Cost of illness of the vaccine-preventable diseases influenza, herpes zoster and pneumococcal disease in France.

BACKGROUND: The incidence of certain vaccine-preventative diseases, such as influenza, herpes zoster and pneumococcal infection, continues to be high despite the availability of vaccines, resulting in a substantial health and economic burden on society, particularly among older adults aged ≥65 years. METHODS: A cost calculator was developed to assess the cost of illness of influenza, herpes zoster and pneumococcal disease in France. Direct medical costs related to diagnosis and treatment in the older adult population in both inpatient and outpatient settings were modelled over a 1-year time horizon. Scenario analyses were conducted to determine the impact of hospitalizations on the results by considering only influenza-attributed diagnoses. RESULTS: In France, influenza has the highest incidence, followed by herpes zoster and pneumococcal disease. Similarly, influenza poses the greatest cost burden among all older adults, while pneumococcal disease poses the greatest cost burden among those aged 65-74 years. When considering only influenza-attributed diagnoses, the number of inpatient visits and associated costs was reduced by 63% in the overall older adult population. In the low-incidence season, the number of inpatient visits and associated costs were reduced by 69%, while in the high-incidence season, the number of inpatient visits and associated costs increased by 63%. CONCLUSION: Influenza remains a leading vaccine-preventable disease among older adults in France, resulting in a substantial economic burden that could be prevented by increasing vaccine uptake.

Identification of an Optimal COVID-19 Booster Allocation Strategy to Minimize Hospital Bed-Days with a Fixed Healthcare Budget.

Healthcare decision-makers face difficult decisions regarding COVID-19 booster selection given limited budgets and the need to maximize healthcare gain. A constrained optimization (CO) model was developed to identify booster allocation strategies that minimize bed-days by varying the proportion of the eligible population receiving different boosters, stratified by age, and given limited healthcare expenditure. Three booster options were included: B1, costing US $1 per dose, B2, costing US $2, and no booster (NB), costing US $0. B1 and B2 were assumed to be 55%/75% effective against mild/moderate COVID-19, respectively, and 90% effective against severe/critical COVID-19. Healthcare expenditure was limited to US$2.10 per person; the minimum expected expense using B1, B2, or NB for all. Brazil was the base-case country. The model demonstrated that B1 for those aged <70 years and B2 for those ≥70 years were optimal for minimizing bed-days. Compared with NB, bed-days were reduced by 75%, hospital admissions by 68%, and intensive care unit admissions by 90%. Total costs were reduced by 60% with medical resource use reduced by 81%. This illustrates that the CO model can be used by healthcare decision-makers to implement vaccine booster allocation strategies that provide the best healthcare outcomes in a broad range of contexts.

Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children.

Pneumococcal conjugate vaccines (PCVs) have been used in the United States since 2000. To assess the cumulative 20-year effect of PCVs on invasive pneumococcal disease (IPD) incidence among children <5 years of age, we analyzed Active Bacterial Core Surveillance data, conducted a literature review, and modeled expected and observed disease. We found that PCVs have averted >282,000 cases of IPD, including ≈16,000 meningitis, ≈172,000 bacteremia, and ≈55,000 bacteremic pneumonia cases. In addition, vaccination has prevented 97 million healthcare visits for otitis media, 438,914-706,345 hospitalizations for pneumonia, and 2,780 total deaths. IPD cases declined 91%, from 15,707 in 1997 to 1,382 in 2019. Average annual visits for otitis media declined 41%, from 78 visits/100 children before PCV introduction to 46 visits/100 children after PCV13 introduction. Annual pneumonia hospitalizations declined 66%-79%, from 110,000-175,000 in 1997 to 37,000 in 2019. These findings confirm the substantial benefits of PCVs for preventing IPD in children.

Ten year public health impact of 13-valent pneumococcal conjugate vaccination in infants: A modelling analysis.

Pneumococcal disease is a substantial contributor to illness and death in young children globally. The introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 had a significant impact in preventing pneumococcal disease in both vaccinated children and unvaccinated individuals (through herd effect). A higher valent PCV13 replaced PCV7 in late 2009. This analysis was undertaken to assess how many cases and deaths have been averted over the last decade since PCV13 introduction. A model estimated the number of infants vaccinated annually with PCV13, as well as the number of cases and deaths of invasive pneumococcal disease, pneumococcal pneumonia, and acute otitis media cases averted. PCV13 vaccination was estimated to have prevented 175.2 million cases of all pneumococcal diseases and 624,904 deaths globally between 2010 and 2019. These results demonstrate the substantial public health impact of PCV13 and highlight the importance of increasing the global reach of PCV programs.

Weight Loss Associated With Employee Income in an Incentivized Employee Wellness Program.

OBJECTIVE: We examined the relationship between the type of incentivized wellness program and employee weight loss and the effects of participant income. METHODS: We retrospectively examined employees who participated in one of six weight loss wellness programs, which were categorized for the present analysis: reweigh/body mass index, Coaching, and Weight Watchers/Meal Replacement. Those who participated were eligible for a $350/year insurance premium discount. RESULTS: Employees in the low-income category of $45K or less participated at a higher rate, however, did not lose as much weight as those participants in the higher income categories of $70K or more. We found a positive association with weight loss in two of the categories, reweigh/body mass index, and Weight Watchers/Meal Replacement programs. CONCLUSION: Wellness programs have a significant impact on employee weight loss, but this relationship may vary across the income level of participants.

