Influenza disease profile
BOX B-1
Influenza
Infectious Agent: Orthomyxoviruses, RNA viruses that infect birds and mammals. Three genera cause influenza: Influenza A, which is the most common cause of disease and has varying serotypes; Influenza B, which has only one serotype; and Influenza C, the least common.
Routes of Transmission: Airborne aerosols and direct contact with secretions or contaminated surfaces.
Health Effects: Influenza illness typically begins with chills or fever. The illness often involves cough, sore throat, nasal congestion, muscle aches, headache, and fatigue. It typically lasts for several days. In contrast with common colds, influenza usually has high fever with sudden onset and extreme fatigue. Influenza can also cause pneumonia either directly or through secondary bacterial infection.
Incidence, Prevalence, and Mortality: Influenza causes annual seasonal epidemics throughout the world as well as periodic pandemics. In the United States influenza has been estimated to cause an average of approximately 36,000 annual deaths during 1990–1999 and 226,000 annual hospitalizations during 1979–2001.
The incidence (or attack rate) varies from year to year and is highest in children aged 0 to 4 years old and in the elderly aged 65 years and older. One paper from the Centers for Disease Control and Prevention estimated seasonal influenza attack rates in the United States ranging from 6.6 percent in healthy young adults to 20 percent in the youngest children.
The 2009 pandemic influenza virus A (H1N1) infected an estimated 11 to 21 percent of the populations where the incidence could be studied. The highest incidence (34–43 percent) occurred in school-aged children. The severity of the disease, in terms of hospitalizations and pneumonia, was similar to that of recent seasonal influenza strains.
Prevention and Treatment: Annual influenza vaccination is the primary tool for prevention. The vaccine is reformulated each year to prevent the strains of the virus that the World Health Organization predicts will be most prevalent during the coming year. In addition, antiviral treatment is most effective when initiated within 48 hours of symptom onset and has typically been directed to persons at high risk of complications due to influenza.
Vaccine: In the United States, vaccination has been recommended for all persons 6 months and older since 2006. Two types of vaccines are produced: inactivated (for intramuscular administration) and live attenuated (for intranasal administration).
Tuberculosis disease profile
BOX B-2
Tuberculosis
Infectious Agent: Mycobacteria in the M. tuberculosis complex, primarily M. tuberculosis, M. bovis, and M. africanum.
Routes of Transmission: Inhaling droplet nuclei in airborne aerosols generated by coughing or sneezing by individuals with pulmonary tuberculosis and consuming contaminated, unpasteurized cow’s milk.
Health Effects: In a small proportion of newly infected individuals, especially infants, initial infection progresses rapidly—in weeks to months—to primary tuberculosis, which often disseminates to blood, bone, and other distant sites. Pulmonary tuberculosis produces cough, fever, night sweats, fatigue, and weight loss; it often goes undiagnosed for a number of months, during which time infection is transmitted to others, especially to close contacts, such as household members. However, infection in the lung can be contained by the immune system and remains latent; fewer than 10 percent of latently infected individuals subsequently develop reactivation pulmonary tuberculosis, generally when age, malnutrition, HIV infection, or other conditions suppress the immune system and thereby allow latent infection to reactivate.
Incidence, Prevalence, and Mortality: Approximately one-third of the world’s population is estimated to be latently infected with M. tuberculosis, but only a small proportion of these individuals will develop tuberculosis. WHO estimated that in 2010, 8.8 million people developed tuberculosis worldwide, yielding an incidence of 128 cases per 100,000 people. About 650,000 cases were caused by multi-drug-resistant strains of M. tuberculosis, and 1.4 million with tuberculosis died of the
disease. The incidence rate, number of cases, and deaths from tuberculosis has been declining in recent years, mainly due to increased attention and resources devoted to diagnosing cases and assuring that patients receive and complete the lengthy treatment regimen.
Prevention: In most wealthy countries with low incidence rates, prevention of tuberculosis primarily rests on prompt diagnosis, correct multi-drug treatment, and ensuring completion of treatment among those with pulmonary tuberculosis. Latent infected individuals are also treated with drugs, especially those at high risk of reactivation tuberculosis, such as HIV-infected individuals. In poor countries with high incidence rates of tuberculosis, prevention of tuberculosis, while also dependent on prompt diagnosis, correct treatment, and ensuring completion of treatment, primarily rests on targeting all infants with a single dose of the vaccine, given shortly after birth.
Treatment: Successful treatment of tuberculosis requires multiple drugs (at least three) given for a lengthy time period (9 to 12 months), even though the patient is usually asymptomatic (and non-infectious) after a few weeks of treatment. Treatment of latently infected individuals to prevent reactivation tuberculosis is generally accomplished with a single drug (example, isoniazid), also given for an extended period of time (6 to 12 months).
Vaccine: Bacille Calmette-Guerin (BCG) vaccine is widely used at birth throughout South Africa, where there is a high burden of pediatric HIV infection. BCG is given to all newborns as soon as possible after birth to protect infants infected with tuberculosis from progressing to the more dangerous forms of meningeal and miliary tuberculosis.
