Annual Disease Burden Research Articles

Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore

BackgroundDengue illness causes 50–100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings.Methods and FindingsWe estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%–59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9–14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively.ConclusionsDengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially.

UK Estimates of Burden of Disease Associated with Management of Intermediate-2 or High-Risk Myelodysplastic Syndromes

Abstract 4749 BACKGROUND:Previous UK studies into the burden of disease (BoD) of intermediate-2 (INT-2) or high-risk myelodysplastic syndromes (MDS) have focused on the potential budget impact of azacitidine. No estimates have been published for the UK that incorporate the costs associated with basic disease management in the UK for this group of patients. OBJECTIVE:To estimate the annual burden of MDS in the UK. METHODS:The research comprised a systematic review of studies in haematological cancer, and a subsequent economic analysis. The systematic review extracted all relevant BoD information from identified papers, including not only patient or healthcare elements, but also the burden on carers and family. The economic analysis combined all available, relevant evidence into annual, UK-specific cost estimates. RESULTS:The systematic literature review identified and extracted information from 23 papers. Study designs were comprised of economic evaluations (n=6), observational studies (n=2), RCTs (n=2), retrospective analyses involving registries or hospital data (n=6), review articles (n=3) and surveys (n=4). The National Institute for Health and Clinical Excellence appraisal of azacitidine was also included as was information from the pivotal trial of azacitidine, AZA-001. Across the literature reviewed, three main types of standard care were identified: supportive care (SC) alone, low-dose chemotherapy (LDC) and, more rarely, standard dose chemotherapy (SDC).Many papers provided estimates of transfusion burden, which had the largest BoD impact in patients who were considered transfusion dependent. Use of erythropoiesis-stimulating agents was identified as an additional important resource, and the societal burden of haematological cancer was also quantified in one study, which examined time required of carers and family for transfusion visits. The most recent UK epidemiological estimates were used to convert average per-patient BoD figures to national estimates. Each type of standard care had a different associated burden of blood transfusions; therefore, the subsequent economic analysis weighted the estimated BoD according to the proportion of patients expected to be eligible for BSC, LDC and SDC.It is expected that 761 INT-2 and high-risk MDS patients will be treated each year. Among these, it was estimated that a total 5,121 blood transfusions would be required per year. These transfusions are expected to be associated with a total UK annual cost of approximately £1.4 million to the NHS, as well as £17,955 to carers and family members based on expected time off work to attend transfusion sessions with the patient. Values ranging between £10 million and £14 million per year were estimated for the likely national BoD on hospitals for inpatient stays, and the national cost of NHS community nurse visits was estimated to be £115,877 per year. The societal cost of inpatient stays was also experimentally calculated based on hospitalisation statistics from the AZA-001 trial; this produced an estimated annual burden of £312,010 for the UK. CONCLUSION:The annual burden of disease associated with MDS in the UK is estimated at between £12 million and £16 million. Major components of this burden include hospitalisation and transfusion costs. Indirect costs associated with MDS such as productivity costs for patients and carers appear relatively modest but are nonetheless an important consideration and should not be overlooked. Disclosures:Brereton:Celgene Ltd: Consultancy. Nicklasson:Celgene Ltd: Employment. Mufti:Celgene: Consultancy, Research Funding.

