The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies.

BACKGROUND: Hepatitis A (HepA) vaccines are recommended for US adults at risk of HepA. Ongoing United States (US) HepA outbreaks since 2016 have primarily spread person-to-person, especially among at-risk groups. We investigated the health outcomes, economic burden, and outbreak management considerations associated with HepA outbreaks from 2016 onwards. METHODS: A systematic literature review was conducted to assess HepA outbreak-associated health outcomes, health care resource utilization (HCRU), and economic burden. A targeted literature review evaluated HepA outbreak management considerations. RESULTS: Across 33 studies reporting on HepA outbreak-associated health outcomes/HCRU, frequently reported HepA-related morbidities included acute liver failure/injury (n = 6 studies of 33 studies) and liver transplantation (n = 5 of 33); reported case fatality rates ranged from 0% to 10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6% to 84.8%. Ten studies reported on outbreak-associated economic burden, with a national study reporting an average cost of over $16 000 per hospitalization. Thirty-four studies reported on outbreak management; challenges included difficulty reaching at-risk groups and vaccination distrust. Successes included targeted interventions and increasing public awareness. CONCLUSIONS: This review indicates a considerable clinical and economic burden of ongoing US HepA outbreaks. Targeted prevention strategies and increased public awareness and vaccination coverage are needed to reduce HepA burden and prevent future outbreaks.

The macroeconomic impact of a dengue outbreak: Case studies from Thailand and Brazil.

BACKGROUND: Dengue is spreading in (sub)tropical areas, and half of the global population is at risk. The macroeconomic impact of dengue extends beyond healthcare costs. This study evaluated the impact of dengue on gross domestic product (GDP) based on approaches tailored to two dengue-endemic countries, Thailand and Brazil, from the tourism and workforce perspectives, respectively. FINDINGS: Because the tourism industry is a critical economic sector for Thailand, lost tourism revenues were estimated to analyze the impact of a dengue outbreak. An input-output model estimated that the direct effects (on international tourism) and indirect effects (on suppliers) of dengue on tourism reduced overall GDP by 1.43 billion US dollars (USD) (0.26%) in the outbreak year 2019. The induced effect (reduced employee income/spending) reduced Thailand's GDP by 375 million USD (0.07%). Overall, lost tourism revenues reduced Thailand's GDP by an estimated 1.81 billion USD (0.33%) in 2019 (3% of annual tourism revenue). An inoperability input-output model was used to analyze the effect of workforce absenteeism on GDP due to a dengue outbreak in Brazil. This model calculates the number of lost workdays associated with ambulatory and hospitalized dengue. Input was collected from state-level epidemiological and economic data for 2019. An estimated 22.4 million workdays were lost in the employed population; 39% associated with the informal sector. Lost workdays due to dengue reduced Brazil's GDP by 876 million USD (0.05%). CONCLUSIONS: The economic costs of dengue outbreaks far surpass the direct medical costs. Dengue reduces overall GDP and inflicts national economic losses. With a high proportion of the population lacking formal employment in both countries and low income being a barrier to seeking care, dengue also poses an equity challenge. A combination of public health measures, like vector control and vaccination, against dengue is recommended to mitigate the broader economic impact of dengue.

Understanding the uneven spread of COVID-19 in the context of the global interconnected economy.

The worldwide spread of the COVID-19 pandemic is a complex and multivariate process differentiated across countries, and geographical distance is acceptable as a critical determinant of the uneven spreading. Although social connectivity is a defining condition for virus transmission, the network paradigm in the study of the COVID-19 spatio-temporal spread has not been used accordingly. Toward contributing to this demand, this paper uses network analysis to develop a multidimensional methodological framework for understanding the uneven (cross-country) spread of COVID-19 in the context of the globally interconnected economy. The globally interconnected system of tourism mobility is modeled as a complex network and studied within the context of a three-dimensional (3D) conceptual model composed of network connectivity, economic openness, and spatial impedance variables. The analysis reveals two main stages in the temporal spread of COVID-19, defined by the cutting-point of the 44th day from Wuhan. The first describes the outbreak in Asia and North America, the second stage in Europe, South America, and Africa, while the outbreak in Oceania intermediates. The analysis also illustrates that the average node degree exponentially decays as a function of COVID-19 emergence time. This finding implies that the highly connected nodes, in the Global Tourism Network (GTN), are disproportionally earlier infected by the pandemic than the other nodes. Moreover, countries with the same network centrality as China are early infected on average by COVID-19. The paper also finds that network interconnectedness, economic openness, and transport integration are critical determinants in the early global spread of the pandemic, and it reveals that the spatio-temporal patterns of the worldwide spreading of COVID-19 are more a matter of network interconnectivity than of spatial proximity.

