1 Universal Immunization Against Rare Diseases  How much is a child’s life worth?  The individual vs society.

Slides:



Advertisements
Similar presentations
Vaccines related epidemiology Programme design and policy options First EpiTrain course in Advanced Epidemiology Jurmala Latvia Hanna Nohynek.
Advertisements

Meningococcemia: Epidemiology & Prevention Baylor College of Medicine Med-Peds Continuity Clinic Anoop Agrawal, M.D.
Bacterial Meningitis What you need to know to protect yourself.
Pertussis Disease Pertussis (‘whooping cough’) is a bacterial infection affecting the respiratory system, caused by the organism Bordetella pertussis.
Maternal, neonatal, child health and nutrition
Hepatitis A and Hepatitis A Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease Control.
Hepatitis B and Hepatitis B Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory Diseases.
ACIP Meeting Update November 4 th
Adolescent Vaccines What every parent needs to know!
Pneumococcal Disease and Pneumococcal Vaccines Epidemiology and Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease.
Pneumococcal Disease and Pneumococcal Vaccines Epidemiology and Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease.
Amanda Cohn, MD CDR, US Public Health Service National Center for Immunization and Respiratory Diseases April 6, 2011 Epidemiology of Meningococcal Disease.
Hot Topics Region 7 HCC April 16, 2015 Jackie Dawson, PhD Region 7 Public Health Epidemiologist
Common Childhood Diseases. Routine childhood immunization schedule Age at vaccination2 mos4 mos6 mos12 mos18 mos4-6 yrs9-13 yrs14-16 yrs Diptheria 8 Tetanus.
Meningitis Created By: VSU Student Health Center Nursing Staff.
The Facts about this Infection!
Meningitis.
Adult Immunization 2010 Meningococcal Vaccine Segment This material is in the public domain This information is valid as of May 25, 2010.
Varicella Zoster Virus Herpesvirus (DNA) Primary infection results in varicella (chickenpox) Recurrent infection results in herpes zoster (shingles) Short.
What's New on the Child and Adolescent Immunization Schedules William L. Atkinson, MD, MPH National Center for Immunization and Respiratory Diseases William.
1 1 Immunization Update 2011 Connecticut Immunization Teleconference April 19, 2011 William Atkinson, MD, MPH National Center for Immunization and Respiratory.
Epidemiology and Prevention of Viral Hepatitis A to E: Hepatitis A Virus Division of Viral Hepatitis.
Vital & Health Statistics
Multiple Choice Questions for discussion. Part 2
Overview National Hepatitis B Data
Measurement Measuring disease and death frequency FETP India.
Measuring disease and death frequency
Moving towards universal varicella vaccination: the German experience P. Wutzler Jena, Germany Friedrich Schiller University, Jena, Germany Institute of.
AETIOLOGY Case control studies (also RCT, cohort and ecological studies)
A/Prof Brian Cox Cancer Epidemiologist Dunedin. Research Associate Professor Brian Cox Hugh Adam Cancer Epidemiology Unit Department of Preventive and.
Bacterial Meningitis By Dana Burkart.
Meningococcal Disease. What is Meningococcal Disease Meningococcal disease is a potentially life-threatening bacterial infection. Expressed as either.
Pertussis Update Linda Bethel, RN, MPH Epidemiology and Immunization Services Branch.
Chapter 3: Measures of Morbidity and Mortality Used in Epidemiology
Heartland Health 2020 Population Health Unnatural Causes Vignette.
William W. Thompson, PhD Immunization Safety Office Office of the Chief Science Officer Centers for Disease Control and Prevention Impact of Seasonal Influenza.
CURRENT HEALTH PROBLEMS IN STUDENT'S HOME SOUNTRIES HEPATITIS B IN MALAYSIA MOHD ZHARIF ABD HAMID AMINUDDIN BAKI AMRAN.
Meningococcal Disease and Meningococcal Vaccines
HOW ARE PRIORITY ISSUES FOR AUSTRALIA’S HEALTH IDENTIFIED? HEALTH PRIORITIES IN AUSTRALIA.
CAUSING BACTERIAL MENINGITIS Cochlear Implants. Cochlear Implant Is a surgically implanted device that helps overcome problems in the inner ear, or cochlea.
Quick Insights on Some Viral Issues Dr. Haya Al-Tawalah Clinical Virologist.
Diabetes and Obesity Journal Club Carina Signori Endocrinology Fellow
 Carolyn A. Parry, MPH CDC Public Health Advisor Montana Immunization Program 2016 Regional Immunization Workshops.
Meningococcal Disease and Meningococcal Conjugate Vaccine National Immunization Conference March 7, 2007.
1 13-valent pneumococcal conjugate vaccine (PCV13) – new ACIP recommendations 44 th National Immunization Conference April 21, 2010 Pekka Nuorti, MD, DSc.
Impact of Childhood Hepatitis A Vaccination: New York City Vikki Papadouka, PhD, MPH Jane R. Zucker, MD, MSc Sharon Balter, MD Vasudha Reddy, MPH Kristen.
Epidemiology and Current Issues Annual Update Lambeth and Southwark Practice Nurses 4 May 2016 Nicki Banyard South London Health Protection Team.
Date of download: 6/22/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved. Notes: aHepatitis B vaccine (HepB). AT BIRTH: All newborns should.
Prevention of Perinatal and Childhood Hepatitis B Virus Infections Background on Where We’ve Been Lisa Jacques-Carroll, MSW Immunization Services Division,
Where Has All the Pertussis Gone? Pertussis Trends from and the Potential Early Impact of Tdap Vaccination National Immunization Conference Dallas,
C. Jillian Tsai, Ph.D. Department of Preventive Medicine
Chapter 28 Meningococcal Disease. Epidemiology – U.S. Each year 1,400-3,000 cases of meningococcal disease (MD) in the US per 100,000 population.
Pneumococcal Disease and Pneumococcal Vaccines Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory.
What is meningococcal disease?  Adolescents and young adults are at increased risk of meningococcal disease, often referred to as meningitis, a serious.
Adolescent Immunization Trivia
Adolescent Immunization Trivia
Meningococcal Conjugate Vaccine Failures in the United States
Epidemiology of Mumps Let’s move on now to mumps….
Medical English Group 5 Meningitis.
Bacterial Infection Immunizations
Influenza Vaccine Effectiveness Against Pediatric Deaths:
Meningococcal Disease: Optimizing Protection in Adolescents
Global Update on Varicella: Protecting Against an Old Enemy
RISK R isk of Perinatal and Early Childhood Infection
Immunization FaQs 2018 Amy Bachyrycz.
Adolescent Immunization Trivia
Preventing Meningococcal B Disease
Epidemiological Terms
MenB Update: Communicating the Imperative With Parents
Meningitis Created By: VSU Student Health Center Nursing Staff
Presentation transcript:

1 Universal Immunization Against Rare Diseases  How much is a child’s life worth?  The individual vs society

2 Meningococcal Meningitis  THE SYMPTOMS INCLUDE SUDDEN ONSET OF FEVER, HEADACHE, AND STIFF NECK. IT IS OFTEN ACCOMPANIED BY OTHER SYMPTOMS, SUCH AS  NAUSEA  VOMITING  PHOTOPHOBIA (INCREASED SENSITIVITY TO LIGHT)  ALTERED MENTAL STATUS (CONFUSION)  SEPSIS RASH

3

4 After Effects

5 U.S. Multicenter Study: Sequelae in 146 Surviving Children at Hospitalization (Aged 0-19 Years) SequelaeN (%) Amputation2 (1.4) Skin necrosis14 (9.6) Skin graft4 (2.7) Seizures after admission9 (6.2) Unilateral hearing loss*6 (4.1) Bilateral hearing loss*8 (5.5) Ataxia4 (2.7) Hemiplegia3 (2.1) *All among patients with meningitis Kaplan et al., Pediatrics 2006, 118(4):e

6 Available Vaccines

7

8

9 Meningococcal Disease Incidence, United States, NNDSS data, ABCs data estimated to U.S. population with 18% correction for under reporting *In 2010, estimated case counts from ABCs were lower than cases reported to NNDSS and may not be representative

10 Three Age Peaks in Meningococcal Disease Incidence ABCs cases from and projected to the U.S. population with 18% correction for under reporting

11 Incidence Declines in All Serogroups ABCs cases from estimated to the U.S. population with 18% correction for under reporting *In 2010, estimated case counts from ABCs were lower than cases reported to NNDSS and may not be representative MCV4 College Recs MPSV4

12 Incidence Declines in All Age Groups ABCs cases from estimated to the U.S. population with 18% correction for under reporting *In 2010, estimated case counts from ABCs were lower than cases reported to NNDSS and may not be representative

13 Three Incidence Time Frames: Base Case, High and Low Age Group “High Incidence Years” * “Base Case” “Low Incidence Years” <5 years All ages* Average annual incidence of serogroup C, Y, and W135 meningococcal disease ABCs data estimated to U.S. population with 18% correction for under reporting * for adolescents years