Group B streptococcus disease profile
BOX B-3
Group B Streptococcus
Infectious Agent: Group B Streptococcus (Streptococcus agalactiae) is a gram-positive organism found as a normal inhabitant of the gastrointestinal and genital tract of humans. The majority of the disease is caused by five serotypes.
Routes of Transmission: Transmission from mother to infant occurs in utero or at the time of delivery. Exposure to GBS in the hospital, at home, or in the community may result in late-onset disease.
Health Effects: Group B Streptococcus (Streptococcus agalactiae) is a leading cause of disease in young children. There are two distinct presentations: Early-onset disease (days of life 0–6) is the result of vertical transmission from a colonized mother, and late-onset disease (days of life 7–89) is acquired from either the mother or environmental sources. Early-onset disease is characterized by sepsis or meningitis with a high mortality rate. Late-onset disease often presents as meningitis with a somewhat lower mortality rate but with prominent sequelae.
Incidence, Prevalence, and Mortality: Group B Streptococcus is the most common cause of sepsis and meningitis in infants from developed countries and one of the most common causes in infants globally. The mean invasive GBS disease incidence is 0.53 per 1,000 live births. The mean incidence of early-onset disease is 0.43 per 1,000 live births, with
the highest incidence reported from Africa: 0.53 per 1,000 live births. The mean incidence of late-onset disease (7–89 days) is 0.24 per 1,000 live births. Incidence is again highest in Africa, at 0.7 per 1,000 live births. Typically, early-onset disease is more likely to cause mortality (case fatality rate of 12.1 percent) than the late-onset disease (case fatality rate of 6.8 percent).
Prevention: Currently, to control group B streptococcus intrapartum antibitotics are administered to pregnant women with either known risk factors for group B streptococcos or documented carriage of the bacteria. This approach was widely adopted in the United States and many developed countries and resulted in substantial declines in disease in infants younger than 7 days. In the United States, culture-based screening is used to identify candidates for chemoprophylaxis, but implementing this strategy has been a difficult in low- and middle-income countries.
Treatment: Supportive care and antibiotics are needed for the successful treatment of GBS in infants. Benzylpenicillin or amoxicillin combined with aminoglycosides is the mainstay of therapy at the onset when GBS is suspected. When GBS is confirmed, benzylpenicillin or amoxicillin can be used as a single agent. Treatment duration for sepsis is generally 10 days, but meningitis is treated for a minimum of 14 days, with more prolonged therapy in complicated cases.
Vaccine: A vaccine is not currently available for group B streptococcal infection.
U.S. Population Data
Femalea | |||||||
Age Group | Population | Life Table | Health | Productivity | |||
N | Living (lx) | Life Years (nLx) | Life Expectancy (ex) | Standard Life Expectancyb (ex) | HUI2c | Hourly Wage Rated *(<15 parents) | |
<1 | 2,183,518 | 100,000 | 99,452 | 80.9 | 86.5 | 0.99 | $17.90 |
1-4 | 8,456,004 | 99,391 | 397,326 | 80.4 | 85.7 | 0.99 | $17.97 |
5-9 | 10,228,540 | 99,292 | 496,309 | 76.5 | 81.7 | 0.99 | $23.50 |
10-14 | 10,309,899 | 99,232 | 495,991 | 71.6 | 76.8 | 0.99 | $24.57 |
15-19 | 10,910,307 | 99,164 | 495,387 | 66.6 | 71.8 | 0.99 | $8.45 |
20-24 | 10,862,866 | 98,991 | 494,371 | 61.7 | 66.9 | 0.99 | $10.90 |
25-29 | 10,634,528 | 98,758 | 493,104 | 56.9 | 62 | 0.95 | $16.40 |
30-34 | 10,326,394 | 98,484 | 491,541 | 52 | 57.1 | 0.90 | $16.47 |
35-39 | 10,441,258 | 98,133 | 489,384 | 47.2 | 52.2 | 0.86 | $18.20 |
40-44 | 10,944,157 | 97,621 | 486,111 | 42.4 | 47.3 | 0.86 | $18.20 |
45-49 | 11,697,857 | 96,823 | 481,067 | 37.7 | 42.5 | 0.84 | $18.50 |
50-54 | 11,270,132 | 95,603 | 473,634 | 33.2 | 37.8 | 0.84 | $18.50 |
55-59 | 9,904,308 | 93,850 | 463,085 | 28.8 | 33.1 | 0.81 | $18.70 |
60-64 | 8,297,733 | 91,384 | 447,776 | 24.5 | 28.5 | 0.81 | $18.70 |
65-69 | 6,266,131 | 87,726 | 425,003 | 20.4 | 24 | 0.83 | $16.07 |
70-74 | 4,919,414 | 82,275 | 391,682 | 16.6 | 19.7 | 0.83 | $16.00 |
75-79 | 4,159,980 | 74,398 | 344,041 | 13.1 | 15.5 | 0.82 | $16.00 |