STI-GMaS: an open-source environment for simulation of sexually-transmitted infections.

BACKGROUND: Sexually-transmitted pathogens often have severe reproductive health implications if treatment is delayed or absent, especially in females. The complex processes of disease progression, namely replication and ascension of the infection through the genital tract, span both extracellular and intracellular physiological scales, and in females can vary over the distinct phases of the menstrual cycle. The complexity of these processes, coupled with the common impossibility of obtaining comprehensive and sequential clinical data from individual human patients, makes mathematical and computational modelling valuable tools in developing our understanding of the infection, with a view to identifying new interventions. While many within-host models of sexually-transmitted infections (STIs) are available in existing literature, these models are difficult to deploy in clinical/experimental settings since simulations often require complex computational approaches. RESULTS: We present STI-GMaS (Sexually-Transmitted Infections - Graphical Modelling and Simulation), an environment for simulation of STI models, with a view to stimulating the uptake of these models within the laboratory or clinic. The software currently focuses upon the representative case-study of Chlamydia trachomatis, the most common sexually-transmitted bacterial pathogen of humans. Here, we demonstrate the use of a hybrid PDE-cellular automata model for simulation of a hypothetical Chlamydia vaccination, demonstrating the effect of a vaccine-induced antibody in preventing the infection from ascending to above the cervix. This example illustrates the ease with which existing models can be adapted to describe new studies, and its careful parameterisation within STI-GMaS facilitates future tuning to experimental data as they arise. CONCLUSIONS: STI-GMaS represents the first software designed explicitly for in-silico simulation of STI models by non-theoreticians, thus presenting a novel route to bridging the gap between computational and clinical/experimental disciplines. With the propensity for model reuse and extension, there is much scope within STI-GMaS to allow clinical and experimental studies to inform model inputs and drive future model development. Many of the modelling paradigms and software design principles deployed to date transfer readily to other STIs, both bacterial and viral; forthcoming releases of STI-GMaS will extend the software to incorporate a more diverse range of infections.

A mathematical model of chlamydial infection incorporating movement of chlamydial particles.

We present a spatiotemporal mathematical model of chlamydial infection, host immune response, and movement of infectious particles. The resulting partial differential equations model both the dynamics of the infection and changes in infection profile observed spatially along the length of the host genital tract. This model advances previous Chlamydia modelling by incorporating spatial change. Numerical solutions and model analysis are carried out, and we present a hypothesis regarding the potential for treatment and prevention of infection by increasing chlamydial particle motility.

Changes in maternal sensitivity across the first three years: are mothers from different attachment dyads differentially influenced by depressive symptomatology?

Hierarchical linear modeling was used to describe longitudinal relations between maternal sensitivity and depressive symptomatology for mothers of children with differing attachment classifications at 36 months of child age using data from the NICHD Study of Early Child Care. Attachment during toddlerhood was assessed using a modified Strange Situation Paradigm developed by the MacArthur Working Group on Attachment. On average, maternal sensitivity increased longitudinally from 6 to 36 months for groups with children classified as secure or resistant, but not for groups classified as avoidant or disorganized. Higher maternal depressive symptoms were associated with lower levels of sensitivity for all mothers, although this effect was significantly less severe for mothers of securely attached children. In addition, higher maternal depressive symptoms were associated with decreases in sensitivity from 6 to 36 months for mothers of children who at 36 months showed disorganized attachments combined with underlying patterns of avoidant or resistant behavior.

Infant and parent factors associated with early maternal sensitivity: a caregiver-attachment systems approach.

We examined variations in maternal sensitivity at 6 months of child age as a function of child negativity and maternal physiology. We expected maternal vagal withdrawal in response to infant negative affect to facilitate the maintenance of sensitivity, but only for mothers of securely attached children. One hundred and forty-eight infant-mother dyads were observed in multiple contexts at 6 months of child age, and associations among maternal and child variables were examined with respect to 12-month attachment quality. Mothers of later securely attached children were more sensitive than mothers of avoidant children. However, sensitivity decreased for all mothers at high levels of infant negative affect. Furthermore, for mothers of avoidant children, vagal withdrawal was associated with sensitivity to child distress. No association was found between vagal withdrawal and sensitivity for mothers of securely attached children. This suggests that mothers of avoidant children may be uniquely challenged by the affective demands of their infants.

Altered diurnal pattern of salivary substance P in adults with developmental disabilities and chronic self-injury.

Morning and afternoon salivary substance P and cortisol levels were measured in 26 adults with chronic self-injurious behavior (SIB) and severe developmental disabilities and compared with matched controls without SIB. Chronic SIB was associated with an altered diurnal pattern of salivary substance P relative to matched controls, characterized primarily by lower levels of morning substance P, which were significantly correlated with overall severity of SIB. There was a trend for SIB subjects to exhibit higher levels of cortisol, which was significantly correlated with overall severity of SIB. These results support a model of altered nociception and possible stress-induced analgesia among individuals with developmental disability and chronic SIB.