DOCSLIB.ORG

Prevalence and Determinants of Vaccine Hesitancy and Vaccines Recommendation Discrepancies Among General Practitioners in French-Speaking Parts of Belgium

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prevalence and Determinants of Vaccine Hesitancy and Vaccines Recommendation Discrepancies Among General Practitioners in French-Speaking Parts of Belgium Article Prevalence and Determinants of Vaccine Hesitancy and Vaccines Recommendation Discrepancies among General Practitioners in French-Speaking Parts of Belgium Cathy Gobert 1, Pascal Semaille 2, Thierry Van der Schueren 3 , Pierre Verger 4 and Nicolas Dauby 1,5,6,* 1 Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Bruxelles, Belgium; [email protected] 2 Department of General Medicine, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; [email protected] 3 Scientific Society of General Practice, 1060 Bruxelles, Belgium; [email protected] 4 Southeastern Health Regional Observatory (ORS PACA), 13005 Marseille, France; [email protected] 5 School of Public Health, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium 6 Institute for Medical Immunology, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium * Correspondence: [email protected] Abstract: General practitioners (GPs) play a critical role in patient acceptance of vaccination. Vaccine hesitancy (VH) is a growing phenomenon in the general population but also affects GPs. Few data exist on VH among GPs. The objectives of this analysis of a population of GPs in the Belgian Wallonia-Brussels Federation (WBF) were to: (1) determine the prevalence and the features of VH, (2) identify the correlates, and (3) estimate the discrepancy in vaccination’s behaviors between the GPs’ children and the recommendations made to their patients. An online survey was carried out Citation: Gobert, C.; Semaille, P.; Van among the population of general practitioners practicing in the WBF between 7 January and 18 der Schueren, T.; Verger, P.; Dauby, N. March 2020. A hierarchical cluster analysis was carried out based on various dimensions of vaccine Prevalence and Determinants of hesitancy: perception of the risks and the usefulness of vaccines as well as vaccine recommendations Vaccine Hesitancy and Vaccines for their patients. A total of 251 GPs answered the survey. The average percentage of moderate Recommendation Discrepancies among General Practitioners in to high vaccine hesitancy was 50.6%. Three factors were independently associated with increased French-Speaking Parts of Belgium. risk of vaccine hesitancy: an age <50 years old, having no children, and having no contact with Vaccines 2021, 9, 771. https:// selected vaccine-preventable disease (measles, complicated influenza, chronic hepatitis B (HBV), doi.org/10.3390/vaccines9070771 bacterial meningitis, or cervical cancer) in the past 5 years. VH was associated with controversies on vaccines’ safety. GPs who had vaccinated their children against six diseases (MMR, meningococcus C Academic Editor: Brian D. Poole (MenC), HBV, and HPV) tended not to recommend the same vaccines to their patients. Among GPs with all children vaccinated against HBV, only 37.5% recommended catch-up HBV immunization to Received: 9 April 2021 their patients. In this small cohort of GP, moderate to high VH was associated with controversies Accepted: 6 July 2021 on vaccines’ safety and with specific personal characteristics (age <50, no children, and no recent Published: 10 July 2021 experience with a serious VPD). As previously reported, GPs have different vaccine prescription attitude toward their patients and children. These findings should be confirmed in larger cohorts. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in Keywords: vaccine hesitancy; general practice; health-care workers; vaccination published maps and institutional affil- iations. 1. Introduction Vaccination is a simple and effective means of protecting against certain potentially Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. fatal diseases. Vaccination provides both individual and community protection for certain This article is an open access article vaccine-preventable diseases and has also broad societal impact that includes increased distributed under the terms and productivity, positive fiscal impact, and decreased antibiotic consumption [1]. In order conditions of the Creative Commons to avoid the resurgence of vaccine-preventable diseases (VPD), it is necessary to keep a Attribution (CC BY) license (https:// sufficiently high vaccination coverage. creativecommons.org/licenses/by/ In Belgium, only the polio vaccine is currently compulsory [2]. Vaccination coverage 4.0/). in the Wallonia-Brussels Federation (WBF), the two French-speaking regions of Belgium, Vaccines 2021, 9, 771. https://doi.org/10.3390/vaccines9070771 https://www.mdpi.com/journal/vaccines Vaccines 2021, 9, 771 2 of 13 particularly for measles–mumps–rubella (MMR) and for human papillomavirus (HPV) vaccination, is still far from