Herpes zoster in Germany: Quantifying the burden of disease

BackgroundHerpes zoster (HZ) is caused by a reactivation of the varicella-zoster-virus (VZV) and mainly affects individuals aged ≥ 50 years. Vaccines have been licensed or are under development that can protect against HZ and its main complication postherpetic neuralgia (PHN). In Germany, the burden of disease caused by HZ is not well known. To support the decision making process related to a potential vaccination recommendation, we estimated annual HZ disease burden in people aged ≥ 50 years in Germany by utilizing various data sources.MethodsWe assessed for 2007 and 2008 HZ-outpatient incidence (number of cases per 1,000 person-years, PY) by utilizing the Association of Statutory Health Insurance Physicians (ASHIP) database, which contains nationwide routine outpatient data. For the same time period annual number of HZ-inpatients and HZ-associated deaths were identified by using the Federal Health Monitoring System (FHM). PHN-incidence and loss of quality-adjusted life years (QALYs) caused by HZ were calculated by multiplying number of identified HZ-patients with upper and lower limit estimates for proportion of HZ-cases developing PHN and HZ-related QALY, respectively.ResultsFor the study period we identified an annual average of 306,511 HZ-outpatients aged 50+, resulting in a HZ-incidence of 9.6/1,000 PY. A total 14,249 HZ-associated inpatients and 66 deaths were reported in both years on average. HZ-incidence increased by age from 6.21 in people 50-54 years to 13.19 per 1,000 PY in people aged ≥ 90 years. Females were significantly more frequently affected than males in terms of outpatient HZ-incidence (11.12 vs. 7.8 per 1,000 PY), inpatient HZ-incidence (0.51 vs. 0.38 per 1,000 PY) and mortality (0.29 vs. 0.10 per 100,000 PY). PHN-incidence was estimated to range between 0.43 and 1.33 per 1,000 PY. Based on these figures, there were between 3,065 to 24,094 QALYs lost due to HZ in persons aged ≥ 50 years in Germany per annum.ConclusionOur study provides important baseline estimates for HZ-related disease burden in Germany. HZ poses a considerable burden on the health care system in Germany both in terms of outpatient and inpatient services. Follow-up assessments of HZ disease burden are needed to monitor the impact of VZV-vaccinations in Germany.

The burden of 2009 pandemic influenza A(H1N1) in the Netherlands

The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands.

The annual costs associated with human papillomavirus types 6, 11, 16, and 18 infections in Finland

It is known that infections with human papillomavirus (HPV) types 6, 11, 16, and 18, cause cervical cancers (CC), cervical intraepithelial neoplastic lesions (types 1 to 3; CIN 1-3), and genital warts (GW). Together with equivocal cytological abnormalities (ECA), these place a considerable burden on society, but the costs and resource usage are not easily estimated. Therefore, we undertook this study to estimate the burden and costs associated with HPV-related diseases. We used Finnish registry-based data for CC, CIN 1-3 and ECA. Data on GW were estimated from associated procedures and medications. The annual burden of disease was estimated from hospitalizations, visits to specialists and primary level care, and pharmaceutical use. The evaluation of costs included health care and screening costs, and productivity lost (separately). Due to the data obtained being fragmented, 2 cost scenarios were constructed. The follow-up of ECA appears to be the most important cost driver. GW should not be underestimated as they affect both genders at an early age. HPV infections are a burden to society, not only as a result of cancer-related costs, but also costs related to other diseases and indirect costs in the form of lost productivity.

The global burden of alveolar echinococcosis.

BackgroundHuman alveolar echinococcosis (AE) is known to be common in certain rural communities in China whilst it is generally rare and sporadic elsewhere. The objective of this study was to provide a first estimate of the global incidence of this disease by country. The second objective was to estimate the global disease burden using age and gender stratified incidences and estimated life expectancy with the disease from previous results of survival analysis. Disability weights were suggested from previous burden studies on echinococcosis.Methodology/Principal FindingsWe undertook a detailed review of published literature and data from other sources. We were unable to make a standardised systematic review as the quality of the data was highly variable from different countries and hence if we had used uniform inclusion criteria many endemic areas lacking data would not have been included. Therefore we used evidence based stochastic techniques to model uncertainty and other modelling and estimating techniques, particularly in regions where data quality was poor. We were able to make an estimate of the annual global incidence of disease and annual disease burden using standard techniques for calculation of DALYs. Our studies suggest that there are approximately 18,235 (CIs 11,900–28,200) new cases of AE per annum globally with 16,629 (91%) occurring in China and 1,606 outside China. Most of these cases are in regions where there is little treatment available and therefore will be fatal cases. Based on using disability weights for hepatic carcinoma and estimated age and gender specific incidence we were able to calculate that AE results in a median of 666,434 DALYs per annum (CIs 331,000-1.3 million).Conclusions/SignificanceThe global burden of AE is comparable to several diseases in the neglected tropical disease cluster and is likely to be one of the most important diseases in certain communities in rural China on the Tibetan plateau.