80-84 | 3,493,449 | 63,218 | 278,259 | 9.9 | 11.8 | 0.82 | $16.00 |
85-89 | 2,397,331 | 48,086 | 195,937 | 7.3 | 8.5 | 0.82 | $16.00 |
90-94 | 1,194,178 | 30,289 | 104,147 | 5.1 | 5.8 | 0.82 | $15.00 |
95-99 | 422,524 | 14,523 | 38,597 | 3.4 | 3.8 | 0.82 | $15.00 |
Malea | |||||||
Age Group | Population | Life Table | Health | Productivity | |||
N | Living (lx) | Life Years (nLx) | Life Expectancy (ex) | Standard Life Expectancyb (ex) | HUI2c | Hourly Wage Rated *(<15 parents) | |
<1 | 2,294,679 | 100,000 | 99,348 | 76 | 79.6 | 0.99 | $17.90 |
1-4 | 8,889,066 | 99,276 | 396,817 | 75.6 | 78.8 | 0.99 | $17.97 |
5-9 | 10,753,934 | 99,156 | 495,604 | 71.7 | 74.9 | 0.99 | $23.50 |
10-14 | 10,838,788 | 99,085 | 495,185 | 66.7 | 69.9 | 0.99 | $24.57 |
15-19 | 11,472,812 | 98,989 | 493,905 | 61.8 | 65 | 0.99 | $9.25 |
20-24 | 11,374,397 | 98,573 | 491,150 | 57 | 60.1 | 0.99 | $11.45 |
25-29 | 11,021,998 | 97,887 | 487,775 | 52.4 | 55.2 | 0.95 | $17.90 |
30-34 | 10,581,472 | 97,223 | 484,373 | 47.7 | 50.4 | 0.92 | $17.97 |
35-39 | 10,547,351 | 96,526 | 480,477 | 43.1 | 45.6 | 0.88 | $23.50 |
40-44 | 10,872,790 | 95,665 | 475,151 | 38.4 | 40.8 | 0.88 | $23.50 |
45-49 | 11,447,885 | 94,396 | 467,208 | 33.9 | 36.1 | 0.86 | $24.57 |
50-54 | 10,825,136 | 92,487 | 455,327 | 29.6 | 31.5 | 0.86 | $24.57 |
55-59 | 9,393,752 | 89,643 | 438,424 | 25.4 | 27.1 | 0.83 | $24.62 |
60-64 | 7,674,399 | 85,726 | 415,226 | 21.5 | 23 | 0.83 | $24.65 |
65-69 | 5,587,609 | 80,364 | 383,132 | 17.7 | 18.9 | 0.86 | $20.90 |
70-74 | 4,156,592 | 72,889 | 339,373 | 14.3 | 15.2 | 0.86 | $19.00 |
75-79 | 3,219,109 | 62,860 | 281,766 | 11.2 | 11.7 | 0.84 | $19.00 |
80-84 | 2,359,608 | 49,846 | 209,856 | 8.4 | 8.7 | 0.84 | $19.00 |
85-89 | 1,318,716 | 34,096 | 131,028 | 6.2 | 6.3 | 0.84 | $19.00 |
90-94 | 486,989 | 18,315 | 58,224 | 4.4 | 4.4 | 0.84 | $18.00 |
95-99 | 112,289 | 7,198 | 17,589 | 3 | 3 | 0.84 | $18.00 |
aThe country life tables are available from WHO Global Health Observatory Data Repository (http://bit.ly/HyByvk).
bStandard life expectancy depicts the life expectancy for the Japanese population. Data available through WHO Global Health Observatory Data Repository (http://bit.ly/Ho2VI3).
cHUI-2 scores are derived from: Fryback, D. G., N. C. Dunham, M. Palta, J. Hanmer, J. Buechner, D. Cherepanov, S. Herrington, R. D. Hays, R. M. Kaplan, and T. G. Ganiats. 2007. U.S. norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical Care 45(12):1162–1170.
dHourly wage rate was gathered from the Bureau of Labor Statistics Wages. The parents’ wage rate was used for children under the age of 15 years.
U.S. data for influenza
Disease Burden
Female | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Rate (per 100,000) | Case Fatality Ratea (%) | Vaccine Coverage (%) | Vaccine Effectivenessb (%) | Herd Immunity Thresholdc (%) |
(<1) | 2,183,518 | 100% | 20,300 | 0.004 | 30% | 60% | 100% |
(1-19) | 39,904,750 | 100% | 11,947 | 0.002 | 20% | 70% | 100% |
(20-64) | 94,379,233 | 100% | 6,600 | 0.05 | 40% | 75% | 100% |
(>65) | 22,853,007 | 100% | 9,000 | 1.17 | 60% | 40% | 100% |
Male | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Rate (per 100,000) | Case Fatality Ratea (%) | Vaccine Coverage (%) | Vaccine Effectivenessb (%) | Herd Immunity Thresholdc (%) |
(<1) | 2,294,679 | 100% | 20,300 | 0.004 | 30% | 60% | 100% |
(1-19) | 41,954,600 | 100% | 11,947 | 0.002 | 20% | 70% | 100% |
(20-64) | 93,739,180 | 100% | 6,600 | 0.05 | 40% | 75% | 100% |
(>65) | 17,240,912 | 100% | 9,000 | 1.17 | 60% | 40% | 100% |
aMolinari, N. A., I. R. Ortega-Sanchez, M. L. Messonnier, W. W. Thompson, P. M. Wortley, E. Weintraub, C. B. and Bridges. 2007. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 25(27):5086–5096.
bAllison, M. A., M. F. Daley, L. A. Crane, J. Barrow, B. L. Beaty, N. Allred, S. Berman, and A. Kempe. 2006. Influenza vaccine effectiveness in healthy 6-to 21-month-old children during the 2003–2004 season. Journal of Pediatrics 149(6):755–762. e751; Nichol, K. L. 2003. The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines. Vaccine 21(16):1769–1775; Vu, T., S. Farish, M. Jenkins, H. and Kelly. 2002. A meta-analysis of effectiveness of influenza vaccine in persons aged 65 years and over living in the community. Vaccine 20(13–14):1831–1836.
cHerd immunity threshold is assumed to be at 100 percent due to the infectious nature of Influenza.
