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Kujawski SA, Casey CS, Haas H, Patel A, Diomatari C, Holbrook T, Pawaskar M. Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France. Pediatr Infect Dis J 2024; 43:393-399. [PMID: 38456715 PMCID: PMC10919277 DOI: 10.1097/inf.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. METHODS A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. RESULTS Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. CONCLUSION This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.
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Affiliation(s)
- Stephanie A. Kujawski
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Hervé Haas
- Department of Pediatrics and Neonatalogy, Centre Hospitalier Princesse Grace, Monaco
| | | | | | | | - Manjiri Pawaskar
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
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Shah HA, Meiwald A, Perera C, Casabona G, Richmond P, Jamet N. Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis. Infect Dis Ther 2024; 13:79-103. [PMID: 38117427 PMCID: PMC10828225 DOI: 10.1007/s40121-023-00899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Varicella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella symptoms are usually self-limiting; however, different complications with widespread and systemic manifestations can occur. This systematic literature review aims to explore and quantify varicella-associated complication rates. METHODS Two databases (Embase and MEDLINE), congress abstracts, and reference lists of systematic reviews were screened to identify evidence on varicella complications. Complications were identified and grouped into 14 clinically relevant categories. Proportional meta-analyses were conducted using a random-effects model and tests for heterogeneity and publication bias were performed. Subgroup, sensitivity, and meta-regression analyses were also conducted. A total of 78 studies, spanning 30 countries, were included in the meta-analysis. RESULTS Pooled prevalence was highest in severe varicella (22.42%; 95% confidence interval [CI] 10.13-37.77), skin-related complications (20.12%; 95% CI 15.48-25.20), and infection-related complications (10.03%; 95% CI 7.47-12.90). Cardiovascular (0.55%; 95% CI 0.08-1.33), genitourinary (1.17%; 95% CI 0.55-1.99), and musculoskeletal (1.54%; 95% CI 1.06-2.11) complications had the lowest pooled prevalence. The remaining complication categories ranged between 1% and 10%. Subgroup analysis showed that complications were more prevalent in children versus adults and in hospitalized patients versus outpatients. Meta-regression analysis found that no ecological level covariates were accurate predictors for the overall prevalence of varicella-associated complications. There was substantial heterogeneity and publication bias across all meta-analyses. CONCLUSION Results suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease.
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Affiliation(s)
| | | | | | | | - Peter Richmond
- University of Western Australia School of Medicine, Telethon Kids Institute and Perth Children's Hospital, Nedlands, Australia
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Williame I, George M, Shah HA, Homer N, Alderson D, Jamet N. Healthcare resource use and costs of varicella and its complications: A systematic literature review. Hum Vaccin Immunother 2023; 19:2266225. [PMID: 37885425 PMCID: PMC10760364 DOI: 10.1080/21645515.2023.2266225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Varicella is a highly contagious disease caused by the varicella zoster virus (VZV). While the disease is usually mild, severe complications can occur requiring costly hospitalization. A thorough understanding of the healthcare resource use (HCRU) and costs of varicella is needed to inform health-economic models of preventive strategies. A systematic literature review was carried out to retrieve relevant publications between 1999 and 2021, reporting HCRU and cost outcomes for varicella and its complications. Data were extracted and stratified according to pre-specified age groups and complication categories. Costs were re-based to a $US2020 footing using both purchasing power parity and the medical component of consumer price indexes. Data were summarized descriptively due to high heterogeneity in study design and outcome reporting. Forty-four publications fulfilled the inclusion and exclusion criteria of which 28 were conducted in Europe, 6 in Middle East and Asia, 5 in South America, 3 in North America, and 2 in multiple regions. Primary healthcare visits accounted for 30% to 85% of total direct costs. Hospitalization costs varied between $1,308 and $38,268 per episode depending on country, complication type, and length of stay, contributing between 2% and 60% to total direct costs. Indirect costs, mostly driven by workdays lost, accounted for approximately two-thirds of total costs due to varicella. The management of varicella and related complications can lead to substantial HCRU and costs for patients and the healthcare system. Additional research is needed to further characterize the varicella-associated economic burden and its broader impact from a societal standpoint.