Sector-by-sector analysis of dependence dynamics between global large-cap companies and infectious diseases: A time-varying copula approach in EBOV and COVID-19 episodes.

Infectious diseases and widespread outbreaks influence different sectors of the economy, including the stock market. In this article, we investigate the effect of EBOV and COVID-19 outbreaks on stock market indices. We employ time-varying and constant bivariate copula methods to measure the dependence structure between the infectious disease equity market volatility index (IEMV) and the stock market indices of several sectors. The results show that the financial and communication services sectors have the highest and the lowest negative dependency on IEMV during the Ebola virus (EBOV) pandemic, respectively. However, the health care and energy sectors have the highest and lowest negative dependency on IEMV during the COVID-19 outbreak, respectively. Therefore, the results confirm the heterogeneous time-varying dependency between infectious diseases and the stock market indices. The finding of our study contributes to the ongoing literature on the impact of disease outbreaks, especially the novel coronavirus outbreak on global large-cap companies in the stock market.

How Much Money Should be Paid for a Patient to Isolate During the COVID-19 Outbreak? A Discrete Choice Experiment in Iran.

INTRODUCTION: Isolation of COVID-19 patients is a vital strategy for preventing the spread of the virus. Isolation without any incentive or compensation for the patients cannot be effective. We sought to find the monetary value of the willingness to accept (WTA) being isolated for COVID-19 in Iran. METHODS: In this discrete choice experiment, scenarios were designed by reviewing the literature and semi-structural interviews. Fourteen choice sets with two scenarios were included in an internet-based questionnaire that was sent to the Telegram Social Network. A total of 617 individuals completed the questionnaire. A random-effects logistic regression model was used for the main analysis. RESULTS: The average monetary value of a WTA 7 days of isolation was US$51.71 (95% confidence interval [CI] 43.09-60.33). The WTA for one day of isolation was US$1.48 (95% CI 1.11-1.85) for unemployed groups, US$1.49 (95% CI 1.18-1.79) for office employees and US$1.36 (95% CI 0.73-2.01) for manual workers. The WTA was 0.44 (95% CI 0.35-0.53) US$ for low-income groups, US$0.68 (95% CI 0.52-0.84) for middle-income groups and US$0.77 (95% CI 0.35-1.18) for high-income groups. CONCLUSIONS: Our findings suggested that financial preferences for being isolated vary widely across individuals within different socioeconomic groups. Policymakers should consider these differences when designing effective intervention to increase compliance with the isolation protocols during infectious disease outbreaks.

A systematic examination of international funding flows for Ebola virus and Zika virus outbreaks 2014-2019: donors, recipients and funding purposes.

INTRODUCTION: There has been no systematic comparison of how the policy response to past infectious disease outbreaks and epidemics was funded. This study aims to collate and analyse funding for the Ebola epidemic and Zika outbreak between 2014 and 2019 in order to understand the shortcomings in funding reporting and suggest improvements. METHODS: Data were collected via a literature review and analysis of financial reporting databases, including both amounts donated and received. Funding information from three financial databases was analysed: Institute of Health Metrics and Evaluation's Development Assistance for Health database, the Georgetown Infectious Disease Atlas and the United Nations Financial Tracking Service. A systematic literature search strategy was devised and applied to seven databases: MEDLINE, EMBASE, HMIC, Global Health, Scopus, Web of Science and EconLit. Funding information was extracted from articles meeting the eligibility criteria and measures were taken to avoid double counting. Funding was collated, then amounts and purposes were compared within, and between, data sources. RESULTS: Large differences between funding reported by different data sources, and variations in format and methodology, made it difficult to arrive at precise estimates of funding amounts and purpose. Total disbursements reported by the databases ranged from $2.5 to $3.2 billion for Ebola and $150-$180 million for Zika. Total funding reported in the literature is greater than reported in databases, suggesting that databases may either miss funding, or that literature sources overreport. Databases and literature disagreed on the main purpose of funding for socioeconomic recovery versus outbreak response. One of the few consistent findings across data sources and diseases is that the USA was the largest donor. CONCLUSION: Implementation of several recommendations would enable more effective mapping and deployment of outbreak funding for response activities relating to COVID-19 and future epidemics.

