Potential impact and cost-effectiveness of future ETEC and Shigella vaccines in 79 low- and lower middle-income countries
Potential impact and cost-effectiveness of future ETEC and Shigella vaccines in 79 low- and lower middle-income countries
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DOI：
10.1016/j.jvacx.2019.100024
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发表时间：
2019-08-09
期刊：
影响因子：
3.8
通讯作者：
Rheingans, Richard
中科院分区：
文献类型：
--
作者：
Anderson, John D.;Bagamian, Karoun H.;Rheingans, Richard
虽然儿童腹泻死亡率在过去20年中有所下降，但腹泻发病率的下降速度较慢。反复出现腹泻与儿童发育迟缓有关，导致传染病死亡风险增加。目前正在开发针对肠致病性大肠杆菌[ETEC]和志贺氏菌的候选疫苗，这是低收入国家儿童的重要肠道病原体。这些未来的疫苗可以显着减少腹泻负担，防止ETEC和志贺氏菌引起的发育迟缓，和发育迟缓相关mortality.We开发了一个成本效益模型两个假定的独立ETEC和志贺氏菌疫苗候选人，以评估疫苗对死亡率，发病率，发育迟缓，和发育迟缓相关的其他传染病死亡的影响。我们对79个低收入和中低收入国家的5岁以下儿童接种疫苗后的前10年的影响进行了建模。179，700 - 309，800]和340，300 [256，500 - 440，800]儿童死亡。这些死亡大多发生在非洲国家。ETEC和志贺氏菌中度至重度腹泻发作将分别导致超过1370万[840万-1900万]和2140万[1310万-2980万]发育迟缓儿童。引入ETEC或志贺氏菌疫苗，每种疫苗的效力均为60%，可预防92，000 [61，000 - 129，000]例ETEC和126，600 [84，000 - 179，000]例志贺氏菌直接死亡以及21，400 [11，300 - 34，800]例ETEC和34，200 [18，000 - 56，000]例志贺氏菌诱导的发育迟缓死亡。ETEC的ICER从非洲的2172美元/DALY [1457-4369]到欧元的19，172美元/DALY [12，665 - 39，503]不等。志贺氏菌ICER范围从EMRO的952美元/DALY [632-2001]到EURO的640，316美元/DALY [434，311 - 1，297，192]。纳入因发育迟缓导致的其他传染病死亡率，可以更准确地评估ETEC和志贺氏菌疾病的总负担，并增加疫苗接种的预期影响和成本效益。仅在高负担国家和地区引入疫苗可以大幅降低成本，而不会大幅减少影响。(C)2019作者爱思唯尔有限公司出版
While diarrhea mortality in children has declined over the last two decades, there has been a slower decline in diarrheal episodes. Repeated diarrheal episodes are associated with childhood stunting, which leads to increased mortality risk from infectious diseases. Vaccine candidates are under development for enterotoxigenic Escherichia coli [ETEC] and Shigella, important enteric pathogens in children in low income countries. These future vaccines could significantly reduce diarrheal burden, prevent ETEC- and Shigella-induced stunting, and stunting-associated mortality.We developed a cost-effectiveness model for two putative standalone ETEC and Shigella vaccine candidates to evaluate vaccine impact on mortality, morbidity, stunting, and stunting-associated deaths from other infectious diseases. We modeled impact over the first ten years after vaccine introduction in children under five years old living in 79 low and low-middle income countries.ETEC and Shigella diarrhea would cause an estimated 239,300 [95% UL: 179,700-309,800] and 340,300 [256,500-440,800] child deaths, respectively, from years 2025 to 2034. Most of these deaths would occur in AFRO countries. ETEC and Shigella moderate-to-severe diarrheal episodes would result in over 13.7 [8.4-19.0] and 21.4 [13.1-29.8] million stunted children, respectively. Introducing ETEC or Shigella vaccine each with 60% efficacy could prevent 92,000 [61,000-129,000] ETEC and 126,600 [84,000-179,000] Shigella direct deaths and 21,400 [11,300-34,800] ETEC- and 34,200 [18,000-56,000] Shigella-induced stunting deaths. ETEC ICERs ranged from $2172/DALY [1457-4369] in AFRO to $19,172/DALY [12,665-39,503] in EURO. Shigella ICERs ranged from $952/DALY [632-2001] in EMRO to $640,316/DALY [434,311-1,297,192] in EURO.Limitations of this analysis include uncertainty of vaccine efficacy, duration of protection, and vaccine price. Inclusion of other infectious disease mortality due to stunting provides a more accurate assessment of total ETEC and Shigella disease burden and increased the projected impact and cost-effectiveness of vaccination. Introducing vaccines only in high burden countries and regions could substantially reduce cost without substantially reducing impact. (C) 2019 The Authors. Published by Elsevier Ltd.