Effects of a Public Subsidy Program for Mumps Vaccine on Reducing the Disease Burden in Nagoya City, Japan.

Nagoya City initiated a public subsidy program for mumps vaccination using either the Torii or Hoshino strains in August 2010. To determine the effects of the program, we used publicly available information from Nagoya City to investigate the changes in immunization rates and numbers of patients who developed post-immunization adverse reactions, including post-vaccinal aseptic meningitis, in the 7 years since its initiation. We also investigated the numbers of mumps patients reported by sentinel sites in a national database during this period. The immunization rate in one-year-old children increased from 24.3% before the program to 91.0% after 7 years. The mean numbers of reported mumps cases per sentinel site in one-year-old to preschool children-the age groups targeted by the program- were 12.9 in the 7 years before the program and 4.93 in the 7 years after initiation of the program, showing a significant decrease of 1/2.6 (p = 0.01). The number of vaccinations during the 6.5-year period was 140,316, with only one case of aseptic meningitis reported (0.7 cases/100,000 vaccinations). No other serious adverse reactions were observed. The present findings demonstrate that the public subsidy program in Nagoya City is an effective and safe measure against mumps in children.

Economic evaluation of vaccination programme of mumps vaccine to the birth cohort in Japan.

The most common preventative measure against mumps is vaccination with mumps vaccine. In most parts of the world, mumps vaccine is routinely delivered through live attenuated Measles-Mumps-Rubella (MMR) vaccine. In Japan, receiving mumps vaccine is voluntary and vaccine uptake rate is less than 30%. The introduction of mumps vaccine into routine vaccination schedule has become one of the current topics in health policy and has raised the need to evaluate efficient ways in protecting children from mumps-related diseases in Japan. We conducted a cost-effectiveness analysis with Markov model and calculated incremental cost effectiveness ratios (ICERs) of 11 different programmes; a single-dose programme at 12-16 months and 10 two-dose programmes with second dose uptakes at ages 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11. Our base-case analyse set the cost per shot at ¥6951 (US$72; 1US$=96.8). Results show that single-dose programme dominates status quo. On the other hand, ICERs of all 10 two-dose programmes are under ¥6,300,000 (US$65,082) per QALY from payer's perspective while it ranged from cost-saving to <¥7,000,000 (US$72,314) per QALY from societal perspective. By adopting WHO's classification that an intervention is cost-effective if ICER (in QALY) is between one and three times of GDP as a criterion, either of the vaccination programme is concluded as cost-effective from payer's or societal perspectives. Likewise, to uptake second dose at 3-5 years old is more favourable than an uptake at any other age because of lower incremental cost-effectiveness ratios.

Epidemiology and the economic assessment of a mumps outbreak in a highly vaccinated population, Orange County, New York, 2009-2010.

Studies assessing the economic burden of a mumps outbreak in a highly vaccinated population are limited. The Orange County Health Department (OCHD), New York State Department of Health (NYS DOH), and the Centers for Disease Control and Prevention conducted a mumps investigation in an affected village with a highly vaccinated population. To understand the epidemiology, standardized mumps case definition and active surveillance were used to identify mumps cases. In addition, an economic assessment of a combined outbreak investigation and third dose measles-mumps-rubella (MMR) vaccine intervention conducted by OCHD and NYS DOH was performed; estimated by retrospectively evaluating public health response-related activities including use of a third dose of MMR vaccine. From September 24, 2009, through June 15, 2010, 790 mumps cases were reported-64% were male and highest attack rate was among 11-17 year age group (99.1 cases per 1000 individuals). Of the 658 cases with known vaccination history, 83.6% had documentation of 2 doses of mumps containing vaccine. No deaths were reported. The 2 major exposure settings were schools (71.8%) and households (22.5%). Approximately 7736 h of public health personnel time were expended with the total approximate cost of US $463,000, including US $34,392 for MMR vaccine-the estimated cost per household was US $827. Mumps continues to be endemic in many parts of the world, resulting in importations into the United States. Large mumps outbreaks similar to this in highly vaccinated populations may require considerable investigation and control activities.

Economic analysis of measles elimination program in the Republic of Korea, 2001: a cost benefit analysis study.

BACKGROUND: In this study, we modeled the cost benefit analysis for three different measles vaccination strategies based upon three different measles-containing vaccines in Korea, 2001. We employed an economic analysis model using vaccination coverage data and population-based measles surveillance data, along with available estimates of the costs for the different strategies. In addition, we have included analysis on benefit of reduction of complication by mumps and rubella. METHODS: We evaluated four different strategies: strategy 1, keep-up program with a second dose measles-mumps-rubella (MMR) vaccine at 4-6 years without catch-up campaign; strategy 2, additional catch-up campaign with measles (M) vaccine; strategy 3, catch-up campaign with measles-rubella (MR) vaccine; and strategy 4, catch-up campaign with MMR vaccine. The cost of vaccination included cost for vaccines, vaccination practices and other administrative expenses. The direct benefit of estimated using data from National Health Insurance Company, a government-operated system that reimburses all medical costs spent on designated illness in Korea. RESULTS: With the routine one-dose MMR vaccination program, we estimated a baseline of 178,560 measles cases over the 20 years; when the catch-up campaign with M, MR or MMR vaccines was conducted, we estimated the measles cases would decrease to 5936 cases. Among all strategies, the two-dose MMR keep-up program with MR catch-up campaign showed the highest benefit-cost ratio of 1.27 with a net benefit of 51.6 billion KRW. CONCLUSION: Across different vaccination strategies, our finding suggest that MR catch-up campaign in conjunction with two-dose MMR keep-up program was the most appropriate option in terms of economic costs and public health effects associated with measles elimination strategy in Korea.

