Low uptake of routinely recommended adult immunizations is a public health concern. Using data from the peer-reviewed literature, government disease-surveillance programs, and the US Census, we developed a customizable model to estimate human and economic burden caused by four major adult vaccine-preventable diseases (VPD) in 2013 in the United States, and for each US state individually. To estimate the number of cases for each adult VPD for a given population, we multiplied age-specific incidence rates obtained from the literature by age-specific 2013 Census population data. We then multiplied the estimated number of cases for a given population by age-specific, estimated medical and indirect (non-medical) costs per case. Adult VPDs examined were: (1) influenza, (2) pneumococcal disease (both invasive disease and pneumonia), (3) herpes zoster (shingles), and (4) pertussis (whooping cough). Sensitivity analyses simulated the impact of various epidemiological scenarios on the total estimated economic burden. Estimated US annual cost for the four adult VPDs was $26.5 billion (B) among adults aged 50 years and older, $15.3B (58 %) of which was attributable to those 65 and older. Among adults 50 and older, influenza, pneumococcal disease, herpes zoster, and pertussis made up $16.0B (60 %), $5.1B (19 %), $5.0B (19 %), and $0.4B (2 %) of the cost, respectively. Among those 65 and older, they made up $8.3B (54 %), $3.8B (25 %), $3.0B (20 %), and 0.2B (1 %) of the cost, respectively. Most (80–85 %) pneumococcal costs stemmed from nonbacteremic pneumococcal pneumonia (NPP). Cost attributable to adult VPD in the United States is substantial. Broadening adult immunization efforts beyond influenza only may help reduce the economic burden of adult VPD, and a pneumococcal vaccination effort, primarily focused on reducing NPP, may constitute a logical starting place. Sensitivity analyses revealed that a pandemic influenza season or change in size of the US elderly population could increase these costs dramatically.

All three direct acting antiviral regimens appear highly effective in achieving sustained virologic response.

The timing of initiation of antiviral treatment for HCV patients with HCC or DCC relative to LT is an important area of clinical and policy research; our results indicate that pre-LT treatment with a highly effective, all-oral DAA regimen provides the best health outcomes and is the most cost-effective strategy for the treatment of HCV patients with HCC or DCC waitlisted for LT. (Hepatology 2017;66:46-56).

Thirty eight observational studies from 14 countries were included. Classification of outbreaks by setting was straightforward: 29 outbreaks occurred over a territory (country, region, city, etc.), 4 outbreaks in a school, 2 outbreaks at hospital, 2 in an isolated community and 1 at university. Costs included in this study were costs incurred in controlling the outbreak. Treatments with antibiotics or prophylaxis were reported in 10 references covering all settings. GP or specialist visits were reported in 3 articles (2 outbreaks over a territory and 1 outbreak in a school). Finally 22 references reported information on hospitalisations: hospitalisation rates ranged from 0% to 8.8% for cases of pertussis (in 2 references, no hospitalisation occurred in the population exposed to the outbreak). Length of stay was reported in 2 references: 8.9 days in hospital and 13 days in paediatric intensive care unit considering an outbreak at hospital, and 4 days (1 to 48 days) over a territory. CONCLUSIONS: The extent and the management of outbreaks differed by setting, and the economic burden of pertussis outbreaks was not always comparable. Nevertheless this review shows that the burden may be substantial.