New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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4. Comparison of Disease Burdens
4. Comparison of Disease Burdens
Pages 44-62
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From page 44... ...
The same principles have been used in the comparisons of potential health benefits anticipated from individual vaccine candidates in Chapter 7. It is possible to use the same system to compare diseases identified in Appendix A that are candidates for long-term rather than accelerated vaccine development.
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From page 46... ...
. ELEMENTS OF THE SYSTEM FOR COMPARING MORBIDITY AND MORTALITY BURDENS ARISING FROM VARIOUS DISEASES The system described below was designed not only to incorporate information relating to a disease (i.e., incidence, severity, complications, sequelae, duration, and distribution)
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From page 48... ...
Expression of Morbidity and Mortality Burdens Specific infant mortality equivalence values can be combined with disease burden estimates, such as those given in Appendixes D-1 through D-l9, to generate scores that express the seriousness of a disease relative to others as viewed by the individual making the trade-off Decisions. The procedure begins with the calculation of a subtotal for each morbidity category/age group combination, as shown: .
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E Moderate to severe chronic Cases 5 5 10 2 disability (requiring hospitalization, special care, or other major limitation of normal activity. and seriously restricting ability to work)
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. Impairment requlrlng minor change in normal activities, and associated with some restriction of work activity Moderate pain and/or moderate impairment requiring moderate change in normal activities, e.g., housebound or in bed, and associated with temporary loss of ability to work Days 20, 000 7,500 3, 000 15, 000 Days 10,000 5,000 1,500 1.500 C Severe pain, severe short-term Days 1,000 250 60 300 impairment, or hospitalization D E Mild chronic disab ility (not requiring hospitalization, institutionalization, or other major limitation of normal activity, and resulting in minor limitation of ability to work)
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From page 51... ...
· To simplify implementation of the scheme, acute episodes of illness usually were assigned entirely to the morbidity category representing the most severe signs and symptoms present, although the episode might include periods of recovery at less severe levels. · Category C was interpreted as morbidity for which hospitalization was desirable, even if probably not accessible.
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From page 52... ...
Value Subtotal A Moderate localized pain ardor 40,000 0 32,500 0 mild systemic reaction or impairment requiring minor change in normal activities, and associated with some restriction of work activity B Moderate pain and/or moderate impairment requiring moderate change in normal activities, e . g ., housebound or in bed, and associated with temporary loss of ability to work 139,843 7 23,713 41 635,651 7 17,500 254 ., C Severe pain, severe short-term 31,735 14 2,000 222 158,675 14 2,244 990 impairment, or hospitalization D Mild chronic disability (not n.
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Therefore, the exceptionally broad scope of the attempted estimates and the occasional need to extrapolate data from very few countries or studies to the entire developing world led to numerical estimates of uncertain validity.
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Each individual's perspective is equally valid; hence, there can be no single, correct set of trade-off or IME values. Several composite or hypothetical perspectives are worth considering, however, because they illustrate how differences in perspectives are reflected in the ultimate rankings of disease burdens and benefits expected from vaccines.
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From page 55... ...
Choosing IME values to guide policy formulation is discussed at the end of this chapter. The Effect of Adopting Other IME Perspectives Other sets of IME values might reflect the view that morbidity and mortality in young age groups, chronic disability in adults, hospitalizations (at any age)
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E Moderate to revere chronic Cases 5.5 5.5 2.75 23.125 disability (requiring hospitalization, special care, or other major limitation of normal activity, and seriously restricting ability to work) F Total impairment Cares 1 0 .
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TABLE 4.8 The Median Infant Mortality Equivalence Values for Respondents from the United States Infant Mortality Equivalents Morbidity 60 Yearn Category Description Unit Under 5 Years 5-14 Years 15-59 Years and Over B Moderate localized pain end/or mild systemic reaction, or ~ mps~rment requiring manor change in normal activities, and associated with some restriction of work activity Moderate pain and/or moderate impairment requiring moderate change in normal activities, e.g., housebound or in bed, and associated with temporary loss of ability to work Days 300,000 140,000 50,000 10,000,000 Days 80,000 10,000 4,000 100,000 C Severe pain, severe short-term Days 8, 000 1, 000 500 10, 000 impairment, or hospitalization D Mild chronic disability (not Cases 500 80 25 5,000 requiring hospitalization, institutionalization, or other major limitation of normal activity, and resulting in minor limitation of ability to work) E Moderate to severe chronic Cases 5 1 0.6 50 disability (requiring hospitalization, special care, or other major limitation of normal activity, and seriously restricting ability to work)
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From page 58... ...
No data exist on these questions, and the committee judged that convening a group sufficiently large to develop reliable estimates of these costs would not be practical. Estimating Costs for Diseases in Specific Countries or Regions Although it was not feasible to include disease cost comparisons in this analysis, it might be possible to compare the costs of treating various diseases in a particular region or country in the developing world.
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bInfant mortality equivalence units. CValues in parentheses represent the anticipated disease burden from certain diarrheas pathogens if a plausible increase in oral rehydration therapy is assumed (see Appendix C)
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(Rotavirus) Hemophilus influenzas type b Vibrio cholera Respiratory syncytial virus Parainfluenza virus Neisseria meningitidis Rabies virus Dengue virus Yellow fever virus Hepatitis A virus Japanese encephalitis virus 6,612,261 2,394,256 2,111,795 1,308,121 978,248 925,042 828,068 811,477 657,349 (550,248)
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RECOMMENDATIONS The capacity to make rational choices of vaccine development priorities and vaccine formulation would be enhanced by better information on disease incidence and the pathogen serotypes prevalent in particular regions. Therefore, the National Institute of Allergy and Infectious Diseases and other national and international agencies should consider ways to improve the epidemiologic information on infectious diseases.
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Population Reference Bureau.
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