Annual Disease Burden Research Articles

Health impact assessment of transportation noise in two Estonian cities

Transportation noise is a growing public health concern worldwide, especially in urban areas, causing annoyance, sleep disturbance, cardiovascular diseases and other health effects. Recently, European Commission (EC) has developed a mutual methodology for assessing health impacts of transportation noise in European Union using strategic noise mapping. Applying this methodology, our aim was to quantify the health effects of road, rail and aircraft noise in two Estonian cities, Tallinn and Tartu. We also aimed to assess sensitivity of this methodology, while implementing lower threshold values and employing additional health outcomes.The proportion of highly annoyed residents due to road traffic noise was 11.6% in Tallinn, and 9.2% in Tartu; around 2.5% residents in both cities could have high sleeping disturbances. As exposure to railway and aircraft noise was relatively low in both cities, people with high annoyance and high sleep disturbance caused by railway and aircraft noise was below 1%. Ischemic heart disease (IHD) cases attributable to road traffic noise was estimated to be 122.6 in Tallinn and 21.5 in Tartu. Altogether transportation noise was estimated to cause 1807 disability adjusted life years (DALYs) in Tallinn and 370 DALYs in Tartu. The health costs were calculated as €126.5 and €25.9 million annually, respectively in the two cities.When we included higher number of health outcomes (stroke incidence, IHD deaths) and lowered exposure threshold by 5 dB, the annual burden of disease was doubled. As the latest epidemiological studies showed transportation noise having larger number of effects on lower noise levels, the results with the currently applied European Commission health impact assessment (HIA) methodology were rather conservative. Despite of uncertainties associated to applied methodology, transportation noise, especially road traffic noise, is an important environmental risk factor, that leads to considerable loss of healthy life years and causes large health costs in urban areas.

#41: Mechanistic Immune Correlates of Protection Following Vaccination Against Rift Valley Fever Virus

Abstract Background Rift Valley fever virus (RVFV) is a zoonotic arbovirus endemic to large areas of Africa and the Arabian peninsula that causes a significant annual burden of disease in ruminant animals, and is associated with periodic outbreaks in human populations. RVFV causes a wide spectrum of disease in infected patients ranging from a self-limiting febrile illness to hepatitis, encephalitis, hemorrhagic fever, and death. Despite the significant economic and public health impact of RVFV, there are no currently available vaccines or therapeutics available for RVFV. Methods Previous work has established that vaccination with an attenuated strain of RVFV, RVFV-ΔNSs, confers protection against subsequent lethal challenge in a murine model of infection. To characterize mechanistic immune correlates of protection, we vaccinated C57BL/6 mice with RVFV-ΔNSs then depleted vaccinated mice of various memory lymphocyte subsets, including CD4+, CD8+, CD4+/CD8+ T-cells before challenging mice with a lethal dose of WT RVFV. To assess for the role of antibodies in providing protection, we depleted mice of their B cells prior to vaccination with RVFV-ΔNSs, confirmed the lack of RVFV specific antibodies, and then challenged them with lethal WT RVFV. To determine the minimal immunologic factors required for protection, we vaccinated a series of donor mice, transferred either immunoglobulins or splenocytes to naïve recipient mice, then challenged them with WT RVFV. Results Vaccination with RVFV-ΔNSs protected mice from subsequent challenge, and this protection was not abrogated by depletion of CD4+, CD8+, or combined CD4+ and CD8+ lymphocytes, suggesting that RVFV-specific T-cells are dispensable for protection in the presence of virus specific antibodies. Vaccinated mice depleted of CD20+ B-cells were also protected against WT challenge, suggesting that B-cells/antibodies are also dispensable for protection in the presence of an intact T-cell response. Passive transfer of antibodies from vaccinated mice to recipient mice protected them against subsequent WT challenge, demonstrating that antibodies are sufficient for protection. Adoptive transfer of total splenocytes protected mice against subsequent WT challenge, indicating that lymphocytes are also sufficient to mediate protection. Conclusions In this study we defined the mechanistic immune correlates of protection following vaccination with attenuated RVFV-ΔNSs against WT RVFV in a murine model. Here, we have shown that both humoral and cellular immunity are sufficient to mediate protection in recipient animals, and can compensate for each other when one is missing. These results further our understanding of the protective immunologic response to infection by RVFV, and will help inform further vaccine development efforts against this important emerging pathogen.

