Nosocomial pertussis:: Costs of an outbreak and benefits of vaccinating health care workers
Nosocomial pertussis:: Costs of an outbreak and benefits of vaccinating health care workers
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DOI：
10.1086/500321
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发表时间：
2006-04-01
影响因子：
11.8
通讯作者：
Murphy, TV
中科院分区：
文献类型：
--
作者：
Calugar, A;Ortega-Sánchez, IR;Murphy, TV
背景。2003年9月，卫生保健工作者（HCWs）中有17例有症状的百日咳病例，起因是与一名婴儿接触1天，该婴儿后来被证实患有百日咳。这些卫生保健工作者确定了307名密切接触者。医院采取了广泛的感染控制措施。本研究的目的是确定2003年9月疫情爆发后医院和有症状的卫生保健工作者所产生的直接和间接成本，并从医院的角度估计卫生保健工作者接种疫苗可能带来的好处。我们通过采访感染控制和医院人员、审查账单记录和调查有症状的卫生保健工作者来确定成本。我们使用概率模型来估计每年需要采取控制措施的百日咳暴露次数，计算了卫生保健工作者接种疫苗计划的收益和成本。进行敏感性和阈值分析。该医院的爆发费用为74 870美元。疫情的总成本为81,382美元，包括卫生保健员的费用（6512美元）。我们的模型预测，为医护人员接种百日咳疫苗，每年可防止46%的医护人员感染百日咳，并可提供净储蓄。据估计，该医院的收益是为卫生保健人员接种疫苗所投入资金的2.38倍。预防暴露次数和收益-成本比对暴露次数、卫生工作者百日咳发病率和卫生工作者转换率敏感。一次院内百日咳爆发给医院和卫生保健员造成了严重的破坏和费用。我们的模型表明，通过为卫生保健工作者接种百日咳疫苗，可以节省成本并产生效益。
Background. In September 2003, 17 symptomatic cases of pertussis among health care workers ( HCWs) resulted from a 1-day exposure to an infant who was later confirmed to have pertussis. These HCWs identified 307 close contacts. The hospital implemented extensive infection-control measures. The objective of this study was to determine direct and indirect costs incurred by the hospital and symptomatic HCWs as a result of the September 2003 outbreak and to estimate possible benefits of vaccinating HCWs from the hospital perspective.Methods. We determined costs by interviewing infection-control and hospital personnel, reviewing billing records, and surveying symptomatic HCWs. We calculated the benefits and costs of a vaccination program for HCWs, using a probabilistic model to estimate the number of pertussis exposures that would require control measures annually. Sensitivity and threshold analyses were performed.Results. The outbreak cost to the hospital was $74,870. The total measured cost of the outbreak was $ 81,382, including costs incurred by HCWs ($ 6512). Our model predicted that vaccinating HCWs against pertussis would prevent > 46% of exposures from HCWs with pertussis per year and would provide net savings. The benefit for the hospital was estimated to be 2.38 times the dollar amount invested in vaccinating HCWs. The number of exposures prevented and the benefit-cost ratio were sensitive to the number of exposures identified, the incidence of pertussis among HCWs, and HCW turnover.Conclusions. A single nosocomial pertussis outbreak resulted in substantial disruption and costs to the hospital and to HCWs. Our model suggests that cost savings and benefits could be accrued by vaccinating HCWs against pertussis.