sufficient. For example, vaccine coverage for the second doses of MMR among adolescents was 75% [3]. In the last years, measles outbreaks have been reported both in Brussels and Wallonia regions [4,5]. Vaccine hesitancy (VH) is considered an important cause of under-vaccination [6]. The concept of a matrix of determinants of hesitation, influencing the decision and/or the vaccination methods, has also been proposed in order to group different factors into three impact categories. These categories are contextual, individual, and group, as well as those specific to the vaccine and/or vaccination [7]. In 2016, VH was reported in more than 90% of countries in the world, regardless of socio-economic level [8]. In a 2016 study of 67 countries, Europe had the lowest level of confidence in vaccine safety [9]. Different factors contribute to increased VH: potential side effects, belief that the vaccine could cause the disease it was meant to prevent, doubt about the safety of adjuvants, and overloading the immune system [8]. VH is not limited to patients but also affects healthcare professionals (HCP) [10]. Several causes of VH among HCP have been highlighted: a lack of confidence in the health authorities, the fact of not feeling comfortable transmitting quality information to patients, the fear of serious side effects and doubts regarding the safety of adjuvants and also the efficacy of some vaccines [11]. General practitioners (GPs) play a key role in the promotion and acceptance of vacci- nation in Belgium as well as in many other countries. Various studies have shown that (1) GPs remain one of the most reliable advisers in the eyes of patients and (2) patients tend to be more reassured when information comes from their doctor [12,13]. In 2014, Verger et al. reported a method to describe and estimate the extent of vaccine hesitancy among GPs. Using a survey that included different dimensions of vaccine hesi- tancy (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness), they were able to identify three clusters of GP with different grade of VH. GP with the higher degree of VH were less frequently vaccinated and reported more frequent occasional practice of alternative medicine but also less experience with VPD [11]. Interestingly, recent studies have shown a discrepancy in immunization recommen- dation in a high proportion of GPs toward members of their family, themselves, and their patients [14,15]. There is only a limited amount of data on VH among HCP [13,14,16,17]. In French- speaking parts of Belgium, at present, there is no documented study on this subject. The objectives of the present study were to (1) estimate VH prevalence in a sample of GPs practicing in the Wallonia-Brussels Federation, (2) identify the factors influencing VH among GPs, and (3) highlight the existence or not of a discrepancy between the vaccination of doctors and their children compared to that of their patients. 2. Materials and Methods 2.1. Study Design An online survey aimed at GPs practicing in the Wallonia-Brussels Federation was conducted between 7 January 2020 and 18 March 2020. An online questionnaire was distributed by email to GPs thanks to the collaboration of the Scientific Society of General Practice (SSGP) and the Belgian group of general practitioners (GBO). In addition, sev- eral associations of GPs in the Wallonia-Brussels Federation were contacted in order to disseminate the survey to their members by email. 2.2. Data Collection Each GP who agreed to participate in the study answered a questionnaire that included 24 questions (Supplementary materials File S1). This questionnaire was created and standardized by Verger and colleagues [11] For this work, the questionnaire was adapted to match the specificities of the WBF vaccination program (Supplementary materials Table S2). Participants were asked about their personal and professional vaccination Vaccines 2021, 9, 771 3 of 13 practices. They were asked about their views on vaccination and potential barriers to vaccination. The participants gave their opinion on various possible actions pertaining to vaccination. To answer the questions, 4- or 5-point Likert scales were used [18]. The data collection was anonymous. Data were collected using the open-source LimeSurvey software (LimeSurvey GmbH, Hambourg, Germany) hosted on the servers of the Université Libre de Bruxelles (ULB). 2.3. Immunization Discrepancies between Family and Patients of General Practitioners Among GPs with ≥1 child, immunization recommendations of four vaccines (HPV, MMR, meningococcus C (MenC), and Hepatitis B (HBV)) toward their patients were compared with the immunization practice with their family members. 2.4. Statistical Analysis In order to classify population sample according to VH, a previously
Load more

Recommended publications
  • FORMULAS from EPIDEMIOLOGY KEPT SIMPLE (3E) Chapter 3: Epidemiologic Measures