Environmental burden of disease from unsafe and substandard housing, New Zealand, 2010-2017.

ObjectiveTo assess the burden of disease related to unsafe and substandard housing conditions in New Zealand from 2010 to 2017.MethodsWe focused on substandard housing conditions most relevant for New Zealand homes: crowding, cold, damp or mould, and injury hazards linked to falls. We estimated the population attributable fraction using existing estimates of the population exposed and exposure–response relationships of health disorders associated with each housing condition. We used government hospitalization data, no-fault accident insurance claims and mortality data to estimate the annual disease burden from the most severe cases, as well as the resulting costs to the public sector in New Zealand dollars (NZ$). Using value of a statistical life measures, we estimated the indirect cost of deaths.FindingsWe estimated that illnesses attributable to household crowding accounted for 806 nights in hospital annually; cold homes for 1834 hospital nights; and dampness and mould for 36 649 hospital nights. Home injury hazards resulted in 115 555 annual accident claims. We estimated that direct public sector costs attributable to these housing conditions were approximately NZ$ 141 million (100 million United States dollars, US$) annually. We also estimated a total of 229 deaths annually attributable to adverse housing and the costs to society from these deaths at around NZ$ 1 billion (US$ 715 million).ConclusionOf the conditions assessed in this study, damp and mouldy housing accounted for a substantial proportion of the burden of disease in New Zealand. Improving people’s living conditions could substantially reduce total hospitalization costs and potentially improve quality of life.

Impact of cattle on joint dynamics and disease burden of Japanese encephalitis and leptospirosis

Japanese encephalitis (JE) is a mosquito-borne neglected tropical disease. JE is mostly found in rural areas where people usually keep cattle at home for their needs. Cattle in households reduce JE virus infections since they distract vectors and act as a dead-end host for the virus. However, the presence of cattle introduces risk of leptospirosis infections in humans. Leptospirosis is a bacterial disease that spreads through direct or indirect contact of urine of the infected cattle. Thus, cattle have both positive and negative impacts on human disease burden. This study uses a mathematical model to study the joint dynamics of these two diseases in the presence of cattle and to identify the net impact of cattle on the annual disease burden in JE-prevalent areas. Analysis indicates that the presence of cattle helps to reduce the overall disease burden in JE-prevalent areas. However, this reduction is dominated by the vector's feeding pattern. To the best of our knowledge, this is the first study to examine the joint dynamics of JE and leptospirosis.

Balancing Scientific Advice with Political Realities during the Campaign to Pass California's Ballot Proposition 14.

Balancing Scientific Advice with Political Realities during the Campaign to Pass California's Ballot Proposition 14.

Cost of hemophilia A in Turkey: an economic disease burden analysis

Objective Hemophilia A is the second most common bleeding disorder causing patients to have lifelong follow-up and treatment. Despite being a rare disease, hemophilia A has a high economic burden on individuals and the public. The purpose of this study was to estimate the total disease cost of hemophilia A in Turkey. Materials and Methods Data used in this analysis were collected through literature review, including studies conducted in Turkey in December 2018. A disease burden analysis was performed by modeling hemophilia A-related costs among patients, their relatives, and the social security system. Two expert panels were held to evaluate real-world data sources and to provide further information. All direct medical and non-medical costs were calculated annually from the Social Security Institution of the Republic of Turkey perspective, while indirect costs were estimated from the patient and community perspective. Results For the calendar year of 2018, the number of hemophilia A patients in Turkey were estimated to be 5,055, with an average weight of 64.7 kg. The average annual direct medical, direct non-medical, and indirect costs of hemophilia A were calculated as €93,268 ($109,286; ₺502,717), €2,533 ($2,968; ₺13,655), and €7,957 ($9,323; ₺42,888) per patient, respectively, with a total annual cost of €103,759 ($121,578; ₺559,259). For the management of patients with inhibitors (4.9%), the average annual total cost was calculated to be €325,439 ($381,330; ₺1,754,117) per patient. The total annual disease burden of hemophilia A in 2018 was estimated to be about €524 million ($614 million; ₺2.82 billion), which corresponded to 1.6% of the total health expenditure in Turkey. Conclusion The most important reason hemophilia A has a significant economic burden in Turkey is that replacement therapy is expensive. The major cost contributor was identified as factor replacement therapy. With inhibitor development, the average annual cost increased more than 3-fold.