Disease burden of prosthetic joint infections after hip and knee joint replacement in Finland during 1999–2004: capture–recapture estimation

We evaluated the Finnish Hospital Infection Program (SIRO) conducting incidence surveillance for prosthetic joint infection (PJI) from 1999 to 2004. We estimated its sensitivity using capture-recapture methods and assessed the disease burden of PJIs after hip (THA) and knee (TKA) arthroplasties (N = 13 482). The following three data sources were used: SIRO, the Finnish Arthroplasty Register (FAR), and the Finnish Patient Insurance Center (FPIC), which were cross-matched, and 129 individual PJIs were identified. After adjusting for the positive predictive value of SIRO (91%) a log-linear model including an interaction term between FAR and FPIC provided an estimated PJI rate of 1.6% [95% confidence interval (CI): 1.2-2.4] for THA and 1.3% (1.1-1.6) for TKA. Sensitivity for SIRO varied from 36% to 57%. The annual disease burden was 2.1 PJIs per 100 000 population after THA and 1.5 after TKA. The true disease burden of PJIs may be heavier than the rates from national sentinel surveillance systems usually suggest.

Disease burden of post-infectious irritable bowel syndrome in The Netherlands

Post-infectious irritable bowel syndrome (PI-IBS) has been established as a sequel of infectious intestinal disease (IID). The aim of this study was to estimate the burden of PI-IBS caused by the pathogens Campylobacter, Salmonella and Shigella, and to compare this with other outcomes associated with these pathogens. The attributable risk of PI-IBS due to bacterial pathogens was calculated and linked to national data on gastroenteritis incidence and measures for severity and duration of illness in order to estimate the burden of PI-IBS. One year post-infection, IBS developed in 9% of patients with bacterial IID. The burden of PI-IBS adds over 2300 disability adjusted life years to the total annual disease burden for the selected pathogens. PI-IBS is a frequent sequel of IID, resulting in a considerable disease burden compared to other outcomes. If this relationship is not considered, this will result in an underestimation of the disease burden of IID.

Annual disease burden due to human papillomavirus 16 and 18 infections in Finland

Apart from cancers of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, premalignant and malignant lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (mostly papillomas) are ascribed to the low-risk (LR) HPV types, most notably HPV6 and HPV11. To date, the main interest has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. The recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11) has resulted in considerably increased interest in these LR-HPV types as well. This author recently conducted a systematic survey of the annual disease burden due to HPV6/11 infections in Finland. As a rational continuation, the present survey was conducted to estimate the annual disease burden due to HPV16 and HPV18 infections in our country. Together, these 2 documents form the foundation for calculations of the annual costs needed to treat the diseases caused by these 2 most common LR and HR HPV types. Similar to HPV6/11, accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV16/18 vaccines. In the first step, the published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. The GLOBOCAN 2004 (IARC; International Agency for Research on Cancer) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website was used to obtain these numbers for Finland (y 2005). The evidence linking HPV to each individual tumour category was classified as: (1) established, (2) emerging, and (3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region-by-region, while assessing the attributable fraction of HPV16/18 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by the FCR or GLOBOCAN, different approaches had to be used to derive the estimates for their incidence, based on published literature or other registries. In cases with no reasonable consensus, a lower and an upper boundary was set for the range of these estimates. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The present survey implicates that a minimum of 7859 to 8316 new cases of HPV16- or HPV18-associated clinical lesions would be detected each y in Finland, if all were registered. In other words, these numbers represent the annual disease burden due to these 2 most common HR-HPV genotypes. In the Finnish population, these lower and upper limits translate to the crude annual incidence rates of 147/100,000 and 156/100,000, respectively. When adjusted for the European Standard Population, the respective age-adjusted incidence rates are 137/100,000 and 145/100,000. As compared with the annual disease burden of HPV6/11 in this country (12,666-13,066 new cases), these numbers for HPV16/18 are significantly smaller. Another major difference between HPV6/11 and HPV16/18 is that the disease burden due to the former is much more evenly distributed among the genders, with only a slight female preponderance (approximately 7500 vs 5500 cases). This is in sharp contrast to HPV16/18 disease burden, of which by far the major proportion is contributed by females (approximately 7000 vs 1300 cases). Of note, these clinical lesions counted in this report for HPV16/18 only represent a small minority of the total viral burden due to the infections by these 2 HR-HPV genotypes. This is because the vast majority of these HR-HPV infections are transient and spontaneously resolve within a few months, without ever developing a clinical disease. However, this spontaneous clearance does not make these latent infections less important, because as long as the virus reservoir exists, it serves as the source of viral transmission to susceptible individuals, with a multitude of HPV16/18-associated pathologies as a potential outcome. The implications of these data in the era of effective prophylactic HPV vaccination should be straightforward. However, the 2 impending challenges for designers of future HPV vaccines and vaccination programmes are: (1) the marked imbalance of HPV16/18 disease burden between the genders, and (2) the fact that HPV6/11 annual disease burden far exceeds that of HPV16/18 and it is also more evenly contributed by both genders.