    FORMULAS FROM EPIDEMIOLOGY KEPT SIMPLE (3e) Chapter 3: Epidemiologic Measures Basic epidemiologic measures used to quantify: • frequency of occurrence • the effect of an exposure • the potential impact of an intervention. Epidemiologic Measures Measures of disease Measures of Measures of potential frequency association impact (“Measures of Effect”) Incidence Prevalence Absolute measures of Relative measures of Attributable Fraction Attributable Fraction effect effect in exposed cases in the Population Incidence proportion Incidence rate Risk difference Risk Ratio (Cumulative (incidence density, (Incidence proportion (Incidence Incidence, Incidence hazard rate, person- difference) Proportion Ratio) Risk) time rate) Incidence odds Rate Difference Rate Ratio (Incidence density (Incidence density difference) ratio) Prevalence Odds Ratio Difference Macintosh HD:Users:buddygerstman:Dropbox:eks:formula_sheet.doc Page 1 of 7 3.1 Measures of Disease Frequency No. of onsets Incidence Proportion = No. at risk at beginning of follow-up • Also called risk, average risk, and cumulative incidence. • Can be measured in cohorts (closed populations) only. • Requires follow-up of individuals. No. of onsets Incidence Rate = ∑person-time • Also called incidence density and average hazard. • When disease is rare (incidence proportion < 5%), incidence rate ≈ incidence proportion. • In cohorts (closed populations), it is best to sum individual person-time longitudinally. It can also be estimated as Σperson-time ≈ (average population size) × (duration of follow-up). Actuarial adjustments may be needed when the disease outcome is not rare. • In an open populations, Σperson-time ≈ (average population size) × (duration of follow-up). Examples of incidence rates in open populations include: births Crude birth rate (per m) = × m mid-year population size deaths Crude mortality rate (per m) = × m mid-year population size deaths < 1 year of age Infant mortality rate (per m) = × m live births No.
    [Show full text]
  • Statistical Guidance on Reporting Results from Studies Evaluating Diagnostic Tests Document Issued On: March 13, 2007
    Guidance for Industry and FDA Staff Statistical Guidance on Reporting Results from Studies Evaluating Diagnostic Tests Document issued on: March 13, 2007 The draft of this document was issued on March 12, 2003. For questions regarding this document, contact Kristen Meier at 240-276-3060, or send an e-mail to [email protected]. U.S. Department of Health and Human Services Food and Drug Administration Center for Devices and Radiological Health Diagnostic Devices Branch Division of Biostatistics Office of Surveillance and Biometrics Contains Nonbinding Recommendations Preface Public Comment Written comments and suggestions may be submitted at any time for Agency consideration to the Division of Dockets Management, Food and Drug Administration, 5630 Fishers Lane, Room 1061, (HFA-305), Rockville, MD, 20852. Alternatively, electronic comments may be submitted to http://www.fda.gov/dockets/ecomments. When submitting comments, please refer to Docket No. 2003D-0044. Comments may not be acted upon by the Agency until the document is next revised or updated. Additional Copies Additional copies are available from the Internet at: http://www.fda.gov/cdrh/osb/guidance/1620.pdf. You may also send an e-mail request to [email protected] to receive an electronic copy of the guidance or send a fax request to 240-276-3151 to receive a hard copy. Please use the document number 1620 to identify the guidance you are requesting. Contains Nonbinding Recommendations Table of Contents 1. Background....................................................................................................4
    [Show full text]
  • Estimated HIV Incidence and Prevalence in the United States
    Volume 26, Number 1 Estimated HIV Incidence and Prevalence in the United States, 2015–2019 This issue of the HIV Surveillance Supplemental Report is published by the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, Georgia. Estimates are presented for the incidence and prevalence of HIV infection among adults and adolescents (aged 13 years and older) based on data reported to CDC through December 2020. The HIV Surveillance Supplemental Report is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated. Suggested citation Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report 2021;26(No. 1). http://www.cdc.gov/ hiv/library/reports/hiv-surveillance.html. Published May 2021. Accessed [date]. On the Web: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html Confidential information, referrals, and educational material on HIV infection CDC-INFO 1-800-232-4636 (in English, en Español) 1-888-232-6348 (TTY) http://wwwn.cdc.gov/dcs/ContactUs/Form Acknowledgments Publication of this report was made possible by the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC. This report was prepared by the following staff and contractors of the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC: Laurie Linley, Anna Satcher Johnson, Ruiguang Song, Sherry Hu, Baohua Wu, H.
