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Objective@#To understand the characteristics relating to the etiology and complications of hand, foot and mouth disease (HFMD) based on data from the pilot National Sentinel Surveillance (NSS) program so as to explore the feasibility, advantages and disadvantages of the NSS.@*Methods@#Data were extracted from the NSS system, conducted in 11 provinces of China from November 2015 to October 2016. Characteristics regarding the etiology, complications of HFMD and factors related to the positive rates of HFMD specimens were analyzed under the logistic regression method by SPSS 20.0 software.@*Results@#A total of 4 783 specimens were collected, including 3 390 from mild, 1 390 from severe and 3 from death cases. The overall positive rate was 81.43% (3 895/4 783). Other enteroviruses (non EV71/Cox A16 enteroviruses) appeared the major serotype (52.68%, 1 482/2 813) for mild infection of the disease while EV71 was for the severe cases (65.31%, 706/1 081). The serotype spectrum revealed by the pilot NSS was almost identical with the existing surveillance system. Other enteroviruses tended to infect younger children (χ2=130.17, P<0.001) than EV71 and Cox A16, in China. The multivariate logistic regression results showed that higher positive rate was associated with specimens which were collected from males, at children’ hospitals, in peak seasons, timely and in stools. The positive rates presented downwarding trends with the extension of the onset-sampling interval (χ2=14.47, P<0.001 in stool specimen; χ2=31.99, P<0.001 in throat swab; χ2=24.26, P<0.001 in anal swab). Aseptic meningitis, non-brainstem encephalitis and brainstem encephalitis appeared the top three complications of both EV71-associated and other enteroviruses-associated severe HFMD cases.@*Conclusions@#Factors as gender, season/place/timeliness of specimen collection, and types of hospital all appeared independently influenced the positive rates. NSS seemed feasible to be used as an alternative or supplement tool to the existing surveillance program in China.
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Objectives@#To understand the status of studies about influenza economic burden in mainland China and summarize their major results.@*Methods@#The words of influenza, flu, cost, economic, burden, effectiveness, benefit, utility, China, and Chinese, were used as search keywords. Journal papers published during 2000-2018 were searched from Chinese electronic databases (CNKI and Wanfang) and English electronic databases (PubMed, Web of science, EconLit and Cochrane Library). The language of literature was restricted to Chinese and English. A total of 23 effective documents were included, and the descriptive characteristics, research indexes and methods included in the literature were analyzed. The monetary unit used in this review is Chinese Yuan (CNY).@*Results@#The 23 study sites were mainly in the relatively developed and populous regions. The total cost per capita of laboratory-confirmed influenza,of all age-group was reported in 6 literatures, and only 4 literatures reported it in out-patients (range: 768.0-999.9 CNY), Only one study reported this indicator in inpatients (9 832.0 CNY). One literature reported the total cost per capita of influenza-like illness,, which was 205.1 CNY. And one literature reported that the direct medical cost of inpatients per capita in children under 5 years of age was 6 072.0 CNY while two literature reported this index for the elderly over 60 years of age, ranging from 14 250.0 to 19 349.1 CNY. Four articles reported the economic burden of influenza in urban and rural areas, one of which showed that the related expenses of urban influenza inpatients accounted for 31% of the average annual income, while which for the rural flow was 113%.@*Conclusion@#The average economic burden of lab-confirmed influenza case is higher than that of influenza-like illness, and there are differences in outpatient indirect expenses and inpatients direct medical expenses. The direct medical burden for the hospitalized 60-years-and-beyond influenza case group is heavier thar other age group. By region, the influenza associated individual economic burden in rural area is higher than that of urban area..
ABSTRACT
Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" . The main updates in this version include: epidemiology, disease burden, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, IIV3 and IIV4 immune response, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The influenza vaccine TWG provided the recommendations for influenza vaccination for the 2018-2019 influenza season based on existing scientific evidence. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2017-2018 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels.