Annual disease burden due to human papillomavirus (HPV) 6 and 11 infections in Finland

In addition to cancer of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, precancer and cancer lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (papillomas) are associated with the low-risk (LR) HPV types, most notably with HPV6 and HPV11. Until recently, the main interest in HPV research has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. With the recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11), it has become timely to make a systematic survey on the annual disease burden due to these 2 HPV genotypes in our country. These types of data should form the foundation for all calculations of the annual costs needed to treat these diseases by conventional means. Accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV6 and HPV11 vaccines. If proven useful for any of these purposes, this document will have fulfilled its purpose. In the first step, published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. GLOBOCAN 2004 (IARC) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website for obtaining these (y 2005) numbers in Finland. The evidence linking HPV to each individual tumour category was classified as: 1) established, 2) emerging, and 3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region by region, while assessing the attributable fraction of HPV6/11 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by FCR or GLOBOCAN, different approaches had to be used to derive the best estimates for their incidence, based on published literature or other registries (e.g. genital wart registry of the UK and Wales, and mass screening registry of FCR). With a lack of reasonable consensus, a lower and an upper limit was set for the range of estimates. In cases with different age-specific incidence (e.g. genital warts), the population pyramid of Finland was used to calculate the incident cases. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The malignant neoplasms with established or emerging evidence on the causal role of HPV are listed by their ICD-10 codes in Table I. Included in this list are also 2 controversial malignancies (colorectal cancer and endometrial cancer), of which the contradictory HPV data are critically discussed. The third major cancer in this same category (prostate cancer) was not included in the list, because the data are clearly insufficient to categorize this entity even among the emerging HPV associated malignancies. Estimated disease burden due to HPV6/11 in Finland, calculated as numbers of annual new cases by anatomic region and tumour type is given in Table II, and summarized in Figure 1. The present analysis implicates that a minimum of 12,666 to 13,066 new cases of HPV6- or HPV11-associated clinical lesions would be detected each y in Finland, if all were registered. Notably, these numbers represent the disease burden due to these 2 HPV types. However, these clinical lesions only represent a small minority of the total viral burden due to the infections by these 2 HPV genotypes. This is because the vast majority of all infections by these ubiquitous viruses are latent, being transient in nature and spontaneously resolving within a few months (up to 1 y), without ever developing a clinically detectable disease. This spontaneous clearance does not make these latent infections less important, however, because as long as the virus reservoir exists, it serves as the source of viral transmission to susceptible individuals, with a multitude of HPV6/11 associated pathologies as a potential outcome, as described in this document. The implications of these data in the era of effective prophylactic HPV vaccination against HPV6 and HPV11 should be clear.

Costo Efectividad del Gas Natural Domiciliario como Tecnología Sanitaria en Localidades Rurales del Caribe Colombiano