    [Show full text]
  • Understanding Relative Risk, Odds Ratio, and Related Terms: As Simple As It Can Get Chittaranjan Andrade, MD
    Understanding Relative Risk, Odds Ratio, and Related Terms: As Simple as It Can Get Chittaranjan Andrade, MD Each month in his online Introduction column, Dr Andrade Many research papers present findings as odds ratios (ORs) and considers theoretical and relative risks (RRs) as measures of effect size for categorical outcomes. practical ideas in clinical Whereas these and related terms have been well explained in many psychopharmacology articles,1–5 this article presents a version, with examples, that is meant with a view to update the knowledge and skills to be both simple and practical. Readers may note that the explanations of medical practitioners and examples provided apply mostly to randomized controlled trials who treat patients with (RCTs), cohort studies, and case-control studies. Nevertheless, similar psychiatric conditions. principles operate when these concepts are applied in epidemiologic Department of Psychopharmacology, National Institute research. Whereas the terms may be applied slightly differently in of Mental Health and Neurosciences, Bangalore, India different explanatory texts, the general principles are the same. ([email protected]). ABSTRACT Clinical Situation Risk, and related measures of effect size (for Consider a hypothetical RCT in which 76 depressed patients were categorical outcomes) such as relative risks and randomly assigned to receive either venlafaxine (n = 40) or placebo odds ratios, are frequently presented in research (n = 36) for 8 weeks. During the trial, new-onset sexual dysfunction articles. Not all readers know how these statistics was identified in 8 patients treated with venlafaxine and in 3 patients are derived and interpreted, nor are all readers treated with placebo. These results are presented in Table 1.
    [Show full text]
  • Considerations for Causality Assessment of Neurological And
    Occasional essay J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2021-326924 on 6 August 2021. Downloaded from Considerations for causality assessment of neurological and neuropsychiatric complications of SARS- CoV-2 vaccines: from cerebral venous sinus thrombosis to functional neurological disorder Matt Butler ,1 Arina Tamborska,2,3 Greta K Wood,2,3 Mark Ellul,4 Rhys H Thomas,5,6 Ian Galea ,7 Sarah Pett,8 Bhagteshwar Singh,3 Tom Solomon,4 Thomas Arthur Pollak,9 Benedict D Michael,2,3 Timothy R Nicholson10 For numbered affiliations see INTRODUCTION More severe potential adverse effects in the open- end of article. The scientific community rapidly responded to label phase of vaccine roll- outs are being collected the COVID-19 pandemic by developing novel through national surveillance systems. In the USA, Correspondence to SARS- CoV-2 vaccines (table 1). As of early June Dr Timothy R Nicholson, King’s roughly 372 adverse events have been reported per College London, London WC2R 2021, an estimated 2 billion doses have been million doses, which is a lower rate than expected 1 2LS, UK; timothy. nicholson@ administered worldwide. Neurological adverse based on the clinical trials.6 kcl. ac. uk events following immunisation (AEFI), such as In the UK, adverse events are reported via the cerebral venous sinus thrombosis and demyelin- MB and AT are joint first Coronavirus Yellow Card reporting website. As of ating episodes, have been reported. In some coun- authors. early June 2021, approximately 250 000 Yellow tries, these have led to the temporary halting of BDM and TRN are joint senior Cards have been submitted, equating to around authors.