1389. Economic Evaluation of Universal Varicella Vaccination in Mexico

BackgroundUniversal varicella vaccination (UVV) has proven to be cost-effective in countries where implemented. However, this has not yet been evaluated for Mexico. We assessed the cost-effectiveness of UVV in the Mexican Immunization Program from both healthcare and societal perspectives.MethodsThe annual disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) were derived from Mexican seroprevalence-published data adjusted to the 2020 country’s population. The annual economic burden was calculated by combining disease with Mexican published unit cost data. Four different vaccination strategies were evaluated: 1. One dose of a single varicella vaccine at 1 year old; 2. Two doses of single varicella vaccine at 1 and 6 years; 3. One dose of a single varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) at 6 years; 4. Two doses of MMRV at 1 and 6 years.We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. The impact of vaccination (number of avoided cases/deaths) was evaluated for a 20 years follow-up period based on vaccine effectiveness (87% and 97.4%), and assuming a 95% coverage. Subsequently, we estimated net vaccination costs, benefit-cost ratio (BCR), annual costs saved, cost-effectiveness ratio.ResultsFrom annual disease burden estimation, avoided cases with one dose, and two doses were of 20,570,722 and 23,029,751, respectively. From the 20 years cohort, the yearly number of varicella cases was estimated at 2,041,296, and total costs at $115,565,315 (USD) (healthcare perspective) and $165,372,061 (healthcare and societal perspectives). Strategies 1 and 2 were found to be cost-saving (BCR >1) (Figure 1), and strategy 3 to be cost-effective (CE) ($1539 per Life Year Gained). Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 million and $34.41 million, respectively, to the Mexican society.FIGURE 1 Conclusion1.The disease and economic burden of varicella in Mexico are high.2.UVV with four different vaccination strategies results in a high reduction of cases.3.From healthcare and societal perspectives, UVV was shown to be cost-effective (with strategy 3), and cost-saving (with strategies using one dose or two doses separately).Disclosures All Authors: No reported disclosures

Population genomic evidence that human and animal infections in Africa come from the same populations of Dracunculus medinensis.

BackgroundGuinea worm–Dracunculus medinensis–was historically one of the major parasites of humans and has been known since antiquity. Now, Guinea worm is on the brink of eradication, as efforts to interrupt transmission have reduced the annual burden of disease from millions of infections per year in the 1980s to only 54 human cases reported globally in 2019. Despite the enormous success of eradication efforts to date, one complication has arisen. Over the last few years, hundreds of dogs have been found infected with this previously apparently anthroponotic parasite, almost all in Chad. Moreover, the relative numbers of infections in humans and dogs suggests that dogs are currently the principal reservoir on infection and key to maintaining transmission in that country.Principal findingsIn an effort to shed light on this peculiar epidemiology of Guinea worm in Chad, we have sequenced and compared the genomes of worms from dog, human and other animal infections. Confirming previous work with other molecular markers, we show that all of these worms are D. medinensis, and that the same population of worms are causing both infections, can confirm the suspected transmission between host species and detect signs of a population bottleneck due to the eradication efforts. The diversity of worms in Chad appears to exclude the possibility that there were no, or very few, worms present in the country during a 10-year absence of reported cases.ConclusionsThis work reinforces the importance of adequate surveillance of both human and dog populations in the Guinea worm eradication campaign and suggests that control programs aiming to interrupt disease transmission should stay aware of the possible emergence of unusual epidemiology as pathogens approach elimination.