[Cost-effectiveness analysis of routine mumps immunization in Japan].

OBJECTIVE: Mumps immunization is not included in routine immunization in Japan. We measured the cost-effectiveness of routine immunization. METHODS: We surveyed outpatients prospectively from June 15, 2004, for 19 months in an area with a population of 100,000. Almost all of the 11 pediatric clinics and hospitals in this area cooperated. In 2006, we retrospectively surveyed all inpatients hospitalized for more than 24 hours and dying of mumps. RESULTS: We collected data from 189 doctors who rated outpatients and 112 families. The disease burden for outpatients including family nursing was estimated to be 47.1 billion yen nationwide. We estimated the total number of inpatients as 4,596. The disease burden of inpatients including the cost of family nursing was estimated to be 1.35 billion yen. Adding cases of sequelae and death, the total disease burden was estimated to be 52.5 billion yen. The incremental benefit cost ratio for routine immunization is higher than 1 even in the lower bounds of the 95% confidence interval. DISCUSSION AND CONCLUSIONS: The incremental benefit cost ratio shows that the additional benefit due to routine immunization exceeds additional cost, emphasizing the benefits of routine mumps immunization.

Mumps vaccine virus strains and aseptic meningitis.

Mumps immunization can easily be included in national schedules, particularly if combined with measles or measles and rubella vaccines, but debate continues concerning the relative safety of various licensed mumps vaccine strains. The opportunities for control of mumps are also being affected by differences in the cost of the vaccines prepared with different strains of mumps virus. The present report evaluates available data on the association of the Urabe and other strains of mumps vaccine with the occurrence of aseptic meningitis. We also review the comparative immunogenicity and efficacies of the most widely used mumps vaccines in controlled clinical trials and field evaluations, and briefly examine relative cost as it relates to the implementation of national immunization programs. We conclude that extensive experience with the most widely used mumps vaccine strains in many countries has shown that the risk-benefit ratio of live mumps vaccines is highly favourable for vaccination, despite the occasional occurence of aseptic meningitis.

Are vaccination rates higher if providers receive free vaccines and follow contraindication guidelines?

BACKGROUND AND OBJECTIVES: Economics has been suggested as a barrier to vaccination, but data that link clinician reports to actual immunization rates are limited. This study examined the relationship between clinicians' self-report regarding likelihood of vaccinating and actual age at vaccination from a registry of children seen by the clinicians. METHODS: Standardized telephone survey results of 29 providers were compared to the immunization records of children seeing these providers, using analysis of contingency tables (on time versus late) and conditional hierarchical linear models with log age at diphtheria-tetanus-pertussis (DTP)#3, DTP#4, and measles-mumps-rubella (MMR)#1 as the dependent variables. RESULTS: Children seeing providers likely to refer an uninsured child for immunization were vaccinated at a later log age at DTP#4 but not for DTP#3 or MMR#1 than children seeing providers unlikely to refer. Vaccination rates were higher for MMR#1 (77% versus 48%), DTP#3 (84% versus 71%), and DTP#4 (82% versus 66%) among providers who received free vaccine, compared with children seen by providers who did not receive free vaccine. These results remained significant in the hierarchical analyses. Providers likely to vaccinate an 18-month-old with watery diarrhea had higher vaccination rates than those unlikely to vaccinate for MMR#1, DTP#3, and DTP#4; the results were also significant in the hierarchical analyses. CONCLUSION: Children are vaccinated later in the practices of providers who are likely to refer uninsured children to a public vaccine clinic for vaccination, who do not receive free vaccine supplies, or who overinterpret contraindications.

A cost benefit analysis of routine varicella vaccination in Spain.

The objective of the study was to assess varicella epidemiology and the cost of disease in Spain, in order to perform a cost benefit analysis of universal vaccination at 15 months of age. Epidemiological data were obtained from a survey of 150 children with varicella, from hospitalizations and from the Spanish literature. A Markov decision tree was designed with two alternatives, vaccination or nonvaccination. Direct costs derived from the disease were lower than the cost of vaccination (ratio 0.54:1), however when indirect costs, such as working time loss were taken into account, vaccination was the best alternative, with a saving of P(T)2627 per vaccinated subject (P(T)1.6 recovered per peseta invested in the program). Sensitivity analysis shows that decreasing vaccine coverage and efficacy to 0.7, increasing the annual discount rate to 20% and with a vaccine price less than P(T)6000, vaccination is always the best alternative. In conclusion, from the economic point of view, a universal varicella vaccination program in children at 15 months of age would be justified in Spain.