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Giglio N, Lasalvia P, Pawaskar M, Parellada CI, Rosselli D, Babic VV, Neyro SE. Estimating the health economic impact of the universal varicella vaccination in Argentina from 2015 to 2019. Hum Vaccin Immunother 2023; 19:2245703. [PMID: 37643745 PMCID: PMC10467511 DOI: 10.1080/21645515.2023.2245703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Since the introduction of Universal Varicella Vaccination (UVV) in the Argentinean National Immunization Program in 2015, a significant decline in the incidence of varicella has been reported. This study aimed to estimate the economic impact of single-dose UVV in Argentina from 2015 to 2019. The economic impact was assessed based on the observed incidence of varicella in the post-UVV period and the number of cases avoided, obtained from a previously published study that used an Autoregressive Integrated Moving Average (ARIMA) model. The weighted average cost per case was calculated using local studies. The post-UVV cost reductions were calculated by multiplying the number of cases avoided from 2015 -2019 by the weighted average cost per case. Data were summarized yearly and by peak (September-November) periods for the target (1-4 years) and overall populations. We estimated avoided costs of United States dollars (USD) $65 million in the target population and $112 million in the overall population over 4 years following UVV introduction. We observed a trend toward greater reductions in costs over time, with substantial differences observed in peak periods. We estimated that the single-dose UVV program considerably reduced the economic burden of varicella in Argentina by avoiding direct and indirect costs associated with varicella management.
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Affiliation(s)
- Norberto Giglio
- Epidemiology, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence, Vaccines, Merck & Co., Inc., Rahway, NJ, USA
| | - Cintia I. Parellada
- Center for Observational and Real-World Evidence, Vaccines, MSD Brazil, São Paulo, Brazil
| | - Diego Rosselli
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Virginia V. Babic
- Global and Medical Scientific Affairs, MSD Argentina, Buenos Aires, Argentina
| | - Silvina E. Neyro
- Dirección de Control de Enfermedades Inmunoprevenibles (DiCEI), Ministerio de Salud de la Nación, Buenos Aires, Argentina
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Giglio N, Lasalvia P, Pawaskar M, Parellada CI, Rojas YG, Micone P, Babic VV, Neyro SE. Trends in Varicella Burden of Disease Following Introduction of Routine Childhood Varicella Vaccination in Argentina: A 12-Year Time Series Analysis. Vaccines (Basel) 2022; 10:1151. [PMID: 35891315 PMCID: PMC9317722 DOI: 10.3390/vaccines10071151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022] Open
Abstract
One-dose universal varicella vaccination (UVV) was introduced in the Argentinian National Immunization Program in July 2015. This study examined the impact of one-dose UVV on varicella incidence and mortality in Argentina. Incidence and mortality data were obtained from official databases for pre-UVV (January 2008–June 2015) and post-UVV (July 2015–December 2019) periods. Time series analyses with autoregressive integrated moving average (ARIMA) modeling predicted varicella incidence and mortality in absence of UVV in the target (aged 1–4 years) and overall population. Predicted and observed values post-UVV were compared to estimate UVV impact. Mean annual incidence rates per 100,000 reduced from 1999 (pre-UVV) to 1122 (post-UVV) in the target population and from 178 to 154 in the overall population. Significant declines in incidence were observed, reaching reductions of 83.9% (95% prediction interval [PI]: 58.9, 90.0) and 69.1% (95% PI: 23.6, 80.7) in the target and overall populations, respectively, during peak months (September-November) post-UVV. Decreasing trends in mortality rate from 0.4 to 0.2 per 1,000,000 population were observed. Over the last four years, one-dose UVV has significantly reduced varicella burden of disease in Argentina. Continuous efforts to improve vaccination coverage rates and long-term follow-up are needed to better understand the benefits of the UVV program.