An Emerged Challenge of Air Pollution and Ever-Increasing Particulate Matter in Pakistan; A Critical Review

This study, for the first time, aims to evaluate the situation of air quality in Pakistan critically; through a detailed assessment of sources, policies, and key challenges to identify the plausible way forward. Air pollution and particulate matter have merged as a global challenge in recent years because of its growing health and socio-economic risks. The intensity and impacts of these risks have become more pronounced, especially in developing countries like Pakistan that lack adequate warning, protection, and management systems. Various epidemiological studies have linked poor air quality with different health disorders and increasing death rates. In Pakistan, mortality rates as a result of exposure to increased levels of air pollutants, especially particulate matter, are alarming. According to the World Bank’s estimates, Pakistan’s annual burden of disease from outdoor air pollution is responsible for around 22,000 premature adult deaths and 163,432 DALYs (disability-adjusted life years) lost. The concentration of major air pollutants in Pakistan, such as NOx, O3, and SO2 have also been increasing significantly over the last two decades. Several studies are also reporting multiple instances of air quality around the major cities of Pakistan being consistently exceeding the national guidelines. During teh year 2019 PM2.5 cocnentrations in the city of Lahore revealed that almost every single day was in exceedance of the WHO and national air quality standards. Although the substantial effects of these rising pollutant concentrations in Pakistan have been stated in a few studies, however, the total extent, nature of contributing factors, and consequences remain inadequately understood. This study aims to use data available from monitoring stations, satellites, and literature to highlight the gaps in our understanding and emphasize the critical challenges associated with poor air quality faced in Pakistan. Topmost is the lack of air quality monitoring systems followed by poor initiatives by policymakers and enforcement agencies. A way forward while addressing these key challenges is also discussed, which focuses on the development of flexible monitoring, new technologies, and monitoring approaches in addition to communications among the various public, private agencies, and all relevant stakeholders.

Investigating the public health risks of low impact developments at residential, neighbourhood, and municipal levels

Low Impact Developments (LIDs) employ a series of vegetative techniques to retain rainfall close to the site of origin. Although LIDs offer sustainable runoff management, these infrastructures can be considered a risk to public health due to the presence of pathogens in the runoff and human exposure to contaminated water held in and transported by LIDs. The objective of this study is to examine the disease burden of Gastrointestinal illness (GI) from exposure to LIDs at the residential, neighbourhood, and municipal levels. The authors conducted a meta-analysis of literature on three water features: (1) harvested rainwater obtained from LIDs, (2) surface water, and (3) floodwater. A set of 32 studies were systematically selected to collect values of risks of infection and expressed as the disease burden, i.e. disability adjusted life years (DALYs). The results showed that the percentage of GI illness exceeding the health guidelines were high for harvested rainwater, i.e. 22% of annual disease burden exceeded the WHO guidelines (0.001 DALYs/1000 persons), and 2% exceeded the US EPA guidelines (5.75 DALYs/1000 bathers). Among the six exposures for harvested rainwater, exposure to spray irrigation, exceeded US EPA guidelines whereas; five exposures, i.e. flushing, hosing, daily shower, spray irrigation, and children playing, surpassed the WHO guidelines. Considering LID treatment, the values of annual disease burden from all the selected barriers were below US EPA guidelines however, these values exceeded the WHO guidelines for three barriers i.e. water plaza, grass swale, and open storage ponds. These findings provide a broader perspective of the disease burden associated with LIDs and emphasise to consider the type of exposures and required treatment barriers for developing LID infrastructures in urban areas.

Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends.

There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. In 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis. Inflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15years.

Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends

Introduction and aimsThere is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. Materials and methodsUtilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. ResultsIn 2015, 5009 women (8.1) and 4944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50 years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50 years of age. The hospitalized cases (prevalence of hospitalized cases) were 1097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50 years of age; and 5345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50 years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis. ConclusionsInflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15 years.

Ranking dynamics of economic burden of infectious diseases as a criterion of effectiveness of epidemiologic control

Purpose: rank-based assessment of the economic impact of infectious diseases in the Russian Federation for the further analysis of effectiveness of their prevention and for prioritization of preventive measures.Materials and Methods. The annual economic burden was eStimated by using inflation-adjusted standard economic costs of one case of infectious disease in the Russian Federation. The data on the number of cases were obtained from the official statistical reports (Forms 1, 2) for 2009-2019. The annual burden of the specific disease was estimated by multiplying the standard cost of 1 case by the number of cases registered within a given year. The economic costs were assessed and ranked.Results and discussion. In 2019, the greatest economic burden was exerted by acute respiratory infections, tuberculosis, acute gastrointestinal infections, chickenpox, HIV infection (newly diagnosed cases and deaths in 2019). The economic burden of rotavirus infection was assessed and ranked for the first time. The ranking analysis of the economic costs in 2009-2019 showed the largest decrease in the economic burden of influenza, rubella, acute and chronic hepatitis B. At the same time, the economic burden of measles, pertussis, hemorrhagic fevers and tick-borne borreliosis demonstrated an upward trend. The possibility of using ranking dynamics of economic burden as a performance indicator of epidemiological control has been demonstrated. In response to limited public funding of healthcare, the offered method can be used in setting priorities in decision making in the field of epidemic control.

Campylobacter risk for the consumers of wastewater-irrigated vegetables based on field experiments

Water scarcity is emerging as a major problem in water stressed regions such as Middle East countries which highlights the importance of agricultural reuse of wastewater as a valid alternative source. However, consumption of wastewater-irrigated crops has been implicated as a vehicle for transmission of bacterial infections such as campylobacteriosis. Understanding and minimizing public health threats associated with agricultural reuse of treated wastewater (TWW) are crucial elements in sustainable water resource management. To address this need, the present study was carried out to determine Campylobacter risk for the consumers of TWW-irrigated vegetables by field experiments as well as quantitative microbial risk assessment (QMRA) model. Campylobacter was monitored in secondary treated wastewater, TWW-irrigated soil and harvested vegetables by nested real-time PCR assay. Campylobacter was detected in 64% (16/25) of TWW samples, whereas analysis of TWW-irrigated soil and vegetable samples yielded no positive result for Campylobacter. The estimated mean annual Campylobacter disease burden ranged from 2.37 × 10−5 to 6.6 × 10−5 disability-adjusted life years (DALYs) per person per year (pppy) for vegetable consumers which was lower than the less stringent reference level of 10−4 DALYs pppy has been recommended by world health organization (WHO). Our results in regard to the QMRA estimates and field experiments suggest that the reuse of TWW for irrigation of vegetables doesn’t pose a considerable risk to human health from the viewpoint of Campylobacter infections in a semi-arid area.

Precise exposure assessment revealed the cancer risk and disease burden caused by trihalomethanes and haloacetic acids in Shanghai indoor swimming pool water

Swimming pool disinfection byproducts (DBPs) are becoming increasingly common worldwide. Precise exposure and health risk assessment for DBPs in swimming pool water with optimized parameters for local and specific population is more urgently needed. This study aimed to determine the levels of trihalomethanes (THMs) and haloacetic acids (HAAs) in 16 public indoor swimming pools in Shanghai, China. Swimming habits were also investigated to obtain more accurate exposure assessment parameters. Precise exposure assessment through multiple pathways, resulting cancer risk, and disability-adjusted life years (DALYs) were assessed. Results indicated that the highest total level of THMs and HAAs occurred in autumn. The surveyed swimmers 9–17 years of age had higher average daily dose (ADD) of DBPs than swimmers ≥18 years of age. The total lifetime cancer risk (LCR) attributable to THMs and HAAs exceeded 10−6, which represents a negligible risk level (NRL). The cancer risk from inhalation exposure predominantly by THMs contributed more than 99% of the total risk. Annual disease burden was 19.0 person-years attributed to exposure of DBPs in swimming pool water in Shanghai. This study provides a paradigm and strategic reference of precise exposure assessments, risk assessments, and disease burden estimation of hazards in swimming pool water for other regions.