Disease Morbidity and Vaccine Complications
Disease Morbidity | Percent of Cases | Disutilitya (Toll) | Disability Weightb | Durationc (Years) |
Influenza lllness Without Outpatient Visit | 59.5% | 0.09 | 0.01 | 0.0137 |
Influenza lllness With Outpatient Visit | 40.0% | 0.13 | 0.1 | 0.0137 |
Influenza Hospitalization | 0.5% | 0.2 | 0.3 | 0.0137 |
Vaccine Complications | Probability per Dose | Disutilitya (Toll) | Disability Weightb | Durationc (Years) |
Guillain-Barré Syndrome | 0.000001 | 0.35 | 0.44 | 0.137 |
Systemic Reaction (Fever or Achiness) | 0.011 | 0.25 | 0.1 | 0.0027 |
Anaphylaxis | 0.00000025 | 0.25 | 0.44 | 0.0027 |
aDisutility (toll) is the one-time disutility associated with the specific health state. Fryback, D. G., N. C. Dunham, M. Palta, J. Hanmer, J. Buechner, D. Cherepanov, S. Herrington, R. D. Hays, R. M. Kaplan, and T. G. Ganiats. 2007. U.S. norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical Care 45(12):1162–1170.
bMathers, C. D., A. D. Lopez, C. J. L. and Murray. 2006. The burden of disease and mortality by condition: data, methods, and results for 2001. Global burden of disease and risk factors. Table 3A.6. Global burden of disease 2004 update: Disability weights for diseases and conditions 1:45–93.
cCommittee’s expert opinion.
Costs
Health Care Services | Cost | Disease Morbidity | Vaccine Complications | |||||
Death | Influenza Without Outpatient Visit | Influenza With Outpatient Visit | Influenza With Hospitalization | Guillain- Barré Syndrome |
System ic Reaction | Anaphylaxis | ||
Over-the-counter medicationsa | $3 | 1 | 1 | 1 | 1 | 0 | 0 | 0 |
Physician visita | $200 | 0 | 0 | 0 | 0 | 0 | 1 | 0 |
Outpatient visita | $250 | 1 | 0 | 1 | 1 | 0 | 0 | 0 |
Emergency department visitb | $750 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Hospitalizationb | $1,200 | 5 | 0 | 0 | 5 | 40 | 0 | 0 |
aProsser, L. A., M. A. O’Brien, N. A. Molinari, K. H. Hohman, K. L. Nichol, M. L. Messonnier, and T. A. Lieu. 2008. Non-traditional settings for influenza vaccination of adults: Costs and cost effectiveness. Pharmacoeconomics 26(2):163–178.
bCommittee’s expert opinion and estimates from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample Data. 2009 national statistics for principal diagnosis of influenza only.
Vaccine Characteristics
Length of immunitya | 1 | years or life |
Doses required per persona | 1 | doses |
Cost per doseb | $13 | $ |
Cost to administer per dosec | $10 | $ |
Research costsc | $50,000,000 | $ |
Licensure costsc | $100,000,000 | $ |
Start-up costsc | $100,000 | $ |
Time to adoptionc | 5 | years |
aCDC recommends an influenza shot every year (http://1.usa.gov/tEA0Mg).
bCost is approximated using CDC prices for cost per dose (http://1.usa.gov/26Xjuj).
cCommittee’s expert opinion.
U.S. data for tuberculosis
Disease Burden
Female | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Ratea (per 100,000) | Case Fatality Rateb (%) | Vaccine Coveragec (%) | Vaccine Effectivenessc (%) | Herd Immunity Threshold (%) |
<1 | 2,183,518 | 100% | 1.68 | 9 | 85% | 65% | 100% |
1-19 | 39,904,750 | 0% | 1.15 | 9 | 85% | 65% | 100% |
20-64 | 94,379,233 | 0% | 3.35 | 9 | 85% | 65% | 100% |
>65 | 22,853,007 | 0% | 4.54 | 9 | 85% | 65% | 100% |
Male | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Ratea (per 100,000) | Case Fatality Rateb (%) | Vaccine Coveragec (%) | Vaccine Effectivenessc (%) | Herd Immunity Threshold (%) |
<1 | 2,294,679 | 100% | 3.31 | 9 | 85% | 65% | 100% |
1-19 | 41,954,600 | 0% | 2.27 | 9 | 85% | 65% | 100% |
20-64 | 93,739,180 | 0% | 6.63 | 9 | 85% | 65% | 100% |
>65 | 17,240,912 | 0% | 8.97 | 9 | 85% | 65% | 100% |
aCenters for Disease Control and Prevention. 2011. Summary of notifiable diseases—United States, 2009. Morbidity and Mortality Weekly Report 58(53):1–100.
bThe committee assigned the value for Case Fatality Rate after consulting with several tuberculosis experts.
cSince BCG is not administered in the United States, the committee assumed a potential new vaccine will be 65 percent effective with 85 percent coverage.
