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Establishing the health and economic impact of influenza vaccination within the European Union 25 countries

机译：在欧盟25个国家/地区建立流感疫苗接种对健康和经济的影响

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BACKGROUND: In 2003, the World Health Assembly (WHA) issued a resolution for prevention and control of influenza pandemics and annual epidemics, which urges the European Union 25 (EU-25) Member States to (1) establish and implement strategies to increase vaccination coverage of all people at high risk, including the elderly and people with underlying disease, with the goal of attaining vaccination coverage of the elderly population of at least 50% by 2006 and 75% by 2010; (2) to assess the disease burden and economic impact of annual influenza epidemics as a basis for framing and implementing influenza prevention policies. This resolution was reinforced by the European Union (EU), where Member States agreed to make additional efforts to improve uptake on their territory in accordance with their own recommendations and to achieve the World Health Organisation (WHO) target of 75% in high risk groups before 2010. It was also noted that the changing demographic profile of the EU population would result in an increasing number of elderly people falling within the current target groups. OBJECTIVES: To establish the number of people who may be eligible for influenza vaccination in the EU, and estimate the costs and consequences of not vaccinating this population for five EU Member States, France, Germany, Italy, Spain, and the UK. METHODS: A mathematical model has previously been developed, in which vaccine distribution data are combined with demographic and health economics data to model the public health consequences of influenza and possible intervention strategies. We have extended that model using specific EU-25 demographic data on populations at risk of influenza during the inter-pandemic period. For each country, the total population and age breakdown was calculated to estimate the percentage of the population that falls under the WHA recommendations. Other target groups for influenza vaccination were identified by analysing estimating the proportion of the population with respiratory or cardiovascular related diseases, diabetes, AIDS or transplantation, as well as health care professionals. Target population size and possible vaccination coverage rates across the EU-25 Member States, along with the potential cost and health consequence impact is estimated. RESULTS: For the EU-25, it was estimated that up to 49.1% of the population (or 223.4 million people) should be vaccinated against influenza. This ranged from 41.6% in Cyprus to 56.4% in the UK. There were, on average, 174 vaccine doses distributed per 1000 population within the EU-25, which leads to an average vaccination rate of the target population of 35.4% based on current supply constraints. As a consequence, up to 144.4 million people who could be considered "at risk" may not currently be vaccinated. Implementing a 100% vaccination rate programme for all risk groups across the EU-25 would lead to an estimated reduction of number of influenza cases of 7.22 million, 1.96 million reduced PCP visits for influenza treatment, 796,743 less hospital admissions and 68,537 fewer influenza related deaths for all EU-25 countries. The implementation of a 100% vaccination rate programme for all risk groups in France, Germany, Italy, Spain and UK would require an additional 1.52 billion Euro. This would result in estimated savings of 39.45 million Euro of reduced primary care visits and further savings of 1.59 billion Euro in reduced hospitalisations respectively in these countries. CONCLUSIONS: There is a gap between current vaccination coverage and the EU recommendations. The public health consequences of low vaccination coverage include increased morbidity, hospitalisations and mortality associated with influenza-related complications. This model is a powerful tool to: (1) support EU public health officials in implementing recommendations; (2) to visualize the need for increased vaccination rates for better influenza control; (3) the consequences of low vaccine coverage.
机译：背景：2003年，世界卫生大会（WHA）发布了一项预防和控制流感大流行和年度流行病的决议，该决议敦促欧洲联盟25（EU-25）成员国（1）制定并实施策略以增加疫苗接种量覆盖所有高危人群，包括老年人和有基础疾病的人群，目标是到2006年使老年人口的疫苗接种率至少达到50％，到2010年达到75％; （2）评估年度流感流行的疾病负担和经济影响，以此作为制定和实施流感预防政策的基础。欧盟（EU）加强了该决议，欧盟成员国同意根据自己的建议做出更多努力，以提高其领土上的吸收率，并实现世界卫生组织（WHO）在高风险人群中达到75％的目标2010年之前。还注意到，欧盟人口结构的变化将导致越来越多的老年人落入当前目标群体之内。目标：确定欧盟可能有资格进行流感疫苗接种的人数，并估算五个欧盟成员国（法国，德国，意大利，西班牙和英国）不对该人群进行疫苗接种的成本和后果。方法：以前已经建立了一个数学模型，其中疫苗分配数据与人口统计和健康经济学数据相结合，以模拟流感对公共卫生的后果和可能的干预策略。我们使用关于大流行期间流感风险人群的特定EU-25人口统计数据扩展了该模型。对于每个国家，都计算了总人口和年龄细分，以估计属于WHA建议范围的人口百分比。通过分析估计患有呼吸或心血管相关疾病，糖尿病，艾滋病或移植的人口比例以及医疗保健专业人员，确定了其他流感疫苗接种目标人群。估算了整个EU-25成员国的目标人口规模和可能的疫苗接种覆盖率，以及潜在的成本和健康影响。结果：对于欧盟25国，估计应接种49.1％的人口（或2.234亿人）预防流感。从塞浦路斯的41.6％到英国的56.4％不等。在欧盟25国中，每1000个人口平均分配174种疫苗，根据当前的供应限制，目标人群的平均疫苗接种率为35.4％。结果，多达1.444亿可能被认为处于“危险中”的人目前可能没有接种疫苗。对整个欧盟25国的所有风险人群实施100％的疫苗接种率计划，将导致估计减少722万例流感病例，减少196万例PCP流感治疗就诊人数，减少796,743例住院和68,537例与流感相关的死亡适用于所有EU-25国家。对法国，德国，意大利，西班牙和英国的所有风险人群实施100％的疫苗接种率计划将需要额外的15.2亿欧元。据估计，这两个国家的初级保健就诊人数减少将节省3945万欧元，住院人数减少可进一步节省15.9亿欧元。结论：当前的疫苗接种覆盖率与欧盟的建议之间存在差距。疫苗接种覆盖率低的公共卫生后果包括与流感相关的并发症相关的发病率，住院率和死亡率增加。该模型是以下方面的有力工具：（1）支持欧盟公共卫生官员实施建议; （2）视需要提高疫苗接种率以更好地控制流感; （3）疫苗覆盖率低的后果。

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