Roles of Vegetable Surface Properties and Sanitizer Type on Annual Disease Burden of Rotavirus Illness by Consumption of Rotavirus-Contaminated Fresh Vegetables: A Quantitative Microbial Risk Assessment.

Enteric viruses are often detected in water used for crop irrigation. One concern is foodborne viral disease via the consumption of fresh produce irrigated with virus-contaminated water. Although the food industry routinely uses chemical sanitizers to disinfect post-harvest fresh produce, it remains unknown how sanitizer and fresh produce properties affect the risk of viral illness through fresh produce consumption. A quantitative microbial risk assessment model was conducted to estimate (i) the health risks associated with consumption of rotavirus (RV)-contaminated fresh produce with different surface properties (endive and kale) and (ii) how risks changed when using peracetic acid (PAA) or a surfactant-based sanitizer. The modeling results showed that the annual disease burden depended on the combination of sanitizer and vegetable type when vegetables were irrigated with RV-contaminated water. Global sensitivity analyses revealed that the most influential factors in the disease burden were RV concentration in irrigation water and postharvest disinfection efficacy. A postharvest disinfection efficacy of higher than 99% (2-log10 ) was needed to decrease the disease burden below the World Health Organization (WHO) threshold, even in scenarios with low RV concentrations in irrigation water (i.e., river water). All scenarios tested here with at least 99.9% (3-log10 ) disinfection efficacy had a disease burden lower than the WHO threshold, except for the endive treated with PAA. The disinfection efficacy for the endive treated with PAA was only about 80%, leading to a disease burden 100 times higher than the WHO threshold. These findings should be considered and incorporated into future models for estimating foodborne viral illness risks.

Analytical evaluation of the microarray-based FluChip-8G Influenza A+B Assay

BackgroundInfluenza causes a significant annual disease burden, with characterization of the infecting virus important in clinical and public health settings. Rapid immunoassays are fast but insensitive, whereas real-time RT-PCR is sensitive but susceptible to genetic mutations and often requires multiple serial assays. The FluChip-8G Influenza A+B Assay provides type and subtype/lineage identification of influenza A and B, including non-seasonal A viruses, in a single microarray-based assay with same day turnaround time. ObjectiveTo evaluate key analytical performance characteristics of the FluChip-8G Influenza A+B Assay. Study designAnalytical sensitivity, cross-reactivity, and multi-site reproducibility were evaluated. ResultsThe limit of detection (LOD) for the FluChip-8G influenza A+B Assay ranged from 5.8 × 102–1.5 × 105 genome copies/mL, with most samples ∼2 × 103 genome copies/mL (∼160 genome copies/reaction). Fifty two (52) additional strains were correctly identified near the LOD, demonstrating robust reactivity. Two variant viruses (H1N1v and H3N2v) resulted in dual identification as both “non-seasonal influenza A” and A/H1N1pdm09. No reproducible cross-reactivity was observed for the 34 organisms tested, however, challenges with internal control inhibition due to crude growth matrix were observed. Lastly, samples tested near the LOD showed high reproducibility (97.0% (95% CI 94.7–98.7)) regardless of operator, site, reagent lot, or testing day. ConclusionThe FluChip-8G Influenza A+B Assay is an effective new method for detecting and identifying both seasonal and non-seasonal influenza viruses, as revealed by good sensitivity and robust reactivity to 52 unique strains of influenza virus. In addition, the lack of cross-reactivity to non-influenza pathogens and high lab-to-lab reproducibility highlight the analytical performance of the assay as an alternative to real-time RT-PCR and sequencing-based assays. Clinical validation of the technology in a multi-site clinical study is the subject of a separate investigation.