Effects of Pandemic Outbreak on Economies: Evidence From Business History Context.

The coronavirus pandemic has highlighted the capitalist dysfunction showing that considering profit over people can be deadly. The study reveals the LME economies were more responsive toward the impact of the disease outbreaks as compared to the CME economies wherein the impact of the disease was moderated by the government involvement. This allows us to draw that the impact of the disease outbreaks can be moderated by increasing the involvement of the government authorities.

Societal Costs of a Measles Outbreak.

BACKGROUND AND OBJECTIVES: Between December 31, 2018, and April 26, 2019, 72 confirmed cases of measles were identified in Clark County. Our objective was to estimate the economic burden of the measles outbreak from a societal perspective, including public health response costs as well as direct medical costs and productivity losses of affected individuals. METHODS: To estimate costs related to this outbreak from the societal perspective, 3 types of costs were collected or estimated: public health response (labor, material, and contractor costs used to contain the outbreak), direct medical (third party or patient out-of-pocket treatment costs of infected individuals), and productivity losses (costs of lost productivity due to illness, home isolation, quarantine, or informal caregiving). RESULTS: The overall societal cost of the 2019 Clark County measles outbreak was ∼$3.4 million ($47 479 per case or $814 per contact). The majority of the costs (∼$2.3 million) were incurred by the public health response to the outbreak, followed by productivity losses (∼$1.0 million) and direct medical costs (∼$76 000). CONCLUSIONS: Recent increases in incident measles cases in the United States and across the globe underscore the need to more fully understand the societal cost of measles cases and outbreaks and economic consequences of undervaccination. Our estimates can provide valuable inputs for policy makers and public health stakeholders as they consider budget determinations and the substantial value associated with increasing vaccine coverage and outbreak preparedness as well as the protection of society against vaccine-preventable diseases, such as measles, which are readily preventable with high vaccination coverage.

Challenges related to resources mobilization for measles outbreak response: Madagascar experience during the 2018-2019 measles outbreak.

INTRODUCTION: on October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes challenges related to resources mobilization for the outbreak response. METHODS: data were collected using minutes of coordination committee meetings, activities reports, operational action plans and situation reports. RESULTS: the total cost of the outbreak response was estimated to US$ 11,281,381. Operational cost was the leading cost driver (42.45%) followed by vaccine cost (33.74%). Cases management, epidemiological surveillance, communication and social mobilization and routine immunization strengthening represented 23.81% of the total cost. The main funder of the outbreak response was the measles and rubella initiative. CONCLUSION: good coordination, open dialogue, good use of financial resources and accountability of government and partners have enabled to gain the confidence of national and international donors.

Building resilience to mosquito-borne diseases in the Caribbean.

Small island developing states in the Caribbean are among the most vulnerable countries on the planet to climate variability and climate change. In the last 3 decades, the Caribbean region has undergone frequent and intense heat waves, storms, floods, and droughts. This has had a detrimental impact on population health and well-being, including an increase in infectious disease outbreaks. Recent advances in climate science have enhanced our ability to anticipate hydrometeorological hazards and associated public health challenges. Here, we discuss progress towards bridging the gap between climate science and public health decision-making in the Caribbean to build health system resilience to extreme climatic events. We focus on the development of climate services to help manage mosquito-transmitted disease epidemics. There are numerous areas of ongoing biological research aimed at better understanding the direct and indirect impacts of climate change on the transmission of mosquito-borne diseases. Here, we emphasise additional factors that affect our ability to operationalise this biological understanding. We highlight a lack of financial resources, technical expertise, data sharing, and formalised partnerships between climate and health communities as major limiting factors to developing sustainable climate services for health. Recommendations include investing in integrated climate, health and mosquito surveillance systems, building regional and local human resource capacities, and designing national and regional cross-sectoral policies and national action plans. This will contribute towards achieving the Sustainable Development Goals (SDGs) and maximising regional development partnerships and co-benefits for improved health and well-being in the Caribbean.

