Vaccines for the 21st Century A Tool for Decisionmaking (2000) / Chapter Skim
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Appendix 9: Herpes Simplex Virus
Appendix 9: Herpes Simplex Virus
Pages 195-206
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From page 195... ...
HSV-2 is responsible for approximately 85% of symptomatic primary genital HSV infections, most of which are recurrent infections. Some complications associated with genital herpetic infections include aseptic meningitis, extragenital lesions, and neonatal herpes (in the case of maternal transmission)
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From page 196... ...
Central Nervous System Infections For the purposes of the calculations in this report, it was assumed that all CNS HSV infections are associated with a flu-like illness, and that chronic neurologic sequelae of HSV infection occurs in 20% of teenagers and 15% of
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From page 197... ...
APPENDIX 9 Table A9-1 Incidence and Mortality of HSV Infections Age Groups Populations INCIDENCE OF ORAL lISV INFECTIONS <1 3,963,000 1-4 16,219,000 1,541.40 5-14 38,056,000 394.16 15-24 36,263,000 137.88 25-34 41,670,000 60.00 35-44 42,149,000 59.31 45-54 30,224,000 0.00 55-64 21,241,000 0.00 65-74 18,964,000 0.00 75-84 11,088,000 0.00 85+ 3,598,000 0.00 Total 263,435,000 189.80 197 Incidence Rates % Distribution 0.00 INCIDENCE OF OCULAR HSV INFECTIONS <1 3,963,000 0.00 1-4 16,219,000 6.17 5-14 38,056,000 7.88 15-24 36,263,000 8.27 25-34 41,670,000 7.20 35-44 42,149,000 4.75 45-54 30,224,000 6.62 55-64 21,241,000 9.42 65-74 18,964,000 10.55 75-84 11,088,000 18.04 85+ 3,598,000 0.00 Total 263,435,000 7.59 INCIDENCE OF HSV CNS INFECTION <1 3,963,000 1-4 16,219,000 5-14 38,056,000 15-24 36,263,000 25-34 41,670,000 35-44 42,149,000 45-54 30,224,000 55-64 21,241,000 65-74 18,964,000 75-84 11,088,000 85+ 3,598,000 Total 263,435,000 0.0000 0.5000 0.3000 0.1000 0.0500 0.0500 0.0000 0.0000 0.0000 0.0000 0.0000 1.0000 0.0000 0.0500 0.1500 0.1500 0.1500 0.1000 0.1000 0.1000 0.1000 0.1000 0.0000 1.0000 0.00 0.00 1.97 0.00 0.00 0.00 0.62 0.88 0.99 1.69 0.00 0.57 0.0000 0.0000 0.5000 0.0000 0.0000 0.0000 0.1250 0.1250 0.1250 0.1250 0.0000 1.0000 o 250,000 150,000 50,000 25,000 25,000 500,000 o 1,000 3,000 3,000 3,000 2,000 2,000 2,000 2,000 2,000 lo 20,000 188 188 188 188 1,500 Continued
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From page 198... ...
This chronic condition is assumed to be associated with an HUI of .19 for the duration of the person's life. Genital Infections For the purposes of the calculations in this report, it was assumed that 100% of genital HSV infections are associated with a 2-week period at an HUI of .81 (genital lesions, fever, pain)
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From page 199... ...
Central Nervous System Infections For the purposes of the calculations in this report, it was assumed that all CNS infections are associated with hospitalization and multiple specialist examinations, plus diagnostic evaluation. Long-term-care costs are included for the few patients who experience lifelong, serious neurologic sequelae.
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From page 200... ...
pharyngitis, fever minor recurrences 150,000 30.0% 0.90 0.0192 (1 week) serious recurrences 25,000 5.0% 0.90 0.0384 OCULAR Primary infection 20,000 100.0% blepharitis, conjunctivitis, keratitis Recurrences 6,000 30.0% CNS (ENCEPHALITIS, MENINGITIS)
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From page 201... ...
GENITAL Acute symptomatic infection genital lesions, pain, fever 300,000 Minor recurrence 270,000 Serious recurrence 30,000 NEONATAL HSV Acute non-encephalitis 1,000 Acute encephalitis 500 Chronic neurologic sequelae severe neurologic impai~ment for 20-year period death after 20 years impairment 100.0% 90.0% 10.0% 66.7% 200 33.3% 13.3% 0.81 0.0384 (2 weeks) 0.95 0.0384 (2 weeks)
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From page 202... ...
. severe neurolog1c 1mpalr ment for 10 year period GENITAL Acute symptomatic infection 100.0% genital lesions, pain, fever 100% $6,000 1.0 hospitalization 100% $1,500 15.0 physician c 100% $500 2.0 diagnostics c 100% $225 365.0 Institutional care (per year)
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From page 203... ...
100% $50 4.0 physician a 100% $50 4.0 medication b 1 00% $7,000 100% $150 100% $500 100% $1,000 100% $12,000 100% 150 100% $500 100% $1,000 1.0 hospitalization 28 physician b 4.0 diagnostic c 1 additional delivery costs 1.0 hospitalization 28.0 physician c 4.0 diagnostic c 1.0 additional delivery costs 100% $225 365.0 Institutional care (per year) VACCINE PROGRAM CONSIDERATIONS Target Population For the purposes of the calculations in this report, it is assumed that the target population for this vaccine is all adolescents (age 12 years)
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From page 204... ...
Most of the disease burden is associated with genital and CNS infections due to the large number of genital infections and the serious, chronic sequelae associated with the relatively fewer cases of CNS HSV disease. If a vaccine program for HSV were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the health care costs saved would be $850 million.
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From page 205... ...
Asymptomatic Reactivation of Herpes Simplex Virus in Women after the First Episode of Genital Herpes. Annals of Internal Medicine 1992; 1 16:433-437.
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