PCN57 EXAMINATION OF HEALTH INSURANCE DISEASE BURDEN OF CERVICAL CANCER IN HUNGARY: A REAL WORLD STUDY

The burden of malignanttumour diseases is much higher in the Eastern European countries than in Western Europe because they have limited financial resources in health care. Therefore, it is especially important to evaluate cost-effectiveness of certain actions during the decision making processes. The aim of our analysis is to define the annual health insurance disease burden of cervical cancer for the National Health Insurance Fund of Hungary (NHIFH). The analysis was performed.by the funding database of 2014 data which covered all services and types of care funded by NHIFH. We analysed the in situ diseases (D06), the benign disorders (C53), and the malignant ones (D26.0). The treatment included the costs of the following: care by the general practitioner, outpatient care, caregivers’ fee, CT/MR, PET laboratory tests, home care, patient transportation, acute and chronic inpatient care, price subsidy of medicaments, and price subsidy to medical devices. In 2014 the NHIFH spent 1.05 billion Hungarian Forint (HUF) (3.41 million EUR) for the treatment of cervical cancer patients. The patients, and most of the funded cases (96.85%) were paid due to people treated with malignant cervical tumours while in situ (2.94%) and beningn (0.21%) cancers represents smaller proportion. The highest expense item appeared in the acute inpatient care, which was annually 700.87 million HUF (2.27 million EUR) representing 66.56% of total health insurance expenditure. Expenditures for CT/MRI examinations (108.59 million HUF; 351.82 thousand EUR), medical devices (92.12 million HUF; 298.46 thousand EUR) and outpatient care (58.85 million HUF; 190.65 thousand EUR) are also important cost elements accounting for 10.3%, 8.8% and 5.6% of total health insurance expenditures, respectively. Cervical cancer represents a significant burden for the Hungarian health insurance system.The increased participation on organized cervical screening might change the health insurance expenditures of cervical cancer.

The Resurgence of Measles, Mumps, and Pertussis

Although vaccines are one of the greatest scientific innovations to prevent disease and promote well-being, 1 in 10 children is not being vaccinated. This has directly contributed to the rise in vaccine-preventable diseases. Because of the high contagiousness of measles, mumps, and pertussis, innovative efforts are paramount to prevent disease outbreaks in the United States and worldwide. This article reviews measles, mumps, and pertussis; explains the resurgence of these vaccine-preventable diseases; and offers evidence-based solutions for increasing vaccination rates.

Ecological and life history traits are associated with Ross River virus infection among sylvatic mammals in Australia

BackgroundRoss River virus (RRV) is Australia’s most important arbovirus given its annual burden of disease and the relatively large number of Australians at risk for infection. This mosquito-borne arbovirus is also a zoonosis, making its epidemiology and infection ecology complex and cryptic. Our grasp of enzootic, epizootic, and zoonotic RRV transmission dynamics is imprecise largely due to a poor understanding of the role of wild mammalian hosts in the RRV system.MethodsThe current study applied a piecewise structural equation model (PSEM) toward an interspecific comparison of sylvatic Australian mammals to characterize the ecological and life history profile of species with a history of RRV infection relative to those species with no such history among all wild mammalian species surveyed for RRV infection. The effects of species traits were assessed through multiple causal pathways within the PSEM framework.ResultsSylvatic mammalian species with a history of RRV infection tended to express dietary specialization and smaller population density. These species were also characterized by a longer gestation length.ConclusionsThis study provides the first interspecific comparison of wild mammals for RRV infection and identifies some potential targets for future wildlife surveys into the infection ecology of this important arbovirus. An applied RRV macroecology may prove invaluable to the epidemiological modeling of RRV epidemics across diverse sylvatic landscapes, as well as to the development of human and animal health surveillance systems.