Disease burden of enterovirus infection in Taiwan: Implications for vaccination policy
Journal
Vaccine
Journal Volume
34
Journal Issue
7
Pages
974-980
Date Issued
2016
Author(s)
Abstract
Objectives: This study aimed to assess the disease burden and economic impacts of human nonpolio enteroviruses (NPEV) and enterovirus A71 (EV-A71) infection in Taiwan. Materials and methods: We included children under five years old (n = 983,127-1,118,649) with ICD-9-CM codes 0740 (herpangina) or 0743 (hand-foot-and-mouth disease) from the 2006 to 2010 National Health Insurance Database. Severity of enterovirus infection was assessed from outpatient/emergency visits, hospitalization (with/without intensive care unit [ICU] admission), infection with severe complications, and death. We estimated medical costs and indirect costs from the societal perspective. Results: The annual rates of NPEV events for children under five years old ranged from 13.9% to 38.4%, of which 5.1-8.8% were hospitalized. EV-A71 accounted for 7.8% of all NPEV medical costs, but 79.1% of NPEV ICU costs. Travel costs and productivity loss of caregivers were $37.1 (range: $24.5-$64.7) million per year. These costs were not higher in the EV-A71 dominant year ($34.4 million) compared with those in the other years. Productivity losses resulting from premature mortality by NPEV infection were $0.8 (range: $0.0-$2.9) million per year, of which 96.3% were caused by EV-A71. Conclusions: Diseases associated with NPEV other than EV-A71 were responsible for most of the medical expenses. In addition, caregiver productivity loss by high rates of NPEV infection impacted the society much more than medical costs. A multi-valent vaccine that includes EV-A71 and other serotypes, for example coxsackievirus A16, may be beneficial to the health of children in Taiwan. ? 2015 The Authors.
Other Subjects
virus vaccine; Article; cardiomyopathy; caregiver; child; Coxsackievirus A16; disease severity; emergency; encephalitis; Enterovirus; Enterovirus 71; Enterovirus infection; flaccid paralysis; hand foot and mouth disease; health care cost; health care utilization; hepatitis; herpangina; hospital admission; hospital policy; hospitalization; human; ICD-9-CM; intensive care unit; major clinical study; multiple organ failure; myocarditis; outpatient; premature mortality; priority journal; sepsis; serotype; society; Taiwan; thrombocytopenia; travel; vaccination; cost of illness; economics; Enterovirus A; Enterovirus Infections; epidemic; Hand, Foot and Mouth Disease; health survey; infant; International Classification of Diseases; preschool child; statistics and numerical data; Child, Preschool; Cost of Illness; Disease Outbreaks; Enterovirus A, Human; Enterovirus Infections; Hand, Foot and Mouth Disease; Health Care Costs; Hospitalization; Humans; Infant; International Classification of Diseases; Population Surveillance; Taiwan
Publisher
Elsevier Ltd
Type
journal article