Economic Value of Seasonal and Pandemic Influenza Vaccination during Pregnancy

Division of Reproductive Infectious Diseases, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 11/2009; 49(12):1784-92. DOI: 10.1086/649013
Source: PubMed


The cost-effectiveness of maternal influenza immunization against laboratory-confirmed influenza has never been studied. The current 2009 H1N1 influenza pandemic provides a timely opportunity to perform such analyses. The study objective was to evaluate the cost-effectiveness of maternal influenza vaccination using both single- and 2-dose strategies against laboratory-confirmed influenza secondary to both seasonal epidemics and pandemic influenza outbreaks.
A cost-effectiveness decision analytic model construct using epidemic and pandemic influenza characteristics from both the societal and third-party payor perspectives. A comparison was made between vaccinating all pregnant women in the United States versus not vaccinating pregnant women. Probabilistic (Monte Carlo) sensitivity analyses were also performed. The main outcome measures were incremental cost-effectiveness ratios (ICERs).
Maternal influenza vaccination using either the single- or 2-dose strategy is a cost-effective approach when influenza prevalence > or =7.5% and influenza-attributable mortality is > or =1.05% (consistent with epidemic strains). As the prevalence of influenza and/or the severity of the outbreak increases the incremental value of vaccination also increases. At a higher prevalence of influenza (> or =30%) the single-dose strategy demonstrates cost-savings while the 2-dose strategy remains highly cost-effective (ICER, < or =$6787.77 per quality-adjusted life year).
Maternal influenza immunization is a highly cost-effective intervention at disease rates and severity that correspond to both seasonal influenza epidemics and occasional pandemics. These findings justify ongoing efforts to optimize influenza vaccination during pregnancy from an economic perspective.

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    • "Influenza virus is a significant contributor to population morbidity and mortality on a global and national scale, particularly among at-risk populations such as pregnant women [1] [2] [3] [4]. The American Congress of Obstetricians and Gynecologists (ACOG) and the Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women (and women who expect to be pregnant during the influenza season) receive the trivalent inactivated influenza vaccination [1] [2]. Yet, vaccination rates among Hispanic and Black/African–American pregnant women are significantly lower than those of whites despite persistently higher rates of morbidity, mortality, and hospitalizations due to influenza [3] [4] [5] [6] [7] [8] [9] [10] [11]. "
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    ABSTRACT: A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination ("gain-frame"), or messages which emphasize negative outcomes of forgoing vaccination ("loss-frame"). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations. Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses. Neither gain- [OR=0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR=0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR=3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR=2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR=3.405, 95% CI: (1.412,8.212)]. Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.
    Vaccine 01/2014; 32(15). DOI:10.1016/j.vaccine.2014.01.030 · 3.62 Impact Factor
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    • "Both pregnant women and young infants were found to be vulnerable to a serious sequelae of influenza infection. Immunization of pregnant women offers the theoretical advantage of endowing the fetus with maternal antibody prior to delivery, delaying the onset and decreasing the severity of influenza disease in young infants [10] [11] [20]. No increased risks for maternal or fetal complication were identified in vaccinated pregnant women [11e15]. "
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    ABSTRACT: To determine the prevalence of preexisting antibodies against the pandemic 2009 Influenza A (H1N1) virus in pregnant women and to evaluate the seroprotection of the mothers and infants by a single injection of monovalent vaccine during the pandemic. Seropositivity rate of H1N1 among the nonvaccinated were compared with the vaccinated women. A single dose of vaccine, either nonadjuvanted AdimFlu-S or MF59-adjuvanted vaccine, was injected to the voluntarily vaccinated group. Maternal and cord blood sera were collected to evaluate the antibody response of the H1N1 virus. Seropositivity was defined as a hemagglutination inhibition titer to H1N1 (A/Taiwan/126/09) ≥1:40. A total of 210 healthy, singleton, pregnant women were enrolled between January 2010 and May 2010. Seropositivity (≥1:40) of maternal hemagglutination inhibition was significantly higher in the vaccinated group (78%) than the nonvaccinated group (9.5%); 41.6% (20/48) of seropositive titers were >1:80. In nine vaccinated cases resulting in negative serum titers (<1:40), the prevalence of negative titer in the women received AdimFlu-S (14.8%, 4/31) was lower (p = 0.025) than those received MF59-adjuvanted vaccine (50%, 5/10). Subclinical infection against H1N1 was low in Taiwanese pregnant women in the pandemic 2009. Seropositivity >75% could be achieved in the paired maternal and cord serum samples by a single injection of monovalent H1N1 vaccine.
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    • "For pregnant women, it is recommended optionally [12]. Enough evidence exists about the benefits, safety, and cost efficiency of this proposed measure—not only for mothers but also for newborns [13] [14]. This measure can decrease the excess of morbidity and mortality due to influenza among pregnant women [15] and it should become part of the set of indispensable procedures performed at prenatal controls. "
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    ABSTRACT: To evaluate the impact of the H1N1 influenza pandemic on maternal mortality in the province of Antioquia, Colombia, in 2009. The present study was a descriptive, retrospective, cross-sectional study of maternal deaths in Antioquia in 2009 caused by H1N1-related pneumonia. The study formed part of the epidemiologic surveillance process undertaken by the Health and Social Protection Directorate of Antioquia and the particular healthcare institutions involved in the cases. In 2009, there were 42 maternal deaths in Antioquia, corresponding to a maternal mortality ratio of 46 per 100 000 live births. Ten deaths were due to pneumonia, 9 of which occurred after the H1N1 outbreak was first reported in early 2009. In 3 cases, the women were confirmed to have H1N1 virus infection, and the remainder fulfilled probable case criteria. The main factors contributing to the deaths were underestimation of H1N1 symptoms, and delays in administration of antiviral medication and in hospitalization. For the population subgroup of pregnant women in Antioquia, it is crucial to remain alert regarding H1N1 virus infection, guaranteeing patients adequate monitoring and/or timely administration of immunization, medication, and hospitalization.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 08/2011; 115(2):144-7. DOI:10.1016/j.ijgo.2011.05.022 · 1.54 Impact Factor
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