Vaccine
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Using population-based and epidemiologic data for 25 countries in Asia (22 GAVI-Alliance eligible countries, Thailand, China and Japan), a model-based approach was used to estimate averted cervical cancer cases and deaths, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (I$/DALY averted) for vaccination of young adolescent girls against human papillomavirus (HPV) types 16 and 18. Absolute reduction in lifetime cancer risk varied between countries, depending on incidence, proportion attributable to HPV-16 and -18, and population age-structure; for example, with 70% coverage, cancer reduction was 57% in Indonesia, whereas in Cambodia, it was 49%. Screening of women over age 30 three times per lifetime, after vaccinating them as pre-adolescents, is expected to provide an additional 20% to 30% mortality reduction. ⋯ For the 22 GAVI Alliance-eligible countries, vaccinating 5 consecutive birth cohorts at 70% coverage would cost over US $500 million versus almost US $1.3 billion at per dose costs of $2 and $5, respectively. Including China and Thailand would add US $251 million to US $1.4 billion at per dose prices of $2 and $12.25, respectively. In the countries we assessed, vaccination of young adolescent girls against HPV-16 and -18 could be very cost-effective if the cost per vaccinated girl is less than I$10-I$25; for it to be affordable, however, even with financing assistance, vaccine prices may need to be even lower.
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Using population and epidemiologic data for 33 countries in Latin America and the Caribbean (LAC), a model-based approach estimated averted cervical cancer cases and deaths, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (I$/DALY averted) for human papillomavirus (HPV) vaccination of young adolescent girls. Absolute reduction in lifetime cancer risk varied between countries, depending on incidence, proportion attributable to HPV-16 and 18, and population age-structure; for example, with 70% coverage, cancer reduction ranged from 40% in Mexico to more than 50% in Argentina. Screening of women over age 30 three times per lifetime, after vaccinating them as pre-adolescents, is expected to provide a relative increase of 25% to 30% in mortality reduction. ⋯ For the 33 countries, vaccinating 5 consecutive birth cohorts at 70% coverage would cost $360 million at $5.00 per dose, $811 million at $12.25 per dose, and $1.26 billion at $19.50 per dose. In the LAC region, if effective delivery mechanisms can achieve high coverage rates in young adolescent girls, vaccination against HPV-16 and 18 will provide similar health value for resources invested as other new vaccines such as rotavirus. If the cost per vaccinated girl is less than I$25 HPV-16/18 vaccination would be very cost-effective in all 33 countries; for it to be affordable, costs may need to be lower.
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Asia Oceania includes countries from both the Asia Pacific region and Australasia, which cover very diverse geographical areas and populations as well as bearing 52% of the cervical cancer burden in the world. Human papillomavirus (HPV) genotype distribution in women with normal cytology varies between countries in this region, as well as with the distribution typically observed in worldwide estimates or in Western countries. HPV-16 remains the predominant oncogenic type for high-grade cervical dysplasia and cervical cancer across the region, and HPV-18 is generally among the five most common types. ⋯ These data identify the many challenges and opportunities to be considered for policy decisions for cervical cancer control. Furthermore, this report presents the results of advanced decision analytic models calibrated to countries in the region that provide early insight into what strategies are most promising and those likely to be cost-effective and affordable. It thus provides a synthesis of the available evidence-based scientific information, in the context of a significant and systematic international review, that is likely to be useful to governments and public health providers.
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We present the burden of human papillomavirus (HPV)-related cancers (cancers of the cervix, anogenital areas, and oral cavity and pharynx) in terms of incidence and mortality, for the countries of the Asia Pacific region. The region contains more than half of the world population, and manifests a wide geographic diversity in the prevalence of infection with HPV, and of incidence (and mortality) rates of cancer of the cervix. ⋯ The incidence of other anogenital cancers is low, especially in Asian populations; however, cancers of the mouth and pharynx show a wide range of rates, determined by exposures such as oral tobacco and alcohol and for cancer of the lip, ultraviolet radiation. We also present the estimates of the occurence of genital warts--largely caused by HPV 6 and 11--and the HPV type distribution in the spectrum of women with normal cytology, cervical lesions, and cervical cancer in the region.
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Randomized Controlled Trial Multicenter Study
Phase I and II randomised trials of the safety and immunogenicity of a prototype adjuvanted inactivated split-virus influenza A (H5N1) vaccine in healthy adults.
The primary objective was to evaluate the safety and immunogenicity of a prototype inactivated, split-virus H5N1 (avian influenza A) vaccine. A secondary objective was to assess the cross-reactivity of immune responses to two variant clade 2 H5N1 strains. ⋯ CSL Limited, Australia].