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Chacon-Cruz E, Meroc E, Costa-Clemens SA, Clemens R, Verstraeten T. Economic Evaluation of Universal Varicella Vaccination in Mexico. Pediatr Infect Dis J 2022; 41:439-444. [PMID: 34966138 PMCID: PMC8997664 DOI: 10.1097/inf.0000000000003448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Universal varicella vaccination has proven to be cost-effective (CE) in countries where implemented. However, this has not been evaluated for Mexico. METHODS The yearly disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) was derived from Mexican seroprevalence data adjusted to the 2020 population. The yearly economic burden was calculated by combining disease with Mexican unit cost data from both health care and societal perspectives. Four different vaccination strategies were evaluated: (1) 1 dose of varicella vaccine at 1 year old; (2) 2 doses at 1 and 6 years; (3) 1 dose of varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine at 6 years; (4) 2 doses of measles-mumps-rubella-varicella vaccine at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. Vaccination impact (number of avoided cases/deaths) was evaluated for a 20-year follow-up period based on vaccine effectiveness (87% and 97.4% for 1 and 2 doses), and assuming a 95% coverage. We estimated annual costs saved, incremental cost-effectiveness ratio, and costs per life year gained. RESULTS Avoided cases during the 20-year follow-up with 1, and 2 doses were 20,570,722 and 23,029,751, respectively. Strategies 1 and 2 were found to be cost saving, and strategy 3 to be CE. Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 and $34.41 million USD, respectively, to the Mexican society. CONCLUSIONS Universal varicella vaccination, using 1 dose or 2 doses, would result in a cost-beneficial and CE public health intervention in Mexico.
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Affiliation(s)
| | - Estelle Meroc
- P95 Pharmacovigilance and Epidemiology Services, Leuven, Belgium
| | - Sue Ann Costa-Clemens
- From the Institute for Global Health, University of Siena, Siena, Italy
- University of Oxford, Oxford, England
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Lizano-Díez I, Naharro J, Zsolt I. Indirect costs associated with skin infectious disease in children: a systematic review. BMC Health Serv Res 2021; 21:1325. [PMID: 34895206 PMCID: PMC8665520 DOI: 10.1186/s12913-021-07189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited data in the literature on the indirect costs associated with skin and soft tissue infections (SSTIs) in the pediatric population. This study aimed to conduct a systematic review of the indirect costs associated with SSTIs in children. METHODS The search was conducted in PubMed, SCOPUS, and Web of Science up to January 2020. Thirteen search strategies were designed combining MeSH terms and free terms. SSTIs were defined as bacterial or viral infections, dermatomycoses, and parasitic infestations. Only primary studies were included. All analyzed costs were converted to 2020 Euros. RESULTS Thirteen of the identified publications presented indirect costs of SSTIs in children and were conducted in Argentina, Australia, Brazil, Hungary, New Zealand, Poland, Spain, Taiwan, and the USA. Nine studies described indirect costs associated with infection of Varicella-zoster virus: lost workdays by outpatient caregivers ranged from 0.27 to 7.8, and up to 6.14 if caring for inpatients; total productivity losses ranged from €1.16 to €257.46 per patient. Three studies reported indirect costs associated with acute bacterial SSTIs (community-associated methicillin-resistant Staphylococcus aureus) in children: total productivity losses ranged from €1,814.39 to €8,224.06 per patient, based on impetigo, cellulitis, and folliculitis. One study of parasitic infestations (Pediculus humanus capitis) reported total indirect costs per patient of €68.57 (formal care) plus €21.41 due to time lost by parents in purchasing treatment. CONCLUSIONS The economic burden of SSTIs is highly relevant but underestimated due to the lack of studies reporting indirect costs. Further cost studies will allow a better understanding of the magnitude of the financial burden of the disease.
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Affiliation(s)
- Irene Lizano-Díez
- Ferrer Internacional, S.A., Av Diagonal 549, 5th floor, 08029, Barcelona, Spain.
| | - Jesús Naharro
- Ferrer Internacional, S.A., Av Diagonal 549, 5th floor, 08029, Barcelona, Spain
| | - Ilonka Zsolt
- Ferrer Internacional, S.A., Av Diagonal 549, 5th floor, 08029, Barcelona, Spain
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Gentile A, Giglio N, Lucion MF, Martínez AC, Pejito N, Juarez MDV. Impact of varicella vaccine on nosocomial outbreaks and management of post exposure prophylaxis following in a paediatric hospital. PLoS One 2021; 16:e0251496. [PMID: 34014962 PMCID: PMC8136631 DOI: 10.1371/journal.pone.0251496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction In 2015, varicella vaccine was introduced to the National Immunization Programme in a one-dose regimen for infants aged 15 months. The aim of this study was to describe and compare the epidemiologic characteristics, management strategies and costs of varicella outbreaks in Ricardo Gutierrez Children’s Hospital (HNRG) from 2000 to 2019, before (PreV period) and after (PostV period) the introduction of the varicella vaccine. Methods A retrospective, analytic study of the impact of nosocomial varicella outbreaks at the HNRG, based on active epidemiologic surveillance. We compared nosocomial varicella outbreaks rates (per 10,000 discharges) between PreV and PostV, excluding the intervention year (2015). Results During PreV, an average of 15.87 (13.91–18.02) outbreaks per year was observed and in PostV 5.5 per year (3.44–8.32). Outbreaks adjusted by all cause discharges showed a reduction of 59.13% (-36.68%, -73.62%) after vaccine introduction. Considering that in PreV the average of susceptible cases per outbreak was 5.0 and in PostV 7.8, with a cost per susceptible of AR$ $6,522 (80.27 USD) PreV and 6,708 PostV the economic impact on the reduction of outbreaks after the introduction of the vaccine, showed an estimated average savings per year of AR$ -252,128 AR$ (-3,103.11 USD). Conclusions The number of annual varicella hospital outbreaks at the HNRG decreased significantly after varicella vaccine was introduced to NIP in Argentina with a relevant reduction in terms of costs.