ABSTRACT
Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and its complications.Currently,China has licensed trivalent (IIV3) and quadrivalent inactivated influenza vaccine (IIV4),including split-virus influenza vaccine and subunit vaccine.In most parts of China,influenza vaccine is a category Ⅱ vaccine,which means influenza vaccination is voluntary,and recipients need to pay for it.To strengthen the technical guidance for prevention and control of influenza and the operational research on influenza vaccination in China,the National Immunization Advisory Committee (NIAC),Influenza Vaccine Technical Working Group (TWG),updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)",based on most recent existing scientific evidences.The main updates include:epidemiology and disease burden of influenza,types of influenza vaccines,northern hemisphere influenza vaccination composition for the 2018-2019 season,and,IIV3 and IIV4 vaccines' major immune responses,durability of immunity,immunogenicity,vaccine efficacy,effectiveness,safety,cost-effectiveness and cost-benefit.The recommendations include:Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications.No preferential recommendation is made for any influenza vaccine product for persons who can accept ≥ 1 licensed,recommended,and appropriate products.To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups,the recommendations prioritize seasonal influenza vaccination for children aged 6-60 months,adults ≥60 years of age,persons with specific chronic diseases,healthcare workers,the family members and caregivers of infants ＜6 months of age,and pregnant women or women who plan to pregnant during the influenza season.Children aged 6 months to 8 years old require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection.If they were vaccinated in previous influenza season,1 dose is recommended.People ≥ 9 years old require 1 dose of influenza vaccine.It is recommended that people receive their influenza vaccination by the end of October.Influenza vaccination should be offered as soon as the vaccination is available.Influenza vaccination should continue to be available for those unable to be vaccinated before the end of October during the whole season.Influenza vaccine is also recommended for use in pregnant women during any trimester.These guidelines are intended for CDC members who are working on influenza control and prevention,PoVs members,healthcare workers from the departments of pediatrics,internal medicine,and infectious diseases,and members of materuity and child care institutions at all levels.
ABSTRACT
Influenza can be prevented through annual appropriate vaccination against the virus concerned.In China,influenza vaccine is categorized as "Class Ⅱ " infectious diseases which the cost is paid out of the user's pockets.The annual coverage of influenza vaccination had been 2％-3％.The main reasons for the low coverage would include the following factors:lacking awareness on both the disease and vaccine,poor accessibility of vaccination service,and the cost of vaccination.To reduce the health and economic burden associated with influenza,comprehensive policies should be improved,targeting the coverage of seasonal influenza vaccination.These items would include:① Different financing reimbursement schemes and mechanisms to improve the aspiration on vaccination and on the vaccine coverage in high-risk groups,as young children,elderly,people with underlying medical conditions;② to ameliorate equality of vaccination services;③ to improve knowledge of the health care workers (HCWs) and the public on influenza and related vaccines;④ to improve clinical and preventive medical practice and vaccination among HCWs through revising clinical guidelines,pathway and consensus of experts;⑤ to provide more convenient,accessible and normative vaccination service system;⑥ to strengthen research and development as well as marketing on novel influenza vaccines;⑦ to revise items regarding the contraindication for influenza vaccine on pregnancy women,stated in the Chinese Pharmacopoeia.
ABSTRACT
Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and its complications.Currently,China has licensed trivalent (IIV3) and quadrivalent inactivated influenza vaccine (IIV4),including split-virus influenza vaccine and subunit vaccine.In most parts of China,influenza vaccine is a category Ⅱ vaccine,which means influenza vaccination is voluntary,and recipients need to pay for it.To strengthen the technical guidance for prevention and control of influenza and the operational research on influenza vaccination in China,the National Immunization Advisory Committee (NIAC),Influenza Vaccine Technical Working Group (TWG),updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)",based on most recent existing scientific evidences.The main updates include:epidemiology and disease burden of influenza,types of influenza vaccines,northern hemisphere influenza vaccination composition for the 2018-2019 season,and,IIV3 and IIV4 vaccines' major immune responses,durability of immunity,immunogenicity,vaccine efficacy,effectiveness,safety,cost-effectiveness and cost-benefit.The recommendations include:Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications.No preferential recommendation is made for any influenza vaccine product for persons who can accept ≥ 1 licensed,recommended,and appropriate products.To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups,the recommendations prioritize seasonal influenza vaccination for children aged 6-60 months,adults ≥60 years of age,persons with specific chronic diseases,healthcare workers,the family members and caregivers of infants ＜6 months of age,and pregnant women or women who plan to pregnant during the influenza season.Children aged 6 months to 8 years old require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection.If they were vaccinated in previous influenza season,1 dose is recommended.People ≥ 9 years old require 1 dose of influenza vaccine.It is recommended that people receive their influenza vaccination by the end of October.Influenza vaccination should be offered as soon as the vaccination is available.Influenza vaccination should continue to be available for those unable to be vaccinated before the end of October during the whole season.Influenza vaccine is also recommended for use in pregnant women during any trimester.These guidelines are intended for CDC members who are working on influenza control and prevention,PoVs members,healthcare workers from the departments of pediatrics,internal medicine,and infectious diseases,and members of materuity and child care institutions at all levels.