    [Show full text]
  • Ethics of Vaccine Research
    COMMENTARY Ethics of vaccine research Christine Grady Vaccination has attracted controversy at every stage of its development and use. Ethical debates should consider its basic goal, which is to benefit the community at large rather than the individual. accines truly represent one of the mira- include value, validity, fair subject selection, the context in which it will be used and Vcles of modern science. Responsible for favorable risk/benefit ratio, independent acceptable to those who will use it. This reducing morbidity and mortality from sev- review, informed consent and respect for assessment considers details about the pub- eral formidable diseases, vaccines have made enrolled participants. Applying these princi- lic health need (such as the prevalence, bur- substantial contributions to global public ples to vaccine research allows consideration den and natural history of the disease, as health. Generally very safe and effective, vac- of some of the particular challenges inherent well as existing strategies to prevent or con- cines are also an efficient and cost-effective in testing vaccines (Box 1). trol it), the scientific data and possibilities way of preventing disease. Yet, despite their Ethically salient features of clinical vac- (preclinical and clinical data, expected brilliant successes, vaccines have always been cine research include the fact that it involves mechanism of action and immune corre- controversial. Concerns about the safety and healthy subjects, often (or ultimately) chil- lates) and the likely use of the vaccine (who untoward effects of vaccines, about disturb- dren and usually (at least when testing effi- will use and benefit from it, safety, cost, dis- ing the natural order, about compelling indi- cacy) in very large numbers.
    [Show full text]
  • Disease Incidence, Prevalence and Disability
    Part 3 Disease incidence, prevalence and disability 9. How many people become sick each year? 28 10. Cancer incidence by site and region 29 11. How many people are sick at any given time? 31 12. Prevalence of moderate and severe disability 31 13. Leading causes of years lost due to disability in 2004 36 World Health Organization 9. How many people become sick each such as diarrhoeal disease or malaria, it is common year? for individuals to be infected repeatedly and have several episodes. For such conditions, the number The “incidence” of a condition is the number of new given in the table is the number of disease episodes, cases in a period of time – usually one year (Table 5). rather than the number of individuals affected. For most conditions in this table, the figure given is It is important to remember that the incidence of the number of individuals who developed the illness a disease or condition measures how many people or problem in 2004. However, for some conditions, are affected by it for the first time over a period of Table 5: Incidence (millions) of selected conditions by WHO region, 2004 Eastern The Mediter- South- Western World Africa Americas ranean Europe East Asia Pacific Tuberculosisa 7.8 1.4 0.4 0.6 0.6 2.8 2.1 HIV infectiona 2.8 1.9 0.2 0.1 0.2 0.2 0.1 Diarrhoeal diseaseb 4 620.4 912.9 543.1 424.9 207.1 1 276.5 1 255.9 Pertussisb 18.4 5.2 1.2 1.6 0.7 7.5 2.1 Measlesa 27.1 5.3 0.0e 1.0 0.2 17.4 3.3 Tetanusa 0.3 0.1 0.0 0.1 0.0 0.1 0.0 Meningitisb 0.7 0.3 0.1 0.1 0.0 0.2 0.1 Malariab 241.3 203.9 2.9 8.6 0.0 23.3 2.7
    [Show full text]
  • EPI Case Study 1 Incidence, Prevalence, and Disease
    EPIDEMIOLOGY CASE STUDY 1: Incidence, Prevalence, and Disease Surveillance; Historical Trends in the Epidemiology of M. tuberculosis STUDENT VERSION 1.0 EPI Case Study 1: Incidence, Prevalence, and Disease Surveillance; Historical Trends in the Epidemiology of M. tuberculosis Estimated Time to Complete Exercise: 30 minutes LEARNING OBJECTIVES At the completion of this Case Study, participants should be able to: ¾ Explain why denominators are necessary when comparing changes in morbidity and mortality over time ¾ Distinguish between incidence rates and prevalence ratios ¾ Calculate and interpret cause-specific morbidity and mortality rates ¾ Describe how changes in mortality or morbidity could be due to an artifact rather than a real change ASPH EPIDEMIOLOGY COMPETENCIES ADDRESSED C. 3. Describe a public health problem in terms of magnitude, person, place, and time C. 6. Apply the basic terminology and definitions of epidemiology C. 7. Calculate basic epidemiology measures C. 9. Draw appropriate inference from epidemiologic data C. 10. Evaluate the strengths and limitations of epidemiologic reports ASPH INTERDISCIPLINARY/CROSS-CUTTING COMPETENCIES ADDRESSED F.1. [Communication and Informatics] Describe how the public health information infrastructure is used to collect, process, maintain, and disseminate data J.1. [Professionalism] Discuss sentinel events in the history and development of the public health profession and their relevance for practice in the field L.2. [Systems Thinking] Identify unintended consequences produced by changes made to a public health system This material was developed by the staff at the Global Tuberculosis Institute (GTBI), one of four Regional Training and Medical Consultation Centers funded by the Centers for Disease Control and Prevention. It is published for learning purposes only.