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Affiliation(s)
- Angela Gentile
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
- * E-mail:
| | - Norberto Giglio
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
| | | | | | - Natalia Pejito
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
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Bozzola E, Guolo S, Macchiarulo G, Festa L, Spina G, Krzysztofiak A, Grandin A, Bozzola M, Raponi M, Villani A. Hospitalization for acute cerebellitis in children affected by varicella: how much does it cost? Ital J Pediatr 2020; 46:114. [PMID: 32762761 PMCID: PMC7410155 DOI: 10.1186/s13052-020-00875-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Chickenpox is a highly contagious airborne disease caused by the varicella zoster virus. It is generally benign and self-limiting, but it may be responsible of life-threatening complications. Acute cerebellitis (AC) is the most common neurological complication and is associated with prolonged hospitalization in the acute phase (HAP). Aim of the study To estimate the costs of AC HAP in children affected by varicella. Materials and methods We retrospectively reviewed the medical records of a pediatric cohort hospitalized for chickenpox AC over a period of 15 years (from October 2003 to October 2018) and we analyzed acute care costs. For any patient the HAP has been calculated. The final value includes cost of hospital accommodation and management at the Pediatric and Infectious Diseases Unit. To this cost, the price of procedures (imaging, laboratory exams, medical and paramedical evaluations) and medical treatments was added. Results In the study period, 856 children had been hospitalized for varicella. Out of them, 65 met a diagnosis of AC and were included in the study. The hospitalization length was of 10 days (range 3–20 days). The median cost of HAP for each patient was of 5366 euro, with an average annual cost of 23,252 €. The most significant part of HAP is due to the cost of hospital accommodation and management at the Pediatric Infectious Diseases Unit, which was about € 537.78 for a single day. Discussion Although AC post-varicella is rare, its HAP cost is not negligible resulting in substantial economic burden. Vaccination would have probably prevented varicella and AC complication, avoiding hospitalization. Conclusions Financial studies are important for evaluate the cost saving in order to influence public funding decisions. Further studies are necessary to investigate the economic burden of the disease.
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Affiliation(s)
- Elena Bozzola
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.
| | - Stefano Guolo
- Medical Direction, Bambino Gesù Children Hospital, Rome, Italy
| | - Giulia Macchiarulo
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Lidia Festa
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Giulia Spina
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Annalisa Grandin
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy
| | | | | | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesù Children Hospital, Rome, Italy
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Barrenechea GG, Bastos LS. Evaluation of impact of one dose varicella vaccine on the incidence of chickenpox in Argentina. Vaccine 2019; 38:330-335. [PMID: 31630938 DOI: 10.1016/j.vaccine.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Varicella, also known as chickenpox is one of the most common immunizable diseases. In 1998, the World Health Organization (WHO) recommended to incorporate this vaccine in the national immunization programs, which Argentina did in 2015. OBJECTIVES To describe the behavior of the varicella time series for the 2005-2017 period, and to evaluate the impact of the vaccine in Argentina. METHODOLOGY An ecological observational study was performed, using the varicella cases reported in the National Health Monitoring System, and the data of the National census as secondary data sources. A model based time series analysis of the notified varicella cases in Argentina was performed, using a Negative Binomial Mixed Model. For the verification of the vaccine impact, the 2005-2014 period was selected, and a prognosis for the following years was performed. Impact was evaluated by comparing the rates and confidence intervals between the predicted and observed values. RESULTS Argentina reported 1,775,587 varicella cases for the 2005-2017 period. The series exhibited seasonality, and, a decreasing trend in the number of cases was observed in 2016 and 2017. A reduction of the incidence rate after the implementation of the vaccine was observed. The transmission risk decreased in the country after vaccine implementation. CONCLUSIONS This study is the first concrete evidence of the varicella incidence decline after the implementation of a single dose application program in Argentina.