Disease Morbidity and Vaccine Complications
Disease Morbidity | Percent of Cases | Disutilitya (Toll) | Disability Weightb | Durationc (Years) |
Pulmonary Tuberculosis (with Inpatient Treatment) | 40.0% | 0.30 | 0.28 | 0.06 |
Pulmonary Tuberculosis (with Outpatient Treatment) | 20.0% | 0.08 | 0.27 | 0.16 |
Latent Tuberculosis (with Treatment) | 8.0% | 0.00 | 0.00 | 0.00 |
Extrapulmonary Tuberculosis (with Inpatient Treatment) | 22.0% | 0.30 | 0.29 | 0.06 |
Vaccine Complications | Percent of Cases | Disutilitya (Toll) | Disability Weightb | Durationc (Years) |
Injection Site Abscess | 0.000010 | 0.050000 | 0.100000 | 0.082100 |
Lymphadenitis | 0.000010 | 0.050000 | 0.010000 | 0.043000 |
Severe Local Reaction | 0.000050 | 0.050000 | 0.100000 | 0.008200 |
aDisutility (toll) is the one-time disutility associated with the specific health state. Guo, N., F. Marra, and C. A. Marra. 2009. Measuring health-related quality of life in tuberculosis: A systematic review. Health and Quality of Life Outcomes 7:14.
bMathers, C. D., A. D. Lopez, and C. J. L. Murray. 2006. The burden of disease and mortality by condition: data, methods, and results for 2001. Global burden of disease and risk factors. Table 3A.6. Global burden of disease 2004 update: Disability weights for diseases and conditions 1:45–93.
cCommittee’s expert opinion.
Costs
Health Care Services | Costa | Disease Morbidity | |||||
Death | Pulmonary Tuberculosis (Inpatient) | Pulmonary Tuberculosis (Outpatient) | Latent Tuberculosis with Treatment | Extrapulmonary Tuberculosis | Lung Impairment | ||
Direct Observed Therapy (DOT) Drugsb | $0 | 0 | 0 | 0 | 9 | 0 | 0 |
Outpatient Treatmentb | $400 | 0 | 0 | 1 | 0 | 0 | 0 |
Inpatient Treatmentb | $760 | 1 | 11 | 0 | 0 | 3 | 0 |
Hospitalizationb’ | $1,300 | 15 | 0 | 0 | 0 | 0 | 5 |
Health Care Services | Costa | Vaccine Complications | ||
Injection Site Abscess | Lymphadenitis | Severe Loc al Reaction | ||
Direct Observed Therapy (DOT) Drugsb | $0 | 0 | 0 | 0 |
Outpatient Treatmentb | $400 | 1 | 1 | 0 |
Inpatient Treatmentb | $760 | 0 | 0 | 1 |
Hospitalizationb’ | $1,300 | 0 | 0 | 0 |
aCosts associated with the health care services used to treat morbidity caused by the disease and vaccine.
bBlumberg, H. M., M. K. Leonard, and R. M. Jasmer. 2005. Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA 293(22):2776–2784.
cHolland, D. P., G. D. Sanders, C. D. Hamilton, and J. E. Stout. 2009. Costs and cost effectiveness of four treatment regimens for latent tuberculosis infection. American Journal of Respiratory and Critical Care Medicine 179(11):1055–1060.
dHCUP Brief #60. 2008. Tuberculosis stays in U.S. hospitals, 2006.
Vaccine Characteristics
Length of immunitya | life | years or life |
Doses required per persona | 1 | doses |
Cost per dosea | $50 | $ |
Cost to administer per dosea | $25 | $ |
Research costsa | $100,000,000 | $ |
Licensure costsa | $500,000,000 | $ |
Start-up costsa | $10,000,000 | $ |
Time to adoptiona | 5 | years |
aSince BCG is not administered in the United States, these values are based on expert opinion.
U.S. data for Group B streptococcus
Disease Burden
Female | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Ratea (per 100,000) | Case Fatality Rateb (%) | Vaccine Coveragec (%) | Vaccine Effectivenessd (%) | Herd Immunity Threshold (%) |
(<1) | 2,183,518 | 100% | 35.00 | 3.8 | 85% | 90% | 100% |
(1-19) | 39,904,750 | 0% | 1.37 | 6.3 | 85% | 90% | 100% |
(20-64) | 94,379,233 | 0% | 4.60 | 6.0 | 85% | 80% | 100% |
(>65) | 22,853,007 | 0% | 25.30 | 11.4 | 85% | 80% | 100% |
Male | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Ratea (per 100,000) | Case Fatality Rateb (%) | Vaccine Coveragec (%) | Vaccine Effectivenessd (%) | Herd Immunity Threshold (%) |
(<1) | 2,294,679 | 100% | 35.00 | 3.8 | 85% | 90% | 100% |
(1-19) | 41,954,600 | 0% | 1.37 | 6.3 | 85% | 90% | 100% |
(20-64) | 93,739,180 | 0% | 4.60 | 6.0 | 85% | 80% | 100% |
(>65) | 17,240,912 | 0% | 25.30 | 11.4 | 85% | 80% | 100% |
aPhares, C. R., R. Lynfield, M. M. Farley, J. Mohle-Boetani, L. H. Harrison, S. Petit, A. S. Craig, W. Schaffner, S. M. Zansky, and K. Gershman, 2008. Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005. JAMA 299(17):2056–2065.