    [Show full text]
  • Patient Information Leaflet Pandemrix Suspension and Emulsion For
    gentamicin sulphate (antibiotic) or sodium Patient Information deoxycholate. Signs of an allergic reaction may Leaflet include itchy skin rash, shortness of breath and swelling of the face or tongue. However, in a pandemic situation, it may be Pandemrix suspension appropriate for you to have the vaccine provided that appropriate medical treatment is immediately and emulsion for available in case of an allergic reaction. emulsion for injection If you are not sure, talk to your doctor or nurse Pandemic influenza vaccine (H1N1) before having this vaccine. (split virion, inactivated, adjuvanted) Talk to your doctor • if you have had any allergic reaction other than For the most up-to-date information a sudden lifethreatening allergic reaction to any please consult the website of the UK ingredient contained in the vaccine, to thiomersal, Medicines and Healthcare products to egg and chicken protein, ovalbumin, Regulatory Agency at: formaldehyde, gentamicin sulphate (antibiotic) or www.mhra.gov.uk/swineflu to sodiumdeoxycholate. (see section 6. Further information). Read all of this leaflet carefully before you receive this vaccine. • if you have a severe infection with a high - Keep this leaflet. You may need to read it again. temperature (over 38°C). If this applies to you - If you have any further questions, ask your then your vaccination will usually be postponed doctor or nurse. until you are feeling better. A minor infection such - If any of the side effects gets serious, or if you as a cold should not be a problem, but your notice any side effects doctor or nurse will advise whether you could still not listed in this leaflet, please tell your doctor.
    [Show full text]
  • Likelihood Ratios, Predictive Values, and Post-Test Probabilities The
    Likelihood ratios, predictive values, and post-test probabilities The purpose of this quick tutorial is to help you better understand how to use likelihood ratios (LRs), predictive values (PVs), and post-test probabilities in medical writing. The key point is that LRs are calculated differently depending on whether a test has only two possible results (dichotomous), or whether it has more than two possible outcomes (multichotomous). Examples of the latter include a clinical decision rule (CDR) that identifies low, moderate and high-risk groups, or reporting serum ferritin as < 20, 20 – 60, 61 – 100, and > 100 mg/dl. Dichotomous tests A likelihood ratio (LR) for a dichotomous test is defined as the likelihood of a test result in patients with the disease divided by the likelihood of the test result in patients without the disease. For example, the likelihood of abnormal fecal immunochemical test (FIT) in patients with colorectal cancer, divided by the likelihood of an abnormal FIT in those without cancer. A LR close to 1 means that the test result does not change the likelihood of disease or the outcome of interest appreciably. The more the likelihood ratio for a positive test (LR+) is greater than 1, the more likely the disease or outcome. The more a likelihood ratio for a negative test is less than 1, the less likely the disease or outcome. Thus, LRs correspond nicely to the clinical concepts of ruling in and ruling out disease. One suggested way to interpret LR is as follows (Ebell, 2005 Information Mastery AAFP Home Study): > 10 Large
    [Show full text]
  • ESCMID Online Lecture Library © by Author
