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Snider CJ, Boualam L, Tallis G, Takashima Y, Abeyasinghe R, Lo YR, Grabovac V, Avagyan T, Aslam SK, Eltayeb AO, Aung KD, Wang X, Shrestha A, Ante-Orozco C, Silva MWT, Lapastora-Sucaldito N, Apostol LNG, Jikal MBH, Miraj W, Lodhi F, Kim HJ, Rusli N, Thorley BR, Kaye MB, Nishimura Y, Arita M, Sani JAM, Rundi C, Feldon K. Concurrent outbreaks of circulating vaccine-derived poliovirus types 1 and 2 affecting the Republic of the Philippines and Malaysia, 2019-2021. Vaccine 2023; 41 Suppl 1:A58-A69. [PMID: 35337673 PMCID: PMC10546869 DOI: 10.1016/j.vaccine.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 01/26/2023]
Abstract
Concurrent outbreaks of circulating vaccine-derived poliovirus serotypes 1 and 2 (cVDPV1, cVDPV2) were confirmed in the Republic of the Philippines in September 2019 and were subsequently confirmed in Malaysia by early 2020. There is continuous population subgroup movement in specific geographies between the two countries. Outbreak response efforts focused on sequential supplemental immunization activities with monovalent Sabin strain oral poliovirus vaccine type 2 (mOPV2) and bivalent oral poliovirus vaccines (bOPV, containing Sabin strain types 1 and 3) as well as activities to enhance poliovirus surveillance sensitivity to detect virus circulation. A total of six cVDPV1 cases, 13 cVDPV2 cases, and one immunodeficiency-associated vaccine-derived poliovirus type 2 case were detected, and there were 35 cVDPV1 and 31 cVDPV2 isolates from environmental surveillance sewage collection sites. No further cVDPV1 or cVDPV2 have been detected in either country since March 2020. Response efforts in both countries encountered challenges, particularly those caused by the global COVID-19 pandemic. Important lessons were identified and could be useful for other countries that experience outbreaks of concurrent cVDPV serotypes.
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Affiliation(s)
- Cynthia J Snider
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS H24-2, Atlanta, GA 30329, USA.
| | - Liliane Boualam
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Graham Tallis
- World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Yoshihiro Takashima
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Rabindra Abeyasinghe
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Ying-Ru Lo
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia.
| | - Varja Grabovac
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Tigran Avagyan
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Syeda Kanwal Aslam
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines.
| | - Abu Obeida Eltayeb
- United Nations Children's Fund East Asia and Pacific Regional Office, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand.
| | - Khin Devi Aung
- United Nations Children's Fund East Asia and Pacific Regional Office, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand.
| | - Xiaojun Wang
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Achyut Shrestha
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines.
| | - Carla Ante-Orozco
- United Nations Children's Fund Philippines, 14th Floor- North Tower, Rockwell Business Center Sheridan, Sheridan Street Corner United Street, Highway Hills, Mandaluyong City, Philippines, 1550.
| | - Maria Wilda T Silva
- Republic of the Philippines Department of Health, Department of Health San Lazaro Compound, Rizal Ave., Santa Cruz, Manila, Philippines, 1003.
| | - Nemia Lapastora-Sucaldito
- Republic of the Philippines Department of Health, Department of Health San Lazaro Compound, Rizal Ave., Santa Cruz, Manila, Philippines, 1003.
| | - Lea Necitas G Apostol
- Republic of the Philippines Department of Health, Research Institute for Tropical Medicine, 9002 Research Drive, Filinvest Corporate City Alabang, Muntinlupa City, Philippines, 1781
| | - Muhammad Bin Hj Jikal
- Sabah State Health Department, Tingkat 3, Rumah Persekutuan, Jalan Mat Salleh, 88590 Kota Kinabalu, Sabah, Malaysia.
| | - Waheed Miraj
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia
| | - Faisal Lodhi
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, 4th Floor, Prima 8, Block 3508, Jalan, Teknokrat 6, 63000 Cyberjaya, Selangor, Malaysia.
| | - Hyung Joon Kim
- United Nations Children's Fund Malaysia, Menara PJH, Level 10, No. 2, Jalan Tun Abdul Razak, Precinct 2, 62100 Putrajaya, Malaysia.
| | - Norhayati Rusli
- Ministry of Health Malaysia, Aras 3, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuanm Putrajaya, Malaysia.
| | - Bruce R Thorley
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, Australia, 3000.
| | - Matthew B Kaye
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, Australia, 3000.
| | - Yorihiro Nishimura
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
| | - Minetaro Arita
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
| | - Jamiatul Aida Md Sani
- Ministry of Health Malaysia, Aras 3, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuanm Putrajaya, Malaysia.
| | - Christina Rundi
- Sabah State Health Department, Tingkat 3, Rumah Persekutuan, Jalan Mat Salleh, 88590 Kota Kinabalu, Sabah, Malaysia.