bSince a vaccine for group B streptococcus is not available currently, the effectiveness values are derived from expert opinions.
cA herd immunity threshold of 100 percent is assigned for all age groups.
Disease Morbidity
Percent of Cases | Disutilitya (Toll) | Disability Weightb | Durationc (Years) | |
Meningitis | 25% | 0.70 | 0.61 | 0.04 |
Pneumonia | 20% | 0.13 | 0.15 | 0.04 |
Respiratory distress | 15% | 0.13 | 0.14 | 0.02 |
Sepsis | 15% | 0.09 | 0.09 | 0.03 |
Neurological impairment | 25% | 0.35 | 0.4 |
aFryback, D. G., N. C. Dunham, M. Palta, J. Hanmer, J. Buechner, D. Cherepanov, S. Herrington, R. D. Hays, R. M. Kaplan, and T. G. Ganiats. 2007. U.S. norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical Care 45(12):1162–1170.
bMathers, C. D., A. D. Lopez, and C. J. L. Murray. 2006. The burden of disease and mortality by condition: data, methods, and results for 2001. Global burden of disease and risk factors. Table 3A.6. Global burden of disease 2004 update: Disability weights for diseases and conditions 1: 45–93.
cCommittee’s expert opinion.
Costs
Health Care Services | Cost | Disease | |||||
Death | Meningitis | Pneumonia | Respiratory Distress | Sepsis | Neurological Impairment | ||
Hospitalizationa | $2,100 | 7 | 14 | 7 | 7 | 2 | 14 |
aCommittee’s expert opinion and the HCUP Nationwide Inpatient Sample Data, 2009.
Vaccine Characteristics
Length of immunitya | life | years or life |
Doses required per persona | 1 | doses |
Cost per dosea | $100 | $ |
Cost to administer per dosea | $50 | $ |
Research costsa | $200,000,000 | $ |
Licensure costsa | $600,000,000 | $ |
Start-up costsa | $10,000,000 | $ |
Time to adoptiona | 5 | years |
aSince a vaccine for group B streptococcus does not currently exist, these values are based on expert opinion.
South Africa Population Data
Femalea | |||||||
Age Group | Population | Life Table | Health | Productivity | |||
N | Living (lx) | Life Years (nLx) | Life Expectancy (ex) | Standard Life Expectancyb (ex) | HUI2c | Hourly Wage Rateb *(<15 parents) | |
<1 | 504,851 | 100,000 | 97,376 | 54.9 | 86.5 | 0.99 | $4.48 |
1-4 | 2,061,888 | 96,251 | 381,263 | 56 | 85.7 | 0.99 | $4.49 |
5-9 | 2,556,786 | 94,692 | 471,476 | 52.9 | 81.7 | 0.99 | $5.88 |
10-14 | 2,475,823 | 93,899 | 467,978 | 48.3 | 76.8 | 0.99 | $6.14 |
15-19 | 2,498,988 | 93,293 | 463,506 | 43.6 | 71.8 | 0.99 | $2.11 |
20-24 | 2,518,633 | 92,109 | 450,195 | 39.1 | 66.9 | 0.99 | $2.73 |
25-29 | 2,300,308 | 87,968 | 420,123 | 35.9 | 62 | 0.95 | $4.10 |
30-34 | 1,904,419 | 80,081 | 378,913 | 34.1 | 57.1 | 0.90 | $4.12 |
35-39 | 1,623,918 | 71,485 | 342,388 | 32.9 | 52.2 | 0.86 | $4.55 |
40-44 | 1,432,625 | 65,471 | 317,762 | 30.7 | 47.3 | 0.86 | $4.55 |
45-49 | 1,290,971 | 61,634 | 298,340 | 27.5 | 42.5 | 0.84 | $4.63 |
50-54 | 1,169,991 | 57,702 | 277,578 | 24.2 | 37.8 | 0.84 | $4.63 |
55-59 | 960,397 | 53,329 | 254,939 | 21 | 33.1 | 0.81 | $4.68 |
60-64 | 727,265 | 48,647 | 230,430 | 17.8 | 28.5 | 0.81 | $4.68 |
65-69 | 556,744 | 43,525 | 199,866 | 14.6 | 24 | 0.83 | $4.02 |
70-74 | 385,054 | 36,421 | 162,843 | 11.9 | 19.7 | 0.83 | $4.00 |
75-79 | 239,133 | 28,716 | 120,284 | 9.4 | 15.5 | 0.82 | $4.00 |
80-84 | 124,578 | 19,397 | 78,061 | 7.8 | 11.8 | 0.82 | $4.00 |
85-89 | 52,649 | 11,827 | 44,731 | 6.1 | 8.5 | 0.82 | $4.00 |
90-94 | 16,257 | 6,066 | 19,618 | 4.6 | 5.8 | 0.82 | $3.75 |