ABSTRACT
Influenza can be prevented through annual appropriate vaccination against the virus concerned.In China,influenza vaccine is categorized as "Class Ⅱ " infectious diseases which the cost is paid out of the user's pockets.The annual coverage of influenza vaccination had been 2％-3％.The main reasons for the low coverage would include the following factors:lacking awareness on both the disease and vaccine,poor accessibility of vaccination service,and the cost of vaccination.To reduce the health and economic burden associated with influenza,comprehensive policies should be improved,targeting the coverage of seasonal influenza vaccination.These items would include:① Different financing reimbursement schemes and mechanisms to improve the aspiration on vaccination and on the vaccine coverage in high-risk groups,as young children,elderly,people with underlying medical conditions;② to ameliorate equality of vaccination services;③ to improve knowledge of the health care workers (HCWs) and the public on influenza and related vaccines;④ to improve clinical and preventive medical practice and vaccination among HCWs through revising clinical guidelines,pathway and consensus of experts;⑤ to provide more convenient,accessible and normative vaccination service system;⑥ to strengthen research and development as well as marketing on novel influenza vaccines;⑦ to revise items regarding the contraindication for influenza vaccine on pregnancy women,stated in the Chinese Pharmacopoeia.
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Objective@#To estimate the direct medical cost of severe hand, foot and mouth disease (HFMD) in patients aged less than five years.@*Methods@#A stratified sampling method was used to collect data on severe HFMD cases reported in the National HFMD surveillance database between Jan 1, 2012, and Dec 31, 2013. The sampling was referenced with the national aetiologic distribution of Enterovirus A71 (EV-A71), Coxsackievirus A16 (CV-A16) and other Enteroviruses (OEV) for severe HFMD cases and the included cases were distributed among seven geographic regions (Northeast, North China, Northwest, Central China, Southwest, East China and South China). A nationwide telephone interview using a structured questionnaire was conducted to obtain the direct medical cost and any complications that occurred in patients during the outbreak of laboratory-confirmed HFMD. After excluding the cases who could not recall their medical expenses or complications, a total of 685 cases were included in the analysis. Kruskal-Wallis H test was used to analyze the differences among patients who reported different complications. Multiple linear regression with bootstrap analysis of 500 replicates was used to explore the factors that influenced the direct medical costs.@*Results@#Of 685 patients analyzed, 456 (66.6%) were male and 229 (33.4%) were female. The direct medical costs P50 (P25, P75) were 14 250 (10 301, 20 600) Yuan. In total, 127 (18.5%) patients were diagnosed with severe HFMD patients with respiratory disease, 38 (5.5%) patients were diagnosed with aseptic meningitis, and 378 (55.2%) with encephalitis/brainstem encephalitis/acute flaccid paralysis. Furthermore, 53 (18.5%) patients were diagnosed with myocarditis, 39 (5.7%) with pulmonary hemorrhage/pulmonary edema and 50 (7.3%) with cardiopulmonary failure. The median (interquartile range) direct medical costs were 12 360 (7 313, 16 480) Yuan for severe HFMD patients with respiratory disease, 13 803 (9 064, 19 930) Yuan for aseptic meningitis, 14 438 (11 000, 20 015) Yuan for encephalitis/brainstem encephalitis/acute flaccid paralysis, 14 800 (8 500, 21 218) Yuan for myocarditis, 20 600 (12 500, 31 130) Yuan for pulmonary hemorrhage/pulmonary edema, and 20 043 (12 772, 28 840) Yuan for cardiopulmonary failure (H=17.70, P<0.001). The results of multiple linear regression with bootstrap analysis revealed that the direct medical cost for severe HFMD patients from Central China was 7 881 (95% CI: 3 814-11 949) Yuan higher than that of North China; severe HFMD patients diagnosed with OEV had direct medical costs of 1 987 (95%CI: 206-3 769) Yuan less those associated with EV-A71; severe HFMD patients whose duration of illness was ≥21 d had 20 480 (95% CI: 10 985- 29 974) Yuan higher direct medical costs those whose illness lasted ≤5 d; the direct medical costs for severe HFMD patients with pulmonary hemorrhage/pulmonary edema and cardiopulmonary failure were 7 874 (95%CI: 3 723-12 026) and 9 855 (95% CI: 328- 19 382) Yuan higher, respectively, than that associated with respiratory disease.@*Conclusion@#The direct medical costs associated with severe HFMD were found to be substantial. The total cost was affected by the duration of the illness and the severity of any complications.