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Affiliation(s)
- Guillermo G Barrenechea
- Departamento Bioquímico-Laboratorio de Salud Pública, Mendoza 128 4° Piso, San Miguel de Tucumán, Tucumán CP: 4107, Argentina; Dirección de Investigación en Salud, Virgen de la Merced 189 1° Piso, San Miguel de Tucumán, Tucumán CP: 4107, Argentina.
| | - Leonardo S Bastos
- Scientific Computing Program, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro CEP: 21040-900, Brazil; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Al Kaabi N, Al Olama FMAS, Al Qaseer M, Al Ubaidani I, Dinleyici EC, Hayajneh WA, Bizri AR, Loulou M, Ndao T, Wolfson LJ. The clinical and economic burden of varicella in the Middle East: a systematic literature review. Hum Vaccin Immunother 2019; 16:21-32. [PMID: 31373864 PMCID: PMC7012098 DOI: 10.1080/21645515.2019.1638726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This systematic literature review was conducted to better understand the epidemiology and burden of varicella across the Middle East, gain insight into the evidence to support using universal varicella vaccination (UVV), and identify potential data gaps. Both epidemiology and economic data on the burden of varicella were limited and varied significantly. Most of the data focussed on varicella burden in the absence of a UVV program. In the absence of UVV, varicella incidence is increasing across this region with varicella infection associated with substantial morbidity. Although limited, data on the impact of vaccination at a population level indicated UVV programs reduce varicella incidence and hospitalizations, in line with global experience. Further research and action are needed to better understand varicella epidemiology in the Middle East, increase awareness and understanding in the region, and provide local data to support national public-health decisions regarding the implementation of UVV programs.
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Affiliation(s)
- Nawal Al Kaabi
- Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | | | | | - Idris Al Ubaidani
- Department of Communicable Disease Surveillance & Control, Directorate General of Health Affairs, Ministry of Health HQ, Muscat, Sultanate of Oman
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Wail Ahmad Hayajneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdul Rahman Bizri
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Lara J Wolfson
- Merck & Co., Inc. Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA
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Wolfson LJ, Castillo ME, Giglio N, Mészner Z, Molnár Z, Vàzquez M, Wysocki J, Altland A, Kuter BJ, Stutz M, Rampakakis E, Roberts CS. The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe. BMC Public Health 2019; 19:826. [PMID: 31242875 PMCID: PMC6595594 DOI: 10.1186/s12889-019-7071-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation. Methods Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1–14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country. Results Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%. Conclusions High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications. Electronic supplementary material The online version of this article (10.1186/s12889-019-7071-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara J Wolfson
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA.
| | - Marìa Esther Castillo
- Instituto Nacional de Salud del Niño (INSN), Breña, Perú.,Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Zsófia Mészner
- St. László Hospital for Infectious Diseases, National Institute of Child Health, Budapest, Hungary
| | | | | | - Jacek Wysocki
- Poznan University of Medical Sciences, Poznan, Poland
| | - Alexandra Altland
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA
| | - Barbara J Kuter
- Merck & Co., Inc., Global Vaccines Medical Affairs, Kenilworth, NJ, USA
| | | | - Emmanouil Rampakakis
- JSS Medical Research, Montréal, Québec, Canada.,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Craig S Roberts
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA
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Arlant LHF, Garcia MCP, Avila Aguero ML, Cashat M, Parellada CI, Wolfson LJ. Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review. BMC Public Health 2019; 19:528. [PMID: 31068173 PMCID: PMC6507223 DOI: 10.1186/s12889-019-6795-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Abstract
Background Varicella is typically mild and self-limiting, but can be associated with complications and even death. The limited data available on varicella in Latin America and the Caribbean (LAC) indicate substantial burden in countries where varicella vaccine is not part of publicly funded childhood national immunization programs. Methods A systematic literature review of published studies was complemented by “gray” literature on varicella incidence, complications, mortality, and economic consequences, in the absence and presence of universal varicella vaccination (UVV) in LAC. Results Seroprevalence data indicate that varicella is usually a disease of childhood in LAC. Varicella incidence rates, while unreliable in the absence of mandatory reporting, show a trend to increased incidence due to greater urbanization and population density. The introduction of UVV in national immunization programs has led to significant reductions in varicella incidence in these areas. Conclusions Varicella continues to pose a substantial healthcare burden in LAC. The future introduction of UVV in additional countries is predicted to provide substantial reductions in cases, with important economic benefits. For countries that have already implemented UVV, the challenge is to maintain high rates of coverage and, where relevant, consider inclusion of a second dose to reduce breakthrough cases. Given the significant proportion of the region now implementing UVV, a regional recommendation in order to prevent any potential for age-shifts in varicella infection might be considered. Electronic supplementary material The online version of this article (10.1186/s12889-019-6795-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Maria L Avila Aguero
- National Children's Hospital Costa Rica, San Jose, Costa Rica.,Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University, New Haven, CT, USA
| | - Miguel Cashat
- Global Medical Affairs, MSD México, México City, México
| | | | - Lara J Wolfson
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, 07033, USA.