95-99 | 2,969 | 2,496 | 6,380 | 3.2 | 3.8 | 0.82 | $3.75 |
Malea | |||||||
Age Group | Population | Life Table | Health | Productivity | |||
N | Living (lx) | Life Years (nLx) | Life Expectancy (ex) | Standard Life Expectancyb (ex) | HUI2c | Hourly Wage Rateb *(<15 parents) | |
<1 | 513,738 | 100,000 | 96,596 | 53.9 | 79.6 | 0.99 | $4.48 |
1-4 | 2,094,078 | 95,137 | 375,325 | 55.6 | 78.8 | 0.99 | $4.49 |
5-9 | 2,587,325 | 92,961 | 463,390 | 52.9 | 74.9 | 0.99 | $5.88 |
10-14 | 2,495,950 | 92,395 | 460,642 | 48.2 | 69.9 | 0.99 | $6.14 |
15-19 | 2,514,105 | 91,862 | 457,000 | 43.4 | 65 | 0.99 | $2.31 |
20-24 | 2,542,121 | 90,938 | 450,001 | 38.8 | 60.1 | 0.99 | $2.86 |
25-29 | 2,384,897 | 89,062 | 437,942 | 34.6 | 55.2 | 0.95 | $4.48 |
30-34 | 2,053,143 | 86,115 | 416,874 | 30.7 | 50.4 | 0.92 | $4.49 |
35-39 | 1,700,601 | 80,634 | 386,196 | 27.6 | 45.6 | 0.88 | $5.88 |
40-44 | 1,372,882 | 73,844 | 350,118 | 24.9 | 40.8 | 0.88 | $5.88 |
45-49 | 1,157,933 | 66,203 | 312,525 | 22.5 | 36.1 | 0.86 | $6.14 |
50-54 | 1,004,315 | 58,807 | 275,919 | 20.1 | 31.5 | 0.86 | $6.14 |
55-59 | 814,859 | 51,561 | 238,876 | 17.5 | 27.1 | 0.83 | $6.16 |
60-64 | 598,768 | 43,989 | 202,138 | 15.1 | 23 | 0.83 | $6.16 |
65-69 | 413,005 | 36,866 | 163,729 | 12.5 | 18.9 | 0.86 | $5.23 |
70-74 | 246,008 | 28,626 | 124,506 | 10.4 | 15.2 | 0.86 | $4.75 |
75-79 | 131,479 | 21,177 | 86,228 | 8.2 | 11.7 | 0.84 | $4.75 |
80-84 | 57,263 | 13,315 | 51,119 | 6.6 | 8.7 | 0.84 | $4.75 |
85-89 | 18,099 | 7,133 | 25,265 | 5.1 | 6.3 | 0.84 | $4.75 |
90-94 | 4,082 | 2,973 | 8,783 | 3.8 | 4.4 | 0.84 | $4.50 |
95-99 | 550 | 946 | 2,185 | 2.8 | 3 | 0.84 | $4.50 |
aThe country life tables are available from WHO, Global Health Observatory Data Repository (http://bit.ly/HyByvk).
bStandard life expectancy depicts the life expectancy for the Japanese population. Also available through WHO, Global Health Observatory Data Repository (http://bit.ly/Ho2VI3).
cHUI-2 scores are derived from: Fryback, D. G., N. C. Dunham, M. Palta, J. Hanmer, J. Buechner, D. Cherepanov, S. Herrington, R. D. Hays, R. M. Kaplan, and T. G. Ganiats. 2007. U.S. norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical Care. 45(12):1162–1170. Due to the lack of data for HUI-2 within South Africa, estimates for the United States are used.
dWage Rate for South Africa was crudely estimated by converting the United States wage rate to a South African wage based on the prevailing exchange rate.
South Africa Data for Tuberculosis
Disease Burden
Female | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Ratea (per 100,000) | Case Fatality Rateb (%) | Vaccine Coveragec (%) | Vaccine Effectivenessd (%) | Herd Immunity Threshold (%) |
<1 | 50,4851 | 100% | 800 | 19 | 50% | 60% | 100% |
1-19 | 9,593,485 | 0% | 900 | 19 | 50% | 60% | 100% |
20-64 | 13,928,527 | 0% | 1100 | 22 | 50% | 50% | 100% |
>65 | 1,377,384 | 0% | 981 | 20 | 50% | 40% | 100% |
Male | |||||||
Age Group | Population (N) | Target Population (% of N) | Annual Incidence Ratea (per 100,000) | Case Fatality Rateb (%) | Vaccine Coveragec (%) | Vaccine Effectivenessd (%) | Herd Immunity Threshold (%) |
<1 | 513,738 | 100% | 800 | 19 | 50% | 60% | 100% |
1-19 | 9,691,458 | 0% | 973 | 19 | 50% | 60% | 100% |
20-64 | 13,629,519 | 0% | 1200 | 22 | 50% | 50% | 100% |
>65 | 870,486 | 0% | 981 | 20 | 50% | 40% | 100% |
aWHO. 2011. Global Tuberculosis Control 2011.