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Objective To investigate the clinical severity,etiological classification and risk factors of severe cases with hand,foot and mouth disease (HFMD).Methods A total of 1 489 records on severe and fatal HFMD cases reported to the national pilot surveillance system of HFMD were used to analyze the demographic,medical treatment,etiological classification of the cases.Treatment outcome related risk factors were also studied with multi-variable stepwise logistic regression method.Results Seven out of the 1 489 severe HFMD cases died of this disease.A total of 960 (72.9％) were under three years old and 62.9％ were male and most of the cases (937,62.9％) resided in rural areas.Among all the cases,494 (33.2％) went to seek the first medical assistance at the institutions of village or township level.Durations between disease onset and first medical attendance,being diagnosed as the disease or diagnosed as severe cases were 0(0-1) d,1 (0-2) d and 2 (1-4) d,respectively.In total,773 (51.9％) of the severe HFMD cases were diagnosed as with aseptic meningitis,260 (17.5％) with brainstem encephalitis,377 (25.3 ％) with non-brainstem encephalitis,6 (0.4％) with encephalomyelitis,1 (0.1％) with acute flaccid paralysis,4 (0.3％) with pulmonary hemorrhage/pulmonary edema and 68 (4.6％) with cardiopulmonary failure.Of the etiologically diagnosed 1 217 severe and fatal HFMD cases,642 (52.8％) were with EV71,other enterovirus 261 (21.5％),Cox A16 36 (3.0％),1 (0.1％) with both EV71 and Cox A16.However,277 (22.8％) showed negative on any pathogenic virus.Complication (Z=3.15,P=0.002) and duration between onset and diagnosed as severe cases (Z=3.95,P＜0.001) were shown as key factors related to treatment outcomes.Conclusions Most severe HFMD cases appeared in boys,especially living in the rural areas.Frequently seen complications would include aseptic meningitis,non-brainstem encephalitis and brainstem encephalitis.EV71 was the dominant etiology for severe and fatal cases.Early diagnosis and complication control were crucial,related to the treatment outcome of HFMD.
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Objective Through analyzing the surveillance data on typhoid fever and paratyphoid fever in 2015 to understand the related epidemiological features and most possible clustering areas of high incidence.Methods Individual data was collected from the passive surveillance program and analyzed by descriptive statistic method.Characteristics on seasonal,regional and distribution of the diseases were described.Spatial-temporal clustering characteristics were estimated,under the retrospective space-time method.Results A total of 8 850 typhoid fever cases were reported from the surveillance system,with incidence rate as 0.65/100 000.The number of paratyphoid fever cases was 2 794,with incidence rate as 0.21/100 000.Both cases of typhoid fever and paratyphoid fever occurred all year round,with high epidemic season from May to October.Most cases involved farmers (39.68％),children (15.89％) and students (12.01％).Children under 5 years showed the highest incidence rate.Retrospective space-time analysis for provinces with high incidence rates would include Yurnan,Guangxi,Guizhou,Hunan and Guangdong,indicating the first and second class clusters were mainly distributed near the bordering adjacent districts and counties among the provinces.Conclusion In 2015,the prevalence rates of typhoid fever and paratyphoid fever were low,however with regional high prevalence areas.Cross regional transmission existed among provinces with high incidence rates which might be responsible for the clusters to appear in these areas.
