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      Economic benefits of sharing and redistributing influenza vaccines when shortages occurred

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      PLoS ONE
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          Abstract

          Background

          Recurrent influenza outbreak has been a concern for government health institutions in Taiwan. Over 10% of the population is infected by influenza viruses every year, and the infection has caused losses to both health and the economy. Approximately three million free vaccine doses are ordered and administered to high-risk populations at the beginning of flu season to control the disease. The government recommends sharing and redistributing vaccine inventories when shortages occur. While this policy intends to increase inventory flexibility, and has been proven as widely valuable, its impact on vaccine availability has not been previously reported.

          Material and methods

          This study developed an inventory model adapted to vaccination protocols to evaluate government recommended polices under different levels of vaccine production. Demands were uncertain and stratified by ages and locations according to the demographic data in Taiwan.

          Results

          When vaccine supply is sufficient, sharing pediatric vaccine reduced vaccine unavailability by 43% and overstock by 54%, and sharing adult vaccine reduced vaccine unavailability by 9% and overstock by 15%. Redistributing vaccines obtained greater gains for both pediatrics and adults (by 75%). When the vaccine supply is in short, only sharing pediatric vaccine yielded a 48% reduction of unused inventory, while other polices do not improve performances.

          Conclusions

          When implementing vaccination activities for seasonal influenza intervention, it is important to consider mismatches of demand and vaccine inventory. Our model confirmed that sharing and redistributing vaccines can substantially increase availability and reduce unused vaccines.

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          Most cited references16

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          Effectiveness of influenza vaccine in the community-dwelling elderly.

          Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990-1991 through 1999-2000 and of two other HMOs for 1996-1997 through 1999-2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant--though lower--reductions in the risks of both hospitalization and death. During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. Copyright 2007 Massachusetts Medical Society.
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            The vaccination coverage required to establish herd immunity against influenza viruses.

            P Plans (2012)
            1) To determine the influenza vaccination coverage required to establish herd immunity, and 2) to assess whether the percentages of vaccination coverage proposed and those registered in the United States and Europe are sufficient to establish herd immunity. The vaccination coverage required to establish herd immunity was determined by taking into account the number of secondary cases per infected case (R(o)) and the vaccine effectiveness. The required percentage that would have been required to establish herd immunity against previous influenza viruses ranged from 13% to 100% for the 1918-19, 1957-58, 1968-69 and 2009-10 pandemic viruses, and from 30% to 40% for the 2008-09 epidemic virus. The objectives of vaccination coverage proposed in the United States - 80% in healthy persons and 90% in high-risk persons - are sufficient to establish herd immunity, while those proposed in Europe - only 75% in elderly and high-risk persons - are not sufficient. The percentages of vaccination coverage registered in the United States and Europe are not sufficient to establish herd immunity. The influenza vaccination coverage must be increased in the United States and Europe in order to establish herd immunity. It is necessary to develop new influenza prevention messages based on herd immunity. Copyright © 2012 Elsevier Inc. All rights reserved.
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              • Article: not found

              The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines.

              K Nichol (2003)
              Influenza is a major cause of morbidity and mortality worldwide. Currently available inactivated influenza virus vaccines are safe and effective in preventing influenza. Substantial health benefits are seen across all age and risk groups. Studies assessing the economic benefits of vaccination suggest that vaccination is highly cost effective and in many cases cost saving among the elderly. Influenza vaccination has also been associated with significant economic benefits in younger adults and children. Additional health economic studies from developing countries and from tropical/subtropical regions will be vitally important for better understanding of the global burden of influenza and potential benefits of vaccination.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                17 October 2017
                2017
                : 12
                : 10
                : e0186418
                Affiliations
                [001]Department of Industrial Engineering and Management, School of Management, National Chiao-Tung University, Hsinchu, Taiwan
                Centers for Disease Control, TAIWAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-4648-6133
                Article
                PONE-D-17-26130
                10.1371/journal.pone.0186418
                5645113
                29040317
                7f10c067-a704-4ffe-a968-607f30be3d6b
                © 2017 Sheng-I Chen

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 July 2017
                : 29 September 2017
                Page count
                Figures: 6, Tables: 4, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004663, Ministry of Science and Technology, Taiwan;
                Award ID: MOST 106-2221-E-009 -114 -MY2
                Award Recipient :
                Funding for this study was provided by the Ministry of Science and Technology, Taiwan ( https://www.most.gov.tw/) grants MOST 104-2218-E-009-021 and MOST 106-2221-E-009-114-MY2. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Vaccines
                Medicine and Health Sciences
                Pediatrics
                People and Places
                Population Groupings
                Age Groups
                Adults
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Medicine and Health Sciences
                Infectious Diseases
                Viral Diseases
                Influenza
                People and Places
                Population Groupings
                Age Groups
                People and Places
                Geographical Locations
                Asia
                Taiwan
                Social Sciences
                Sociology
                Criminology
                Police
                People and Places
                Population Groupings
                Professions
                Police
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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