection of multiple dental diseases. Clinical interest in implementing these technologies waned owing to their time-consuming nature. Recently developed carbon nanotube (CNT) X-ray sources allow rapid multi-image acquisition without mechanical motion, making tomosynthesis a clinically viable technique. The objective of this investigation was to evaluate the feasibility of and produce high-quality images from a digital tomosynthesis system employing CNT X-ray technology. METHODS: A test-bed stationary intraoral tomosynthesis unit was constructed using a CNT X-ray source array and a digital intraoral sensor. The source-to-image distance was modified to make the system comparable in image resolution to current two-dimensional intraoral radiography imaging systems. Anthropomorphic phantoms containing teeth with simulated and real caries lesions were imaged using a dose comparable to D-speed film dose with a rectangular collimation. Images were reconstructed and analysed. RESULTS: Tomosynthesis images of the phantom and teeth specimen demonstrated perceived image quality equivalent or superior to standard digital images with the added benefit of 3D information. The ability to "scroll" through slices in a buccal-lingual direction significantly improved visualization of anatomical details. In addition, the subjective visibility of dental caries was increased. CONCLUSIONS: Feasibility of the stationary intraoral tomosynthesis is demonstrated. The results show clinical promise and suitability for more robust observer and clinical studies.
Asunto(s)
Nanotubos de Carbono , Radiografía Dental Digital/métodos , Tomografía Computarizada por Rayos X/métodos , Proceso Alveolar/diagnóstico por imagen , Caries Dental/diagnóstico por imagen , Materiales Dentales/química , Restauración Dental Permanente , Estudios de Factibilidad , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Maxilar/diagnóstico por imagen , Fantasmas de Imagen , Dosis de Radiación , Intensificación de Imagen Radiográfica/métodos , Radiografía Dental Digital/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Diente/diagnóstico por imagen , Película para Rayos XRESUMEN
Surveillance of animal diseases provides information essential for the protection of animal health and ultimately public health. The voluntary pig health schemes, implemented in the United Kingdom, are integrated systems which capture information on different macroscopic disease conditions detected in slaughtered pigs. Many of these conditions have been associated with a reduction in performance traits and consequent increases in production costs. The schemes are the Wholesome Pigs Scotland in Scotland, the BPEX Pig Health Scheme in England and Wales and the Pig Regen Ltd. health and welfare checks done in Northern Ireland. This report set out to compare the prevalence of four respiratory conditions (enzootic pneumonia-like lesions, pleurisy, pleuropneumonia lesions and abscesses in the lung) assessed by these three Pig Health Schemes. The seasonal variations and year trends associated with the conditions in each scheme are presented. The paper also highlights the differences in prevalence for each condition across these schemes and areas where further research is needed. A general increase in the prevalence of enzootic pneumonia like lesions was observed in Scotland, England and Wales since 2009, while a general decrease was observed in Northern Ireland over the years of the scheme. Pleurisy prevalence has increased since 2010 in all three schemes, whilst pleuropneumonia has been decreasing. Prevalence of abscesses in the lung has decreased in England, Wales and Northern Ireland but has increased in Scotland. This analysis highlights the value of surveillance schemes based on abattoir pathology monitoring of four respiratory lesions. The outputs at scheme level have significant value as indicators of endemic and emerging disease, and for producers and herd veterinarians in planning and evaluating herd health control programs when comparing individual farm results with national averages.