14 High Frequency of Hospitalization but Low Case-Fatality in Children <5 Years  86% of all cases were hospitalized  Median length of hospitalization*: 7 days (0-373)  Does not vary by month of age, serogroup or syndrome  Case-fatality Ratio is 6%  Serogroup B: 5%  Serogroup C: 10%  Serogroup Y: 1% *Limited to hospitalized patients ABCs data

15 Annual Cases, Deaths, and Serious Sequelae in Children <5 Years “High Incidence Years” * “Low Incidence Years” Cases Incidence Deaths ** Sequelae*** Average annual cases, incidence, deaths, and serious sequelae * for adolescents years **5-10% case-fatality ratio, ***10-15% of survivors with serious sequelae ABCs data estimated to U.S. population with 18% correction for under reporting

16 Summary: Morbidity and Mortality  75-80% of children <5 years with meningococcal disease survive and fully recover from their illness  Major complications are less frequent in infants than adolescents  Case-fatality ratio is lower in infants

% of Disease in Children <5 Years is Due to Serogroup B *Other includes: serogroup W-135, nongroupables, and other serogroups ABCs cases from estimated to the U.S. population with 18% correction for under reporting In 2010, estimated case counts from ABCs were lower than cases reported to NNDSS and may not be representative

18 Short Period of Risk for Infants Not at Increased Risk for Meningococcal Disease *ABCs, average annual estimated rates to the U.S. population Dose 1 Dose 2 Dose 3 Dose 4

19 Long-term Protection Unlikely  Evidence of declining antibodies 5 years after the 12 month dose  Persistence of antibodies better with 4 doses of HibMenCY compared to 2 doses of MenACWY-D  Lower evidence GRADE compared to short-term immunogenicity data  A vaccinated infant is unlikely to be protected until the year-old vaccination  Adolescent vaccine effectiveness  Infant vaccination in United Kingdom

20 Work Group Interpretation: Burden of Disease  Amount of potentially preventable disease in infants is low at this time  Currently at a stable low in disease incidence  Low proportion of serogroup C+Y disease  Declining incidence after first 6-8 months of life  Dynamic epidemiology that will need to be monitored frequently

21 Cases and Deaths Prevented per 4M Cohort Disease Incidence  An estimated 52 cases (44-62) and 4 deaths (3-5) prevented using current disease epidemiology  Number Needed to Vaccinate: 63,882 per case 826,465 per death Ismael Ortega-Sanchez, October 2011 ACIP Meeting, updated with 5 year persistence data

WORK GROUP RATIONALE FOR PROPOSED RECOMMENDATIONS

23 Should Meningococcal Vaccines be Routinely Recommended for the 4 Million Infants Born Each Year? Is the public health impact based on amount of potentially preventable disease alone sufficient? Does the cost (either total costs or cost-effectiveness) impact your conclusion about the public health impact? Do the potential programmatic aspects (challenges or ease) impact your conclusion about the public health impact? Data Values

24 Proportion of Annual Preventable Cases in Children <5 Years is 20-25%, Cases, 2-4 Deaths Potentially Preventable

Childhood Immunization Schedule

26 Cost per QALY depends on incidence during period of time evaluated Vaccine price= $30 a dose Ismael Ortega-Sanchez, October 2011 ACIP Meeting

27 Options Considered By Work Group 1. Recommend HibMenCY for infants at increased risk for meningococcal disease 2. Recommend HibMenCY for all infants  Work Group used current landscape and data available to inform decision-making  Recent disease epidemiology  Current understanding of vaccine durability  2012 infant immunization schedule

28 Work Group Preference for High-Risk Infant Recommendation  Risk groups small, but feasible target for vaccination (est infants/year at risk)  Infants born with or having a family history of complement component deficiency  Infants with known asplenia, or those with sickle cell disease detected on newborn screening  Infants who are at increased risk due to a community outbreak of serogroup C or Y disease  Mirrors meningococcal recommendations for 9 month through 10 year-olds

29 Primary Rationale for Work Group Recommendations  Low burden of potentially preventable cases  Low proportion of overall cases in infants prevented with this vaccine strategy

30 Working Group Conclusions  Data do not support routine infant meningococcal vaccination at this time  Targeting high-risk infants is a feasible approach consistent with current recommendations for other age groups  Working Group in agreement  Difficult to accept that there will be cases that are preventable  Nevertheless, risk for serogroup C and Y disease is very low in the absence of vaccination  Frequently evaluate disease trends

31 Public Testimony  Parents of children who died from meningoccal disease  Adults with sequelae from meningococcal disease  Parents and children with sequelae  All stating that statistics and cost/benefits are not as important as …….

32 Preventing This

33 And… Asking the question:  If we can prevent the death of even one child, why would we not do it?