Piecewise-constant optimal control strategies for controlling the outbreak of COVID-19 in the Irish population.

We introduce a deterministic SEIR model and fit it to epidemiological data for the COVID-19 outbreak in Ireland. We couple the model to economic considerations - we formulate an optimal control problem in which the cost to the economy of the various non-pharmaceutical interventions is minimized, subject to hospital admissions never exceeding a threshold value corresponding to health-service capacity. Within the framework of the model, the optimal strategy of disease control is revealed to be one of disease suppression, rather than disease mitigation.

Impact of COVID-19 outbreak by income: hitting hardest the most deprived.

BACKGROUND: The impact of the 2019 coronavirus disease (COVID-19) has many facets. This ecological study analysed age-standardized incidence rates by economic level in Barcelona. METHODS: We evaluated confirmed cases of COVID-19 in Barcelona (Spain) between 26 February 2020 and 19 April 2020. Districts were classified according to most recent (2017) mean income data. The reference for estimating age-standardized cumulative incidence rates was the 2018 European population. The association between incidence rate and mean income by district was estimated with the Spearman rho. RESULTS: The lower the mean income, the higher the COVID-19 incidence (Spearman rho = 0.83; P value = 0.003). Districts with the lowest mean income had the highest incidence of COVID-19 per 10 000 inhabitants; in contrast, those with the highest income had the lowest incidence. Specifically, the district with the lowest income had 2.5 times greater incidence of the disease, compared with the highest-income district [70 (95% confidence interval 66-73) versus 28 (25-31), respectively]. CONCLUSIONS: The incidence of COVID-19 showed an inverse socioeconomic gradient by mean income in the 10 districts of the city of Barcelona. Beyond healthcare for people with the disease, attention must focus on a health strategy for the whole population, particularly in the most deprived areas.

Modelling the economics of bovine viral diarrhoea virus control in pastoral dairy and beef cattle herds.

Bovine viral diarrhoea virus (BVDV) is a prevalent pathogen in the New Zealand cattle industries, yet few studies to date have evaluated the economics of BVDV in pastoral dairy and beef herds to help inform management decisions. To address this knowledge gap, we developed stochastic individual-based simulation models to represent the transmission dynamics of BVDV in typical spring-calving dairy and beef farms in New Zealand. The models conservatively estimated the direct losses due to a BVDV outbreak at NZ$ 22.22 and NZ$ 41.19 per mixed-age cow per year for a naïve dairy and beef farm, respectively, over a 5-year period. The greatest economic impacts for the dairy farm occurred when persistently infected replacement heifers joined the lactating cow group and caused transient infection of cows to drop in milk production, whereas the greatest impacts for the beef farm was through the loss of fattening stock for sale due to lowered pregnancy rates. Various combinations of diagnostic testing, vaccination, and biosecurity measures were then explored to evaluate the cost-efficiency of different strategies for controlling BVDV at the farm-level. Providing farmers with the estimates of economic impacts of BVDV in their herds may further encourage the uptake of control measures, but close collaboration with a veterinarian to determine the optimal strategy for their unique farm circumstances is still required.

The Clinical and Economic Burden of Norovirus Gastroenteritis in the United States.

BACKGROUND: Although norovirus outbreaks periodically make headlines, it is unclear how much attention norovirus may receive otherwise. A better understanding of the burden could help determine how to prioritize norovirus prevention and control. METHODS: We developed a computational simulation model to quantify the clinical and economic burden of norovirus in the United States. RESULTS: A symptomatic case generated $48 in direct medical costs, $416 in productivity losses ($464 total). The median yearly cost of outbreaks was $7.6 million (range across years, $7.5-$8.2 million) in direct medical costs, and $165.3 million ($161.1-$176.4 million) in productivity losses ($173.5 million total). Sporadic illnesses in the community (incidence, 10-150/1000 population) resulted in 14 118-211 705 hospitalizations, 8.2-122.9 million missed school/work days, $0.2-$2.3 billion in direct medical costs, and $1.4-$20.7 billion in productivity losses ($1.5-$23.1 billion total). The total cost was $10.6 billion based on the current incidence estimate (68.9/1000). CONCLUSION: Our study quantified norovirus' burden. Of the total burden, sporadic cases constituted >90% (thus, annual burden may vary depending on incidence) and productivity losses represented 89%. More than half the economic burden is in adults ≥45, more than half occurs in winter months, and >90% of outbreak costs are due to person-to-person transmission, offering insights into where and when prevention/control efforts may yield returns.