Asunto(s)
Crianza de Animales Domésticos , Monitoreo Epidemiológico/veterinaria , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/veterinaria , Enfermedades de los Porcinos/epidemiología , Porcinos , Animales , Enfermedades Respiratorias/prevención & control , Enfermedades de los Porcinos/prevención & control , Reino Unido/epidemiologíaRESUMEN
Infection of pigs with influenza A H1N1 2009 virus (A(H1N1)pdm09) was first detected in England in November 2009 following global spread of the virus in the human population. This paper describes clinical and epidemiological findings in the first English pig farms in which A(H1N1)pdm09 influenza virus was detected. These farms showed differences in disease presentation, spread and duration of infection. The factors likely to influence these features are described and relate to whether pigs were housed or outdoors, the age of the pigs, inter-current disease and the management system of the unit. Infection could be mild or clinically inapparent in breeding pigs with more typical respiratory disease being identified later in their progeny. Mortality was low where disease was uncomplicated by environmental stresses or concurrent infections. Where deaths occurred in pigs infected with A(H1N1)pdm09 influenza, they were mainly due to other infections, including streptococcal disease due to Streptococcus suis infection. This paper demonstrates the ease with which A(H1N1)pdm09 virus was transmitted horizontally and maintained in a pig population.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A , Infecciones por Orthomyxoviridae/veterinaria , Enfermedades de los Porcinos/epidemiología , Factores de Edad , Crianza de Animales Domésticos/métodos , Animales , Inglaterra/epidemiología , Femenino , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Gripe Humana/transmisión , Masculino , Infecciones por Orthomyxoviridae/epidemiología , Infecciones por Orthomyxoviridae/patología , Infecciones por Orthomyxoviridae/transmisión , Factores de Riesgo , Estaciones del Año , Porcinos , Enfermedades de los Porcinos/patología , Enfermedades de los Porcinos/transmisión , ZoonosisRESUMEN
Previous studies have linked levels of porcine endogenous retroviruses (PERV) with poor health and disease in pigs. To determine the levels of expression of PERVs and their potential association with disease expression, real-time reverse transcriptase (RT) PCR assays were used to assess PERV-ABC, PERV-C and PERV-A/C levels in three commercial swine operations in the United States. Pigs (n = 204) aged 3-25 weeks were screened, and all 369 serum samples collected were found to be positive for PERV-ABC RNA as expected. PERV-C and PERV-A/C RNA were detected in 24.1% (89/369) and 18.7% (69/369) of the samples, respectively. When divided into age groups, PERV-A/C RNA was identified in 20.0% (43/215) of the nursery pig samples (3-9 weeks of age) compared to 16.9% (26/154) finisher pig samples (12-25 weeks of age). On two of the farms, serum was collected from healthy pigs (n = 60) and from pen-mates with various clinical conditions including diarrhoea, wasting and respiratory disease (n = 60). Overall, 25% (15/60) of the samples from clinically affected pigs were found to be positive for PERV-A/C RNA, whereas in clinically healthy pigs, only 8.3% (5/60) of the samples were found to be PERV-A/C positive (P = 0.026). It was possible to identify PERV-A/C in the same pigs on more than one consecutive bleeding, indicating variable length of PERV-A/C viremia. The results indicate that there is an increased incidence of PERV-A/C viremia in diseased pigs and that PERV-A/C can be detected over time in selected pigs within commercial pig production systems in the United States.
Asunto(s)
Reacción en Cadena en Tiempo Real de la Polimerasa/veterinaria , Infecciones por Retroviridae/veterinaria , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/veterinaria , Enfermedades de los Porcinos/diagnóstico , Viremia/veterinaria , Animales , ARN Viral/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Infecciones por Retroviridae/diagnóstico , Infecciones por Retroviridae/virología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Sensibilidad y Especificidad , Programas Informáticos , Especificidad de la Especie , Porcinos , Enfermedades de los Porcinos/epidemiología , Estados Unidos/epidemiologíaRESUMEN
The measurable microbial load on poultry carcasses during processing is determined by a number of factors including farm or origin, processing hygiene, and external temperature. This study investigated associations between carcass microbial load and progressive delays to processing. A total of 30 carcasses were delayed immediately after defeathering and before evisceration in a commercial abattoir in groups of five, and were held at ambient temperature for 1, 2, 3, 4, 6, and 8 h. Delayed carcasses were reintroduced to the processing line, and quantitative assessment of total viable count, coliforms, Staphylococcus aureus, and Pseudomonas spp. was undertaken on neck skin flap samples collected after carcass chilling and then pooled for each group. Sampling was repeated on 5 separate days, and the data were combined. Significant increases in total viable count (P = 0.001) and coliforms (P = 0.004), but not for S. aureus or Pseudomonas loads, were observed across the 8-h period of delay. In line with previous studies, there was significant variation in microbiological data according to sampling day. In conclusion, there is a significant and measurable decline in microbiological status of uneviscerated but defeathered poultry carcasses after an 8-h delay, but the variability of sampling results, reflecting the wide range of factors that impact microbial load, means that it is not possible to determine maximum or minimum acceptable periods of processing delay based on this criterion alone.