Evaluating the economic impact of natural gas as a sanitary technology regarding respiratory disease associated with indoor air pollution in rural localities on the Colombian Caribbean coast. Three studies were carried out: the burden of respiratory disease was evaluated (acute lower respiratory infection-ALRI and chronic obstructive pulmonary disease - COPD), disease costs were studied and the cost effectiveness of natural gas was analysed in terms of reducing indoor air pollution. Without natural gas in these localities, it would be expected that 498 (477-560) cases of ALRI per year would lead to 149 (119-196) hospitalisations, 6 (4-10) deaths and 7 291 (5,746-9,696) disability adjusted life years (DALY) annually. Furthermore, it is expected that 459 (372-684) cases of COPD per year would lead to 138 (93-239), hospitalisations, 11 deaths (5-26) and 1 500 (973-2 711) DALY annually. Annual disease burden cost was 5,2 (3,8-8,3) million dollars before installing domiciliary natural gas (DNG); most of such cost arose from COPD (around 85 %). ARI and COPD costs after installing DNG would rise to 3,5 (2,5-5,7) million dollars; avoided costs would be 1,6 (1,2-2,6) million dollars, (30 % of disease burden cost without DNG). The incremental cost-effectiveness (ICER) of installing DNG would be 56 (22-74) thousand dollars per life saved and ICER per DALY saved would be 43-66 dollars. DNG is a sanitary technology which reduces the burden of indoor air pollution-associated respiratory diseases arising from burning biomass fuel in rural localities in a cost-effective way.

Benefits of Sunlight: A Bright Spot for Human Health

Each day, Apollo’s fiery chariot makes its way across the sky, bringing life-giving light to the planet. For the ancient Greeks and Romans, Apollo was the god of medicine and healing as well as of sun and light—but Apollo could bring sickness as well as cure. Today’s scientists have come to a similarly dichotomous recognition that exposure to the ultraviolet radiation (UVR) in sunlight has both beneficial and deleterious effects on human health. Most public health messages of the past century have focused on the hazards of too much sun exposure. UVA radiation (95–97% of the UVR that reaches Earth’s surface) penetrates deeply into the skin, where it can contribute to skin cancer indirectly via generation of DNA-damaging molecules such as hydroxyl and oxygen radicals. Sunburn is caused by too much UVB radiation; this form also leads to direct DNA damage and promotes various skin cancers. Both forms can damage collagen fibers, destroy vitamin A in skin, accelerate aging of the skin, and increase the risk of skin cancers. Excessive sun exposure can also cause cataracts and diseases aggravated by UVR-induced immunosuppression such as reactivation of some latent viruses. However, excessive UVR exposure accounts for only 0.1% of the total global burden of disease in disability-adjusted life years (DALYs), according to the 2006 World Health Organization (WHO) report The Global Burden of Disease Due to Ultraviolet Radiation. DALYs measure how much a person’s expectancy of healthy life is reduced by premature death or disability caused by disease. Coauthor Robyn Lucas, an epidemiologist at the National Centre for Epidemiology and Population Health in Canberra, Australia, explains that many diseases linked to excessive UVR exposure tend to be relatively benign—apart from malignant melanoma—and occur in older age groups, due mainly to the long lag between exposure and manifestation, the requirement of cumulative exposures, or both. Therefore, when measuring by DALYs, these diseases incur a relatively low disease burden despite their high prevalence. In contrast, the same WHO report noted that a markedly larger annual disease burden of 3.3 billion DALYs worldwide might result from very low levels of UVR exposure. This burden subsumes major disorders of the musculoskeletal system and possibly an increased risk of various autoimmune diseases and life-threatening cancers. The best-known benefit of sunlight is its ability to boost the body’s vitamin D supply; most cases of vitamin D deficiency are due to lack of outdoor sun exposure. At least 1,000 different genes governing virtually every tissue in the body are now thought to be regulated by 1,25-dihydroxyvitamin D3 (1,25[OH]D), the active form of the vitamin, including several involved in calcium metabolism and neuromuscular and immune system functioning. Although most of the health-promoting benefits of sun exposure are thought to occur through vitamin D photosynthesis, there may be other health benefits that have gone largely overlooked in the debate over how much sun is needed for good health [see “Other Sun-Dependent Pathways,” p. A165]. As for what constitutes “excessive” UVR exposure, there is no one-size-fits-all answer, says Lucas: “‘Excessive’ really means inappropriately high for your skin type under a particular level of ambient UVR.”