Analysis of the incidence of acute respiratory diseases in the paediatric population in Poland in the light of the "Health Needs Map".

INTRODUCTION: Statistical data on the structure of acute respiratory diseases incidence in the paediatric population are still scarce. The demand for such data results mainly from the need to constantly implement new systemic and economic solutions. The aim of the study was to attempt to use reported data for an assessment of the incidence of acute respiratory diseases in various age groups. MATERIAL AND METHODS: An analysis of selected acute respiratory diseases was conducted in relation to diagnoses reported from 1 January to 31 December 2014 to the National Health Fund (NFZ, Narodowy Fundusz Zdrowia) in accordance with the codes of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The study was conducted under the Knowledge Education Development operational programme co-funded by the European Social Fund. RESULTS: A total of 101,000 children were hospitalised due to acute respiratory diseases, which amounted to 1,554 hospitalisa-tions per 100.000. The most common causes of hospitalisation were pneumonia and bronchitis/bronchiolitis. Boys were hospital-ised more often in each age group. The shortest average length of stay (ALOS) was 5.21 days and concerned hospitalisation due to bronchitis. The longest length of stay for children was due to tuberculosis (14.3 days). The highest age average of a child was recorded in pleural diseases (10.51 years) and the lowest in bronchitis (2.93 years). Rehospitalisation was necessary in children in whom tuberculosis or pleural diseases were diagnosed (1.43 vs 1.34). A total of 67 inpatient deaths were recorded, of which 19 were due to pneumonia or its complications. CONCLUSIONS: Epidemiological data reported to the National Health Fund (NFZ) seem quite reliable and do not differ significantly from those reported in other European countries. The analysed data may be useful in estimating health needs in paediatrics.

Economic Consequences of the COVID-19 Outbreak: the Need for Epidemic Preparedness.

COVID-19 is not only a global pandemic and public health crisis; it has also severely affected the global economy and financial markets. Significant reductions in income, a rise in unemployment, and disruptions in the transportation, service, and manufacturing industries are among the consequences of the disease mitigation measures that have been implemented in many countries. It has become clear that most governments in the world underestimated the risks of rapid COVID-19 spread and were mostly reactive in their crisis response. As disease outbreaks are not likely to disappear in the near future, proactive international actions are required to not only save lives but also protect economic prosperity.

Recent setbacks in measles elimination: the importance of investing in innovations for immunizations.

The recent setbacks in efforts to achieve measles elimination goals are alarming. To reverse the current trends, it is imperative that the global health community urgently intensify efforts and make resource commitments to implement evidence-based elimination strategies fully, including supporting research and innovations. The Immunization Agenda 2030: A Global Strategy to Leave No One Behind (IA2030) is the new global guidance document that builds on lessons learned and progress made toward the GVAP goals, includes research and innovation as a core strategic priority, and identifies measles as a "tracer" for improving immunisation services and strengthening primary health care systems. To achieve vaccination coverage and equity targets that leave no one behind, and accelerate progress toward disease eradication and elimination goals, sustained and predictable investments are needed for the identified research and innovations priorities for the new decade.

The COVID-19 Outbreak and Affected Countries Stock Markets Response.

This paper evaluates the short-term impact of the coronavirus outbreak on 21 leading stock market indices in major affected countries including Japan, Korea, Singapore, the USA, Germany, Italy, and the UK etc. The consequences of infectious disease are considerable and have been directly affecting stock markets worldwide. Using an event study method, our results indicate that the stock markets in major affected countries and areas fell quickly after the virus outbreak. Countries in Asia experienced more negative abnormal returns as compared to other countries. Further panel fixed effect regressions also support the adverse effect of COVID-19 confirmed cases on stock indices abnormal returns through an effective channel by adding up investors' pessimistic sentiment on future returns and fears of uncertainties.