Asunto(s)
Bacterias Aerobias/crecimiento & desarrollo , Contaminación de Alimentos/análisis , Contaminación de Alimentos/prevención & control , Manipulación de Alimentos/métodos , Piel/microbiología , Mataderos , Animales , Pollos , Recuento de Colonia Microbiana , Seguridad de Productos para el Consumidor , Enterobacteriaceae/crecimiento & desarrollo , Microbiología de Alimentos , Humanos , Higiene , Carne/microbiología , Pseudomonas/crecimiento & desarrollo , Staphylococcus aureus/crecimiento & desarrollo , Temperatura , Factores de TiempoRESUMEN
A bovine in vitro organ culture (BIVOC) system was evaluated as a model to study host and pathogen events during the course of bovine herpesvirus-1 infection. Upper respiratory tract epithelium, from slaughtered animals, was cultured in an air-liquid interface system and integrity, viability, and TNF-alpha gene expression of tissue explants were monitored over 72h in the presence or absence of infection by bovine herpesvirus type 1 (BHV-1). Uninfected explants maintained viability and integrity over the 72h time course although histological signs of degeneration were first visible from 24h of culture. Explants were productively infected with BHV-1 and typical, dose dependent, cytopathic changes were observed in response to infection. Regulation of TNF-alpha gene expression in uninfected explants varied over time and was region-specific but there was significant down-regulation of TNF-alpha gene expression at 2h post-infection when compared to uninfected controls at the same time point. Taking caveats into consideration the BIVOC system shows promise as a tool for analysis of immediate or early events in host-pathogen interaction.
Asunto(s)
Infecciones por Herpesviridae/patología , Infecciones por Herpesviridae/virología , Herpesvirus Bovino 1/crecimiento & desarrollo , Mucosa Respiratoria/patología , Mucosa Respiratoria/virología , Animales , Bovinos , Supervivencia Celular , Perfilación de la Expresión Génica , Técnicas de Cultivo de Órganos , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
A total of 30 British and 30 Spanish Haemophilus parasuis isolates were tested for their susceptibility to 19 of the antimicrobials currently used in swine practice with a broth microdilution method in order to know the emergence of resistance against these compounds in this porcine pathogen. All the British isolates were susceptible to penicillin, ceftiofur, erythromycin, tilmicosin, enrofloxacin, and florfenicol, and most of them were susceptible to the remaining antimicrobials (the highest resistance rate found was of 20% to neomycin). In contrast, all the Spanish isolates were susceptible exclusively to florfenicol, and high proportions of resistance were encountered for penicillin, ampicillin, oxytetracycline, erythromycin, tilmicosin, tiamulin and trimethoprim+sulphamethoxazole; in addition, a bimodal or multimodal distribution, or tailing of Spanish isolates over the MIC range was observed for clindamycin, sulphonamides and tylosine tartrate, suggesting the development of acquired resistance. In addition, several multiresistance patterns were found among the Spanish isolates, 23.3% of them being resistant to at least eight antimicrobials, the same rate as that encountered for those being susceptible to all antimicrobials tested. This study showed that in general British H. parasuis isolates are susceptible to antimicrobial agents routinely used for treatment of porcine respiratory diseases; however, the Spanish isolates need a more continuous surveillance of their susceptibility patterns.
Asunto(s)
Antiinfecciosos/farmacología , Infecciones por Haemophilus/veterinaria , Haemophilus parasuis/efectos de los fármacos , Enfermedades de los Porcinos/microbiología , Porcinos/microbiología , Animales , Farmacorresistencia Bacteriana , Infecciones por Haemophilus/microbiología , Haemophilus parasuis/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , España , Reino UnidoAsunto(s)
Infecciones por Virus ARN/veterinaria , Retroviridae/aislamiento & purificación , Enfermedades de los Porcinos/virología , Porcinos/virología , Envejecimiento , Secuencia de Aminoácidos , Animales , Datos de Secuencia Molecular , Infecciones por Virus ARN/virología , Porcinos/sangre , Viremia/sangre , Viremia/veterinariaAsunto(s)
Retrovirus Endógenos/aislamiento & purificación , Estado de Salud , ARN Viral/análisis , Porcinos/sangre , Viremia/veterinaria , Animales , Retroviridae , Porcinos/genética , Porcinos/virología , Enfermedades de los Porcinos/sangre , Enfermedades de los Porcinos/virología , Replicación ViralRESUMEN
The use of porcine tissues is being developed as a means to alleviate the shortage of allogeneic tissues and organs available for transplantation. To reduce the possibility of a microorganism of pigs being inadvertently transferred to the recipient of the xenograft, recommendations have been published on the microbiological specifications for organ source pigs. The porcine circoviruses (PCV1 and PCV2) and porcine lymphotropic herpesviruses (PLHV1 and PLHV2) are two infectious agents of pigs which are considered to be of significance for the microbiological safety of xenotransplantation. To ensure the exclusion of these microorganisms from animals destined for use under clinical conditions, reliable breeding methodologies are required. We investigated the efficiency of established derivation procedures for the removal of PCV and PLHV. In comparison with conventionally reared pigs, caesarian and barrier derived animals showed a markedly reduced prevalence of PCVs and PLHVs. Our results indicate that the derivation of animals free of both of these microorganisms is achievable and will enhance the microbiological safety of xenotransplantation.