Estimating the global disease burden due to ultraviolet radiation exposure

WHO's global burden of disease studies, undertaken since 1996, apportion the total global disease burden, measured in disability-adjusted life years (DALYs), to specific diseases and injuries. Recent assessments of the relative burden due to specific environmental risk factors, plus an understanding of the nature of the risk factor, may guide resource allocation in risk factor management. We report here the global disease burden due to ultraviolet radiation (UVR) exposure. A systematic literature review identified nine diseases with sufficient evidence of a causal relationship with UVR exposure and for which the population attributable fraction (PAF) for UVR could be estimated. For cutaneous malignant melanoma and cataract, the PAF was directly applied to disease burdens already calculated by WHO. For seven other diseases, we developed population-level exposure-disease relationships and used these to calculate disease incidence and mortality, and thence disease burden. We also estimated the disease burden from rickets, osteomalacia and osteoporosis that might result if global UVR exposure was reduced to very low levels. UVR exposure is a minor contributor to the world's disease burden, causing an estimated annual loss of 1.6 million DALYs; i.e. 0.1% of the total global disease burden. A markedly larger annual disease burden, 3.3 billion DALYs, might result from reduction in global UVR exposure to very low levels. Sun protection messages are important to prevent diseases of UVR exposure. However, without high dietary (or supplemental) intake of vitamin D, some sun exposure is essential to avoid diseases of vitamin D insufficiency.

Sensitivity analysis in summary measure of population health in France

The aim of this study is to provide estimates of the French burden of disease, using the WHO Global Burden of Disease methodology and to perform sensitivity analysis on different set of mortality data. The burden of disease is measured by disability-adjusted life years (DALYs) that take into account both mortality and morbidity data. Results were obtained using French mortality data for the years 2000 and 2001 and morbidity data estimated by WHO for France. Sensitivity analyses were conducted using different mortality data sets and various life tables as mortality norms. Calculations were also performed with and without discounting and age-weighting. In France, the annual burden of disease was about 12.4 million DALYs. Depending on the mortality data set and the choice of social values used for calculation, results could be quite different. The use of WHO estimates for mortality resulted in an underestimation of 2.6% of total DALYs with respect to French data. Changes of the mortality norm imply changes in the number of years of life lost (YLLs), whereas the use of discounting and age-weighting mainly modifies the ranking of diseases. DALYs constitute a summary measure of population health, which is a powerful tool for the grading of health problems, allowing to compare fatal and non-fatal diseases. Nevertheless, the validity of results obtained depends primarily on the validity of the input data. Collecting morbidity data (mainly incidence) at the national level is hence an important step in order to assess more accurately the specific burden of diseases in France.

Epidemiology of Seasonal Influenza: Use of Surveillance Data and Statistical Models to Estimate the Burden of Disease

The US Centers for Disease Control and Prevention (CDC) uses a 7-component national surveillance system for influenza that includes virologic, influenza-like illness, hospitalization, and mortality data. In addition, some states and health organizations collect additional influenza surveillance data that complement the CDC's surveillance system. Current surveillance data from these programs, together with national hospitalization and mortality data, have been used in statistical models to estimate the annual burden of disease associated with influenza in the United States for many years. National influenza surveillance data also have been used in suitable models to estimate the possible impact of future pandemics. As part of the public health response to the 2003-2004 influenza season, which was noteworthy for its severe effect among children, new US surveillance activities were undertaken. Further improvements in national influenza surveillance systems will be needed to collect and analyze data in a timely manner during the next pandemic.

Survey of Rotavirus Infection in a Hungarian Paediatric Hospital

In anticipation of a future vaccination program against rotavirus disease, a longitudinal survey has been set up to evaluate the epidemiologic features of rotavirus infections. In this report hospitalisation data and serotyping results are compiled from an epidemiologic survey conducted in Baranya County, Hungary. It was found that rotavirus-associated hospitalisation constituted a major part of infectious gastroenteritis cases (range, 14.9% to 28.5%). A higher proportion of rotavirus-positive cases was recorded when the serotype of predominant strains changed from G1 (1996-1999) to G4 (1999-2000), however, due to the short time period it was not possible to demonstrate a firm association between serotype prevalence and rotavirus-associated hospitalisation rate. In the future, such studies might help to understand if serotype-specific immunity against rotavirus infection plays an important role at the population level and if (re-)emerging rotavirus strains make an impact on the annual disease burden.