A model to estimate the potential economic benefits of measles eradication for the United States.

Measles incidence is at a nadir in many parts of the world due to vaccination efforts. Although the technical feasibility of eradication has been acknowledged, financial and political commitment need to be concomitantly identified on the national and global level. We demonstrate the potential value of measles eradication by identifying the potential cost-savings to one country resulting from measles eradication. For the US, measles eradication would save $45 million annually. If achieved by the year 2010, the US would save $500 million to $4.1 billion depending on the year of elimination, post-eradication schedule and discount rate. Intensification of measles control efforts in the US beyond current levels would have minimal marginal benefits on disease burden reduction. Allocation of resources to achieve global measles eradication is the next level of efficiency which would provide substantial savings. Countries may adapt this model to estimate their savings for consideration of the required political and financial contribution towards a global measles eradication program.

A benefit-cost analysis of two-dose measles immunization in Canada.

In 1992, because of the limitations of the one-dose measles immunization program, the National Advisory Committee on Immunization (NACI) recommended a two-dose measles immunization program to eliminate measles. More recently, NACI recommended also a special catch-up program to prevent predicted measles outbreaks and to achieve an earlier elimination of measles. The objective of this study was to complete a benefit-cost analysis of a two-dose immunization program with and without a mass catch-up compaign compared with the current one-dose program. The resulting benefit: cost ratios vary between 2.61:1 and 4.31:1 depending on the strategy used and the age of the children targeted. Given the parameters established for this analysis, the benefits of a second-dose vaccination program against measles far outweight the costs of such a program under all scenarios.

[Wide-spread inflammation of the parotid glands (mumps): an underestimated disease. II. Development, use, efficacy and safety of mumps vaccines]. / Nagminne zapalenie przyusznic (swinka)--niedoceniona choroba. II. Stosowanie, skutecznosc i bezpieczenstwo szczepionki przeciw swince.

Effective attenuated live virus mumps vaccines have been available for more than 30 years. Vaccine strains have been developed on various cell culture systems; the attenuated mumps virus strain most commonly used is the Jeryl Lynn strain. Various vaccines differ in their immunogenicity, efficacy and associated adverse events. It is estimated that the immunization coverage needed to block the transmission of mumps virus is at least 70%. Models indicate that low to moderate levels of mumps vaccine coverage may actually increase the number of susceptibles and the number of cases in older age groups. Benefit-cost analyses in a number of countries have found that the introduction of mumps vaccine is economically justifiable, as vaccination can avert the considerable medical and economic costs associated with mumps morbidity. Countries that do not immunize against mumps continue to register high mumps morbidity, and pay a high toll from neurological and other complications of mumps. Poland, which already has a high level of measles vaccine coverage, should make efforts to replace monovalent measles vaccine with trivalent measles-mumps-rubella (MMR) vaccine.

Cost effectiveness of prevaccination screening of health care workers for immunity to measles, rubella and mumps.

OBJECTIVES: To determine the value of infection and vaccination histories as predictors of immunity to measles, rubella and mumps, and to compare the costs of various screening strategies with the cost of universal vaccination of health care workers. SETTING: Staff employed by a Sydney children's hospital. METHODS: Histories of measles, rubella and mumps infection or vaccination were compared with the results of serological testing to determine which historical statements had high positive predictive values (PPV) for immunity. Using this, we devised three prevaccination screening strategies and compared their costs with the cost of universal staff vaccination. RESULTS: Of 235 participants, 98.3% were serologically immune to measles, 96.6% to rubella and 83.0% to mumps. Historical statements indicating immunity with a PPV of more than 95% were histories of measles or of rubella vaccination, and personal recollection of mumps infection. Strategies using historical screening were cheaper than universal vaccination, which in turn was cheaper than using serological screening alone. CONCLUSIONS: Among health care workers at occupational risk of measles, rubella and mumps, the need for vaccination can be reduced by combining historical and serological screening. Where screening is felt to impose an administrative burden, a universal vaccination strategy costs 30%-50% more than strategies which use historical screening.

Measles-mumps-rubella immunization of susceptible hospital employees during a community measles outbreak: cost-effectiveness and protective efficacy.

OBJECTIVE: To determine cost-effectiveness and protective efficacy of a program to identify and immunize susceptible hospital employees during a measles outbreak. DESIGN: A cost analysis was made of blind measles-mumps-rubella (MMR) immunization versus directed MMR immunization based on 2,000 employees born after December 31, 1956. A directed MMR immunization program for susceptible employees was instituted. Actual costs of the program were calculated at the conclusion of the program. SETTING: A medical center complex with more than 4,000 employees, two acute care community hospitals, and a tertiary care children's hospital. RESULTS: A directed MMR immunization program was projected to be less expensive than blind immunization ($23,106 versus $70,720). MMR vaccine was administered to 169 of 188 susceptible employees. Actual cost of the directed MMR immunization program was $25,384. CONCLUSIONS: The directed MMR immunization program was cost-effective and prevented secondary cases among hospital employees during a community measles outbreak.