bCorbett, E. L., C. J. Watt, N. Walker, D. Maher, B. G. Williams, M. C. Raviglione, and C. Dye. 2003. The growing burden of tuberculosis: Global trends and interactions with the HIV epidemic. Archives of Internal Medicine 163(9):1009–1021.
cVaccine coverage assumed to be 50 percent.
dColditz, G. A., T. F. Brewer, C. S. Berkey, M. E. Wilson, E. Burdick, H. V. Fineberg, and F. Mosteller. 1994. Efficacy of BCG vaccine in the prevention of tuberculosis. JAMA 271(9):698–702; Rahman, M., M. Sekimoto, I. Takamatsu, K. Hira, T. Shimbo, K. Toyoshima, and T. Fuku. 2001. Economic evaluation of universal BCG vaccination of Japanese infants. International Journal of Epidemiology 30(2):380–385; Rodrigues, L. C., V. K. Diwan, and J. G. Wheeler. 1993. Protective effect of BCG against tuberculous, meningitis, and miliary tuberculosis: A meta-analysis. International Journal of Epidemiology 22(6):1154–1158.
Disease Morbidity and Vaccine Complications
Disease Morbidity | Percent of Casesa | Disutilityb (Toll) | Disability Weightc | Durationa (Years) |
Pulmonary Tuberculosis (with Inpatient Treatment) | 40% | 0.30 | 0.28 | 0.06 |
Pulmonary Tuberculosis (with Outpatient Treatment) | 20% | 0.08 | 0.27 | 0.16 |
Latent Tuberculosis (with Treatment) | 8% | 0.00 | 0.00 | 0.00 |
Extrapulmonary Tuberculosis (with Inpatient Treatment) | 22% | 0.30 | 0.29 | 0.06 |
Lung Impairment | 10% | 0.08 | 0.29 |
Vaccine Complications | Probability per Dosea | Disutilityb (Toll) | Disability Weightc | Durationa (Years) |
Injection Site Abscess | 0.000010 | 0.05 | 0.1 | 0.082100 |
Lymphadenitis | 0.000010 | 0.05 | 0.01 | 0.043000 |
Severe Local Reaction | 0.000050 | 0.05 | 0.1 | 0.008200 |
aCommittee’s expert opinion.
bGuo, N., F. Marra, and C. A. Marra. 2009. Measuring health-related quality of life in tuberculosis: A systematic review. Health and Quality of Life Outcomes 7:14.
cMathers, C. D., A. D. Lopez, and C. J. L. Murray. 2006. The burden of disease and mortality by condition: data, methods, and results for 2001. Global Burden of Disease and Risk Factors. Table 3A.6. Global burden of disease 2004 update: Disability weights for diseases and conditions 1:45–93.
Costs
Health Care Services | Cost | Disease Morbidity | |||||||
Death | Pulmonary Tuberculosis (Inpatient) | Pulmonary Tuberculosis (Outpatient) | Latent Tuberculosis with Treatment | Extrapulmonary Tuberculosis | Lung Impairment | ||||
Direct Observed Therapy (DOT) Drugsa | $46 | 0 | 0 | 0 | 1 | 0 | 0 | ||
Outpatient Treatmenta | $250 | 0 | 0 | 1 | 0 | 0 | 0 | ||
Inpatient Treatmenta | $637 | 0 | 1 | 0 | 0 | 3 | 0 | ||
Hospitalizationb | $360 | 1 | 0 | 0 | 0 | 0 | 5 |
Health Care Services | Cost | Vaccine Complications | |||||||
Injection Site Abscess | Lymphadenitis | Severe Local Reaction | |||||||
Direct Observed Therapy (DOT) Drugsa | $46 | 0 | 0 | 0 | |||||
Outpatient Treatmenta | $250 | 1 | 1 | 0 | |||||
Inpatient Treatmenta | $637 | 0 | 0 | 1 | |||||
Hospitalizationb | $360 | 0 | 0 | 0 |
aFloyd, K., D. Wilkinson, and C. Gilks. 1997. Comparison of cost effectiveness of directly observed treatment (DOT) and conventionally delivered treatment for tuberculosis: Experience from rural South Africa. British Medical Journal 315(7120):1407–1411.
Sinanovic, E., and L. Kumaranayake. 2006. Cost effectiveness and resource allocation. Cost Effectiveness and Resource Allocation 4:11.
bWHO. 2011. Econometric estimation of unit costs. WHO-CHOICE 2011 unit cost estimates for service delivery, http://bit.ly/GWGwF1.
Vaccine Characteristics
Length of immunitya | life | years or life |
Doses required per persona | 1 | doses |
Cost per dosea | $25 | $ |
Cost to administer per dosea | $50 | $ |
Research costsa | $200,000,000 | $ |
Licensure costsa | $600,000,000 | $ |
Start-up costsa | $10,000,000 | $ |
Time to adoptiona | 5 | years |
aCommittee’s expert opinion.