Strategies for Group A Streptococcal Prevention

描述（由申请人提供）：在美国，咽炎占门诊就诊的6.4%，占抗生素处方总数的10%。尽管病毒是咽炎的最常见原因，但约15-36%的儿童将有细菌原因，如A组链球菌（GAS）。理想情况下，医生只会用抗生素治疗细菌性疾病。然而，研究发现，70-80%的咽炎患儿会接受抗生素处方，这表明医生可能过度推荐使用抗生素。抗生素的过度使用导致人们越来越担心社区中抗生素耐药性的发展。GAS疫苗试验正在美国和加拿大进行。如果疫苗被证明有效，它不仅有可能预防GAS疾病，如咽炎，侵袭性疾病和风湿热，而且还可能减少社区中不必要的抗生素处方和耐药率。一旦有了疫苗，就需要就合理和具有成本效益的疫苗使用作出决定。该提案的目的是提高我们对如何将患者偏好和先进建模方法纳入评估感染干预措施的成本效益的理解。候选人将解决4个具体目标：（1）确定GAS感染（如咽炎）的社会成本和健康状况偏好;（2）创建决策分析模型，以估计预防侵袭性GAS疾病的选择性疫苗接种策略的成本和健康结果;（3）通过数学建模确定婴儿和/或儿童通用疫苗接种策略的成本效益;以及（4）评估当前咽炎管理策略的成本和结果，并模拟GAS疫苗的潜在下游影响。这个K 08奖的总体目标是为候选人的专业，学术和研究发展做出贡献。她致力于改善儿童的健康结果，结合她在儿科传染病方面的专业知识，为这一提议奠定了坚实的基础。除了在哈佛公共卫生学院和肯尼迪政府学院接受正式培训外，她还将获得一个由有成就的导师和顾问组成的团队的指导和支持。在她的K奖，她希望建立自己在决策科学，传染病建模和卫生政策领域的多学科研究人员。

DESCRIPTION (provided by the applicant): Pharyngitis accounts for 6.4% of office visits and 10% of total antibiotic prescriptions in the U.S. Although viruses are the most common cause of pharyngitis, approximately 15-36% of children will have a bacterial cause such as Group A Streptococcus (GAS). Ideally, physicians would treat only bacterial causes with antibiotics. However, studies have found that 70-80% of children who are seen for pharyngitis will receive an antibiotic prescription, suggesting that physicians may be excessively recommending antibiotic use. Such overuse of antibiotics has led to growing concerns over the development of antibiotic resistance in the community. GAS vaccine trials are underway in the U.S. and Canada. If the vaccine proves efficacious, it will not only have the potential to prevent GAS disease such as pharyngitis, invasive disease, and rheumatic fever, but it may also reduce unnecessary antibiotic prescribing and rates of resistance in the community. Decisions will need to be made about reasonable and cost-effective vaccine use once it becomes available. The goal of this proposal is to enhance our understanding of how to incorporate patient preferences and advanced modeling methods in evaluating the cost-effectiveness of interventions against infections. The candidate will address 4 specific aims: (1) To determine the societal costs and health state preferences for GAS infection such as pharyngitis; (2) To create a decision-analytic model to estimate the costs and health outcomes of selective vaccination strategies to prevent invasive GAS disease; (3) To determine the cost-effectiveness of universal vaccination strategies for infants and/or children through mathematical modeling; and (4) To evaluate the costs and outcomes of current management strategies for pharyngitis and model the potential downstream impact of a GAS vaccine. The overall goal of this K08 Award is to contribute to the professional, academic, and research development of the candidate. Her commitment to improving the health outcomes of children combined with her expertise in pediatric infectious diseases provides a strong foundation for this proposal. In addition to pursuing formal training at Harvard School of Public Health and the Kennedy School of Government, she will receive guidance and support from a team of accomplished mentors and advisors. During her K Award, she hopes to establish herself as a multidisciplinary researcher in the fields of decision sciences, infectious disease modeling, and health policy.