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Objective To evaluate the health related quality of life (HRQoL) for severe hand,foot and mouth disease (HFMD) patients with different complications.Methods A national telephone interview under the EQ-5D proxy2 questionnaire (EQ-SD and EQ-VAS),was conducted to obtain the HRQoL of lab-confirmed severe HFMD patients,aged between six months and five-year-olds from the national communicable disease surveillance system from January 1,2012 to December 31,2013.Results A total of 685 severe HFMD cases were included in the study.A total of 456 (66.6％) of them were males with 75.8％ of them younger than three years old.A total of 337 (49.2％) and 407 (59.4％) of the participants reported that they had problems in mobility or daily activities.A total of 569 (83.1％) and 616 (89.9％) of the cases reported having problems in pain/discomfort or anxiety/depression.The average EQ-5D and EQ-VAS scores were 0.58 ± 0.23 and 53.6 ± 25.7,both were positively associated with the duration of illness.Mean quality adjusted life years loss during the HFMD episode for the severe patients was (15.45 ± 13.75) years/1 000 persons.The QALY losses for severe patients with each of below complication were:respiratory diseases (11.17 ± 8.83) years/1 000 persons,aseptic meningitis (13.56 ± 11.99) years/1 000 persons,encephalitis/brainstem encephalitis/acute flaccid paralysis (AFP) (15.31 ± 12.63) years/1 000 persons,Myocarditis (17.28 ± 18.16) years/1 000 persons,pulmonary hemorrhage/pulmonary edema (17.34 ±14.98) years/1 000 persons,cardiopulmonary failure (25.47 ± 20.53) years/1 000 persons.Among patients with lab confirmed Entero virus A71 (EV71) (16.51 ± 14.48) years/l 000 persons,the QALY loss was seen higher than Coxsackie virus A16 (Cox A16) (13.02± 11.45) years/1 000 persons and other Enter virus (14.74 ± 14.22) years/1 000 persons (Z=11.83,P=0.003).Conclusion The HRQoL loss for severe HFMD patients substantially increased under complications exacerbation and related to the duration of illness.
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Objective To investigate the clinical severity,etiological classification and risk factors of severe cases with hand,foot and mouth disease (HFMD).Methods A total of 1 489 records on severe and fatal HFMD cases reported to the national pilot surveillance system of HFMD were used to analyze the demographic,medical treatment,etiological classification of the cases.Treatment outcome related risk factors were also studied with multi-variable stepwise logistic regression method.Results Seven out of the 1 489 severe HFMD cases died of this disease.A total of 960 (72.9％) were under three years old and 62.9％ were male and most of the cases (937,62.9％) resided in rural areas.Among all the cases,494 (33.2％) went to seek the first medical assistance at the institutions of village or township level.Durations between disease onset and first medical attendance,being diagnosed as the disease or diagnosed as severe cases were 0(0-1) d,1 (0-2) d and 2 (1-4) d,respectively.In total,773 (51.9％) of the severe HFMD cases were diagnosed as with aseptic meningitis,260 (17.5％) with brainstem encephalitis,377 (25.3 ％) with non-brainstem encephalitis,6 (0.4％) with encephalomyelitis,1 (0.1％) with acute flaccid paralysis,4 (0.3％) with pulmonary hemorrhage/pulmonary edema and 68 (4.6％) with cardiopulmonary failure.Of the etiologically diagnosed 1 217 severe and fatal HFMD cases,642 (52.8％) were with EV71,other enterovirus 261 (21.5％),Cox A16 36 (3.0％),1 (0.1％) with both EV71 and Cox A16.However,277 (22.8％) showed negative on any pathogenic virus.Complication (Z=3.15,P=0.002) and duration between onset and diagnosed as severe cases (Z=3.95,P＜0.001) were shown as key factors related to treatment outcomes.Conclusions Most severe HFMD cases appeared in boys,especially living in the rural areas.Frequently seen complications would include aseptic meningitis,non-brainstem encephalitis and brainstem encephalitis.EV71 was the dominant etiology for severe and fatal cases.Early diagnosis and complication control were crucial,related to the treatment outcome of HFMD.
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Objective Through analyzing the surveillance data on typhoid fever and paratyphoid fever in 2015 to understand the related epidemiological features and most possible clustering areas of high incidence.Methods Individual data was collected from the passive surveillance program and analyzed by descriptive statistic method.Characteristics on seasonal,regional and distribution of the diseases were described.Spatial-temporal clustering characteristics were estimated,under the retrospective space-time method.Results A total of 8 850 typhoid fever cases were reported from the surveillance system,with incidence rate as 0.65/100 000.The number of paratyphoid fever cases was 2 794,with incidence rate as 0.21/100 000.Both cases of typhoid fever and paratyphoid fever occurred all year round,with high epidemic season from May to October.Most cases involved farmers (39.68％),children (15.89％) and students (12.01％).Children under 5 years showed the highest incidence rate.Retrospective space-time analysis for provinces with high incidence rates would include Yurnan,Guangxi,Guizhou,Hunan and Guangdong,indicating the first and second class clusters were mainly distributed near the bordering adjacent districts and counties among the provinces.Conclusion In 2015,the prevalence rates of typhoid fever and paratyphoid fever were low,however with regional high prevalence areas.Cross regional transmission existed among provinces with high incidence rates which might be responsible for the clusters to appear in these areas.