    Albert Osterhaus Head Dept Virology Chairman ESWI CSO Viroclinics-Biosciences BV Library Pandemic flu and the anti-H1N1 vaccine: Lecture a retrospective view. author Onlineby © ESCMID ESCMID conference on the impact of vaccines on Public Health Prague, 2nd April 2011 Human influenza: three appearances Library Seasonal influenza (A: H3N2, H1N1; B) Lecture Avian influenza author (A: H7N7, H5N1…)Online by © PandemicESCMID influenza (A: H1N1, H2N2, H3N2, H1N1…?) INFLUENZA A VIRUS Recent zoonotic transmissions Library Subtype Country Year # Cases # Deaths H7N7 UK Lecture1996 1 0 H5N1 Hongkong 1997 18 6 H9N2 SE-Asia 1999author >2 0 H5N1 HongkongOnlineby 2003 2? 1 H7N7 Netherlands© 2003 89 1 H7N2 USA 2003 1 0 H7N3 Canada 2004 2 0 H5N1ESCMIDSE-Asia/M-East/ 2003-11 .>500 >300* Europe/W-Africa *CFR ~ 60% Library Lecture author Onlineby © ESCMID Confirmed H5N1 avian influenza virus endemic areas (poultry and wild birds) since 2003 Avian influenza A H5N1 virus - HA: Receptor specificity - Library Shinya et al., Nature 440, 2006 Lecture Van Riel et al., Science 2006 author Van Riel et al., Online Am J Pathol 2007 by Van Riel et al., © Am J Pathol 2009 Van Riel et al., ESCMID Am J Pathol 2010 Library Lecture author Onlineby © ESCMID Introduction - Attachment to the upper respiratory tract - Seasonal H3N2 Pandemic H1N1 HPAIV H5N1 Last four pandemics Library Lecture Credit: US National Museum of Health and Medicine author 1918 1957Online 1968 2009 “Spanish Flu” “Asian Flu” by “Hong Kong Flu” © ”Swine Flu” >40 million deaths 1-4 million deaths 1-4million deaths ??? A(H1N1)ESCMIDA(H2N2) A(H3N2) A(H1N1) Library Lecture author Onlineby © ESCMID Air traffic from Mexico ~ 1998 PB2,PA: Triple reassortant ~ 1968 ~ 1998 PB1: LibraryN-America ~ 1918 Classical swine HA, NP, NS: Lecture ~ 1979 NA, MA: authorEurasian swine Eurasia Onlineby A/California/4/2009 © PB2 PB1 The H1N1v flu virus PA Courtesy: Ron Fouchier HA NP ESCMID NA MA NS Library Lecture author Onlineby © ESCMID The Mexican flu virus..
    [Show full text]
  • Gsk Vaccines in 2010
    GSK VACCINES IN 2010 Thomas Breuer, MD, MSc Senior Vice President Head of Global Vaccines Development GSK Biologicals Vaccines business characteristics Few global players and high barriers to entry – Complex manufacturing – Large scale investment Long product life cycles – Complex intellectual property High probability of R&D success – 70% post-POC New technology/novel products Better pricing for newer vaccines – HPV vaccines (Cervarix, Gardasil) – Pneumococcal vaccines (Synflorix, Prevnar-13) Operating margin comparable to pharmaceutical products Heightened awareness New markets 2 Research & development timelines Identify Produce Pre-Clinical Proof of Registration/ Phase I Phase II Phase III File Antigens Antigens Testing Concept Post Marketing Research (inc. Immunology) Pre-Clinical Development (inc. Formulation Science) Clinical Development (inc. Post Marketing Surveillance) Transfer Process to Manufacturing Build Facility x x Up to $10-20M Up to $50-100M $500M - $1B x x x 1-10 yrs 2-3 yrs 2-4 yrs > 1 yr GSK vaccines business 2009 sales £3.7 billion (+30%) +19% CAGR excl. H1N1 Vaccines represent 13% since 2005 of total GSK sales Sale s (£m) 4000 3500 Recent approvals: 3000 US: Cervarix 2500 EU: Synflorix 2000 Pandemic: Pandemrix; Arepanrix 1500 1000 500 0 2005 2006 2007 2008 2009 Increased Emerging Market presence Growth rate is CER 5 GSK vaccines: fastest growing part of GSK in 2009 2009 Sales Share Growth (CER) Respiratory £ 6,977m 25% +5% Consumer £ 4,654m 16% +7% Anti-virals £ 4,150m 15% +12% Vaccines £ 3,706m 13% +30% CV & Urogenital
    [Show full text]