Varicella vaccination in England and Wales: cost-utility analysis

Aims: To assess the cost-effectiveness of varicella vaccination, taking into account its impact on zoster. Methods: An age structured transmission dynamic model was used to predict the future incidence of...

CLINICAL COURSE IN KOREAN PATIENTS WITH ULCERATIVE COLITIS

During recent several years, the incidence of ulcerative colitis is rapidly increasing in Korea. Both patients and physicians await good predictors of individual clinical course in terms of morbidity. We wanted to analyse not only clinical features in ulcerative colitis at the time of diagnosis, but also clinical courses during 5 years after diagnosis. Factors affecting clinical courses were also investigated.Methods One hundred and seventy‐four patients with ulcerative colitis regularly followed at least 1 year, spanning from January 1988 to October 2000, were included. Morbidity was evaluated using annual disease burden index, defined as summation of monthly clinical severity (0 for remission, 1 for mild, 2 for moderate, and 3 for severe). Multiple variables such as, demographic parameters, social history, symptoms, duration before diagnosis, extent of disease, endoscopic as well as clinical severity, laboratory data including ANCA and treatment, were used to identify factors affecting clinical course.Results Mean annual disease burden index at first, third and fifth year after diagnosis was 5.8 ± 4.4, 4.9 ± 5.3, and 3.8 ± 4.1, respectively. Mean annual symptomatic period also decreased from 4.0 ± 3.1 months at first year to 3.0 ± 3.4 months in fifth year. Presence of fever at the time of diagnosis was the only factor affecting annual disease burden index and symptomatic period at first year after diagnosis. Cumulative relapse free at 1, 2, and 5 years after diagnosis were 58.2, 68.2 and 86.8%, respectively. Young age at onset (< 30), short extent of disease (proctitis and left‐sided colitis vs. extensive colitis), and history of transfusion were factors significantly related with higher relapse rate (P < 0.05, log–rank test).Conclusion Disease burden index and symptomatic period in each year tend to decrease with time during 5 years after diagnosis. Cumulative relapse rate in Korean patients with ulcerative colitis was comparable to that in Western countries and was affected by age at onset, extent of disease, and history of transfusion.

Ulcer complications associated with anti‐inflammatory drug use. What is the extent of the disease burden?

Information on the intake of non-steroidal anti-inflammatory drugs (NSAIDs) and on aspirin taken regularly by patients with peptic ulcer bleeding aged 60 years and over was used in conjunction with data measuring the overall frequency of hospital admissions with ulcer bleeding in England and Wales to determine the annual burden of disease imposed by particular treatment strategies. Over 40% of the calculated 8528 episodes of ulcer bleeding in those aged 60 years and over, and over 40% of the estimated 981 deaths each year would seem to be causally related to the treatments. Substitution of the NSAID with the lowest associated risk would be expected to reduce the frequency of non-aspirin NSAID-associated episodes of ulcer bleeding, and deaths, each by over 70%. Use of the lowest conventional dose of regular prophylactic aspirin (75 mg) would also be expected to reduce the frequency of treatment-related episodes, and deaths, by nearly 30%. Both strategies employed together would be expected to reduce NSAID and regular aspirin-related bleeding ulcer admissions from 4121 to less than 2184, and deaths from 523 to less than 250. Substitution of completely safe anti-inflammatory analgesics and anti-platelet drugs would be expected to reduce admissions from 4121 to 1072, and deaths from 523 to 123.

Epidemiology of pneumococcal disease in children in Germany.

Recently published and as yet unpublished data allow a reasonable estimate of the annual burden of pneumococcal disease in Germany. At least 277,000 episodes of otitis media and at least 2,000 episodes of sinusitis occur in children under the age of 5 y. Pneumococcal meningitis was found in 200 children under the age of 16 y; the estimate for all age groups ranges from 450 to 1100 cases. Of approximately 150,000 cases of ambulatory pneumococcal pneumonia, at least 63,000-105,000 patients are hospitalized each year. Further studies of pneumococcal epidemiology in Germany are needed, and continued surveillance will be necessary for a better understanding of the overall burden of pneumococcal disease in children as well as adults.