| | - Keith Feldon
- Office of the World Health Organization Representative to the Philippines, Building 3, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila 1003, Philippines
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Villanueva-Uy MET, Lam HY, Aldaba JG, Uy TMZ, Valverde HA, Silva MWT, Mooney J, Clark A, Pecenka C. Cost-effectiveness of rotavirus vaccination in the Philippines: A modeling study. Vaccine 2021; 39:7091-7100. [PMID: 34753614 PMCID: PMC8631456 DOI: 10.1016/j.vaccine.2021.09.075] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/08/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
Introduction Rotavirus gastroenteritis (RVGE) remains a leading cause of hospitalization and death in children under five years of age in the Philippines. Rotavirus (RV) vaccination was introduced into the national immunization program (NIP) in 2012 but has since been limited to one region due to cost considerations and conflicting local cost-effectiveness estimates. Updated estimates of the cost-effectiveness of RV vaccination are required to inform prioritization of national immunization activities. Methods We calculated the potential costs and benefits of rotavirus vaccination over a 10-year-period (2021–2031) from a government and societal perspective, comparing four alternative rotavirus vaccines: Rotavac, Rotasiil, Rotarix and Rotateq. For each vaccine, a proportionate outcomes model was used to calculate the expected number of disease events, DALYs, vaccination program costs, and healthcare costs, with and without vaccination. The primary outcome measure was the cost per DALY averted. Assuming each product would generate similar benefits, the dominant (lowest cost) product was identified. We then calculated the cost-effectiveness (US$ per Disability Adjusted Life Year [DALY] averted) of the least costly product and compared it to willingness-to-pay thresholds of 0.5 and 1 times the national GDP per capita ($3,485), and ran deterministic and probabilistic sensitivity analyses. Results Introducing any of the four rotavirus vaccines would avert around 40% of RVGE visits, hospitalizations, and deaths over the period 2021–2031. Over the same ten-year period, the incremental cost of vaccination from a government perspective was estimated to be around $104, $105, $220, and $277 million for Rotavac, Rotasiil, Rotarix and Rotateq, respectively. The equivalent cost from a societal perspective was $58, $60, $178 and $231 million. The cost-effectiveness of the least costly product (Rotavac) was $1,148 ($830–$1682) from a government perspective and $646 ($233–1277) from a societal perspective. All other products offered similar benefits but at a higher cost. There is a >99% probability that Rotavac would be cost-effective at a willingness-to-pay threshold set at 0.5 times the national GDP per capita. Conclusion Both Rotavac and Rotasiil are likely to be cost-effective options in the Philippines, but it is not possible to say definitively which product should be preferred. Rotarix and Rotateq are expected to offer similar benefits at more cost, so would need to be priced far more competitively to be considered for introduction.
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Affiliation(s)
- Maria Esterlita T Villanueva-Uy
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.
| | - Hilton Y Lam
- Institute of Health Policy and Development Studies, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Josephine G Aldaba
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Tristan Marvin Z Uy
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Haidee A Valverde
- Institute of Health Policy and Development Studies, University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Maria Wilda T Silva
- Disease Prevention and Control Bureau, Department of Health, Manila, Philippines
| | - Jessica Mooney
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
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Minta AA, Silva MWT, Shrestha A, de Quiroz-Castro M, Tohme RA, Quimson ME, Jiz MA, Woodring J. Hepatitis B surface antigen seroprevalence among children in the Philippines, 2018. Vaccine 2021; 39:1982-1989. [PMID: 33712351 DOI: 10.1016/j.vaccine.2021.02.042] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 02/20/2021] [Indexed: 11/30/2022]
Abstract
The World Health Organization Western Pacific Region (WPR) set a hepatitis B virus (HBV) control target to achieve HBV surface antigen (HBsAg) prevalence of <1% among children aged 5 years by 2017. The estimated HBsAg prevalence in the Philippines among adults was 16.7% during the pre-vaccine era. We estimated the HBsAg seroprevalence among children aged 5-7 years to measure the impact of vaccination. We conducted a household serosurvey, using a three-stage cluster survey methodology (provinces, clusters, and households). We estimated HBsAg prevalence using a rapid, point-of-care HBsAg test and calculated vaccination coverage by reviewing vaccination records or by caregiver recall. A questionnaire was administered to assess demographic variables for the child and family. We assessed the association between chronic HBV infection, vaccination coverage, and demographic variables, accounting for the complex survey design. Of the 2178 children tested, HBsAg was detected in 15 children [0.8%, 95% confidence interval (CI): 0.4, 1.7]. Only two of the HBsAg-positive children had been fully vaccinated against HBV. Based on documented vaccination or caregiver recall for the survey population, hepatitis B vaccine birth dose (HepB-BD) coverage was 53%, and the third dose hepatitis B vaccination (HepB3) coverage was 73 percent. Among the 1362 children with documented HepB-BD, timely HepB-BD coverage (given within 24 h of birth) was 43%; children born outside a health facility were less likely to receive a timely HepB-BD than those born in a health facility (adjusted odds ratio 0.10, 95% CI: 0.04, 0.23). HBsAg prevalence among children in the Philippines has decreased compared to the prevalence among adults in the pre-vaccination era. Strategies to further reduce HBsAg prevalence include ensuring that all children, whether born in health facilities or at home, receive a timely HepB-BD, and increasing HepB-BD and HepB3 coverage to reach the WPR goals of ≥95% coverage.
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Affiliation(s)
- Anna A Minta
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Wilda T Silva
- National Immunization Program, Philippines Department of Health, Manila, Philippines
| | - Achyut Shrestha
- Expanded Program on Immunization, World Health Organization - Philippines Country Office, Manila, Philippines
| | - Maricel de Quiroz-Castro
- Expanded Program on Immunization, World Health Organization - Philippines Country Office, Manila, Philippines
| | - Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mario E Quimson
- Immunology Department, Research Institute for Tropical Medicine - Philippines Department of Health, Manila, Philippines
| | - Mario Antonio Jiz
- Immunology Department, Research Institute for Tropical Medicine - Philippines Department of Health, Manila, Philippines
| | - Joseph Woodring
- Expanded Program on Immunization Unit, Division of Communicable Diseases, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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