Asunto(s)
Infecciones por Circoviridae/prevención & control , Circovirus/aislamiento & purificación , Gammaherpesvirinae/aislamiento & purificación , Infecciones por Herpesviridae/prevención & control , Trasplante Heterólogo , Animales , Cesárea , Infecciones por Circoviridae/epidemiología , Infecciones por Circoviridae/transmisión , Circovirus/genética , ADN Viral/análisis , Femenino , Gammaherpesvirinae/genética , Infecciones por Herpesviridae/epidemiología , Infecciones por Herpesviridae/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Prevalencia , Porcinos , Porcinos EnanosRESUMEN
OBJECTIVE: Estimate the economic impact of introducing inactivated poliovirus vaccine (IPV) into the Australian childhood immunisation schedule to eliminate vaccine-associated paralytic poliomyelitis (VAPP). METHODS: Cost-effectiveness of two different four-dose IPV schedules (monovalent vaccine and IPV-containing combination vaccine) compared with the current four-dose oral poliovirus vaccine (OPV) schedule for Australian children through age six years. Model used estimates of VAPP incidence, costs, and vaccine utilisation and price obtained from published and unpublished sources. Main outcome measures were total costs, outcomes prevented, and incremental cost-effectiveness, expressed as net cost per case of VAPP prevented. RESULTS: Changing to an IPV-based schedule would prevent 0.395 VAPP cases annually. At $20 per dose for monovalent vaccine and $14 per dose for the IPV component in a combination vaccine, the change would incur incremental, annual costs of $19.5 million ($49.3 million per VAPP case prevented) and $6.7 million ($17.0 million per VAPP case prevented), respectively. Threshold analysis identified break-even prices per dose of $1 for monovalent and $7 for combination vaccines. CONCLUSIONS: Introducing IPV into the Australian childhood immunisation schedule is not likely to be cost-effective unless it comes in a combined vaccine with the IPV-component price below $10. IMPLICATIONS: More precise estimates of VAPP incidence in Australia and IPV price are needed. However, poor cost-effectiveness will make the decision about switching from OPV to IPV in the childhood schedule difficult.
Asunto(s)
Programas de Inmunización/economía , Poliomielitis/prevención & control , Vacuna Antipolio de Virus Inactivados/economía , Australia/epidemiología , Niño , Preescolar , Análisis Costo-Beneficio , Costos de la Atención en Salud , Humanos , Incidencia , Lactante , Modelos Econométricos , Análisis Multivariante , Formulación de Políticas , Poliomielitis/economía , Poliomielitis/epidemiología , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Vacuna Antipolio Oral/administración & dosificación , Vacuna Antipolio Oral/efectos adversos , Factores de Riesgo , Sensibilidad y EspecificidadAsunto(s)
Infecciones por Citomegalovirus/transmisión , Citomegalovirus/fisiología , Porcinos/virología , Trasplante Heterólogo/efectos adversos , Zoonosis/virología , Animales , Línea Celular , Técnicas de Cocultivo , Citomegalovirus/aislamiento & purificación , Humanos , Macrófagos Alveolares/virología , Reacción en Cadena de la Polimerasa , Células Tumorales CultivadasRESUMEN
CONTEXT: Rotavirus is the most common cause of severe diarrhea in children, and a live, oral vaccine may soon be licensed for prevention. OBJECTIVE: To estimate the economic impact of a national rotavirus immunization program in the United States. DESIGN: Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree used estimates of disease burden, costs, vaccine coverage, efficacy, and price obtained from published and unpublished sources. INTERVENTION: The proposed vaccine would be administered to infants at ages 2, 4, and 6 months as part of the routine schedule of childhood immunizations. MAIN OUTCOME MEASURES: Total costs, outcomes prevented, and incremental cost-effectiveness. RESULTS: A routine, universal rotavirus immunization program would prevent 1.08 million cases of diarrhea, avoiding 34000 hospitalizations, 95000 emergency department visits, and 227000 physician visits in the first 5 years of life. At $20 per dose, the program would cost $289 million and realize a net loss of $107 million to the health care system-$103 per case prevented. The program would provide a net savings of $296 million to society. Threshold analysis identified a break-even price per dose of $9 for the health care system and $51 for the societal perspective. Greater disease burden and greater vaccine efficacy and lower vaccine price increased cost-effectiveness. CONCLUSIONS: A US rotavirus immunization program would be cost-effective from the perspectives of society and the health care system, although the cost of the immunization program would not be fully offset by the reduction in health care cost of rotavirus diarrhea unless the price fell to $9 per dose.