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Objective To evaluate the health related quality of life (HRQoL) for severe hand,foot and mouth disease (HFMD) patients with different complications.Methods A national telephone interview under the EQ-5D proxy2 questionnaire (EQ-SD and EQ-VAS),was conducted to obtain the HRQoL of lab-confirmed severe HFMD patients,aged between six months and five-year-olds from the national communicable disease surveillance system from January 1,2012 to December 31,2013.Results A total of 685 severe HFMD cases were included in the study.A total of 456 (66.6％) of them were males with 75.8％ of them younger than three years old.A total of 337 (49.2％) and 407 (59.4％) of the participants reported that they had problems in mobility or daily activities.A total of 569 (83.1％) and 616 (89.9％) of the cases reported having problems in pain/discomfort or anxiety/depression.The average EQ-5D and EQ-VAS scores were 0.58 ± 0.23 and 53.6 ± 25.7,both were positively associated with the duration of illness.Mean quality adjusted life years loss during the HFMD episode for the severe patients was (15.45 ± 13.75) years/1 000 persons.The QALY losses for severe patients with each of below complication were:respiratory diseases (11.17 ± 8.83) years/1 000 persons,aseptic meningitis (13.56 ± 11.99) years/1 000 persons,encephalitis/brainstem encephalitis/acute flaccid paralysis (AFP) (15.31 ± 12.63) years/1 000 persons,Myocarditis (17.28 ± 18.16) years/1 000 persons,pulmonary hemorrhage/pulmonary edema (17.34 ±14.98) years/1 000 persons,cardiopulmonary failure (25.47 ± 20.53) years/1 000 persons.Among patients with lab confirmed Entero virus A71 (EV71) (16.51 ± 14.48) years/l 000 persons,the QALY loss was seen higher than Coxsackie virus A16 (Cox A16) (13.02± 11.45) years/1 000 persons and other Enter virus (14.74 ± 14.22) years/1 000 persons (Z=11.83,P=0.003).Conclusion The HRQoL loss for severe HFMD patients substantially increased under complications exacerbation and related to the duration of illness.
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Objective To estimate the indirect economic burden of disease-related premature deaths in China,2012.Methods Both human capital approach and friction cost methods were used to compute the indirect economic burden of premature deaths from the following sources:mortality from the national disease surveillance system in 2012,average annual income per capita from the China Statistic Yearbook in 2012,population size from the 2010 China census,and life expectancy in China from the World Health Organization life table.Results Data from the Human Capital Approach Estimates showed that the indirect economic burden of premature deaths in China was 425.1 billion in 2012,accounting for 8‰ of the GDP.The indirect economic burden of chronic non-communicable diseases associated premature deaths was accounted for the highest proportion (67.1％,295.4 billion),followed by those of injuries related premature deaths (25.6％,108.9 billion),infectious diseases,maternal and infants diseases,and malnutrition related deaths (6.4％,26.9 billion).The top five premature deaths that cause the indirect economic burden were malignancy,cardiovascular diseases,unintentional injuries,intentional injuries,and diseases of the respiratory system.The indirect economic burden of premature deaths mainly occurred in the population of 20-59 year-olds.Under the Friction Cost method,the estimates appeared to be 0.11％-3.49％ of the total human capital approach estimates.Conclusion Premature death caused heavy indirect economic burden in China.Chronic non-communicable diseases and injuries seemed to incur the major disease burden.The indirect economic burden of premature deaths mainly occurred in the working age group.
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Objective To undertake a systematic review of the economic burden of diabetes in China.Methods Published literatures about the medical cost and economic burden of diabetes in China were searched for analyzing the methodologies and results.Results Altogether 374 articles were identified in the literatures.Review of the articles resulted in the identification of 40 of these that met all criteria.Cost of illness studies and hospitalization expenditure per admission comprised the largest source of the studies.Cost of illness approach,calculations from the national survey's data and the matching method were adopted in most researches and led to variations of result.Conclusions Differences in research methods are the key determinants of variations of the result.Even the same method with different data sources,patient types or investigating spots still contributes to great variations.Without well-accepted standards to guide researchers in their execution of these studies,policymakers and the general publicmust be wary of the methods and data source used in their calculation and subsequent results.