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Wolfson LJ, Castillo ME, Giglio N, Meszner Z, Molnar Z, Vazquez M, Wysocki J, Altland A, Kuter BJ, Rickard J, Rampakakis E. Varicella healthcare resource utilization in middle income countries: a pooled analysis of the multi-country MARVEL study in Latin America & Europe. Hum Vaccin Immunother 2019; 15:932-941. [PMID: 30681397 PMCID: PMC6605820 DOI: 10.1080/21645515.2018.1559687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Varicella is a mild and self-limited illness in children, but can result in significant healthcare resource utilization (HCRU). To quantify/contrast varicella-associated HCRU in five middle-income countries (Hungary, Poland, Argentina, Mexico, and Peru) where universal varicella vaccination was unimplemented, charts were retrospectively reviewed among 1-14 year-olds. Data were obtained on management of primary varicella between 2009-2016, including outpatient/inpatient visits, allied healthcare contacts, tests/procedures, and medications. These results are contrasted across countries, and a regression model is fit to extrapolated country-level costs as a function of gross domestic product (GDP). A total of 401 outpatients and 386 inpatients were included. Significant differences between countries were observed in the number of skin lesions among outpatients, ranging from 5.3% to 25.4% of patients with ≥250 lesions. Among inpatients, results were less variable. Average ambulatory medical visits ranged from 1.1 to 2.2. Average hospital stay ranged from 3.6 to 6.8 days. Use of tests/procedures was infrequent in outpatients, except in Argentina (13.3%); among inpatients, a test/procedure was ordered for 81.3% of patients, without regional variation. Prescription medications were administered in 44.4% of outpatients (range 9.3%-80.0%), and in 86% of inpatients (range 70.4%-94.9%). Total estimated spending on varicella treatment in the absence of vaccination was predicted from income levels (GDP) with an exponential function (R2 = 0.89). This study demonstrates that substantial HCRU is associated with varicella resulting in significant public health burden that could be alleviated through the use of varicella vaccination. Differences observed between countries possibly reflect treatment guidelines, healthcare resource availabilities and physician practices.
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Affiliation(s)
- Lara J Wolfson
- a Center for Observational and Real-World Evidence , Merck & Co., Inc ., Kenilworth , NJ , USA
| | - Maria Esther Castillo
- b Instituto Nacional de Salud del Niño (INSN) , Breña , Perú.,c Universidad Peruana Cayetano Heredia (UPCH) , Lima , Perú
| | - Norberto Giglio
- d Hospital de Niños Ricardo Gutiérrez , Buenos Aires , Argentina
| | - Zsofia Meszner
- e St. László Hospital for Infectious Diseases , Budapest , Hungary
| | | | - Mirella Vazquez
- g Instituto Nacional de Pediatría , Ciudad de México , México
| | - Jacek Wysocki
- h Poznan University of Medical Sciences , Poznan , Poland
| | - Alexandra Altland
- a Center for Observational and Real-World Evidence , Merck & Co., Inc ., Kenilworth , NJ , USA
| | - Barbara J Kuter
- i Global Vaccines Medical Affairs , Merck & Co., Inc ., Kenilworth , NJ , USA
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