Suchergebnisse

En accès libre ; International audience ; Studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can appear in feces within three days of infection, which is much sooner than the time taken for people to develop symptoms and get an official diagnosis (Mallapaty 2020). Therefore, earlier identification in wastewater of the virus's arrival in a community might limit the health and economic damage caused by the coronavirus disease 2019 (COVID-19). Despite centuries of technological advances, the COVID-19 pandemic is highlighting the limitations of our ability to control viral spread and infections worldwide. This knowledge gap has induced highly variable and sometimes contradictory government decisions in many countries, such as whether to wear a mask or not, and various strategies for testing, contact tracing and isolation of infected patients. The failure of control strategies has led many countries to lockdowns. In particular, powerful and rapid analytical techniques are actually still missing because virus detection is a key step in controlling viral transmission. The biomarker approach, which was initially developed in geochemistry to measure the maturity of dead organic matterand to link molecular fossils with biological homologs, has been applied to modern samples such as soils, sediments, wastewaters and plants (Albrecht and Ourisson 1971; Lichtfouse et al. 1994 1997; Bryselbout et al. 1998; Payet et al. 1999; Dsikowitzky and Schwarzbauer 2014; Choi et al. 2020). Here, we discuss the emergence of wastewater epidemiology based on ribonucleic acid (RNA) biomarkers, a discipline linking biomedical and environmental sciences for the detection of pathogens, with focus on analytical challenges.

This paper examines the costs, impacts, and cost-effectiveness of scaling up over five years the nutrition interventions included in Afghanistan's Basic Package of Health Services (BPHS) as a first step in investing in the early years to build human capital. The total public investment required for the scale up to government-set program coverage levels is estimated to be 44 million US dollars per year over five years, or 1.49 US dollars per capita per year. Each dollar invested would yield at least 13 US dollars in economic returns and even under conservative assumptions regarding future economic growth, the economic benefits exceed the cost by six times which is 815 million US dollars over the productive lives of the beneficiaries. This scale up would prevent almost 25,000 child deaths and over 4,000 cases of stunting and avert a loss of 640,000 disability-adjusted life years (DALYs) and almost 90,000 cases years of anemia. Almost 100,000 more children would be exclusively breastfed. However, this scale-up would only have a marginal effect, a decrease of less than one-half percentage point on stunting prevalence because the current government-set target program coverage rates are very low for the preventive interventions that affect stunting. A substantially greater impact could be achieved if preventive interventions could be scaled to full program coverage levels, which would require less than 5 million US dollars more a year. This would triple the number of DALYs averted, double the number of deaths averted and avert almost eight times as many cases of stunting, resulting in a 2.6 percentage point decline in stunting over the five year period (from 41 percent to 38 percent). The prevalence of anemia in pregnant women could be reduced by 12 percentage points and the prevalence of exclusive breastfeeding could be increased by 18 percentage points. In addition, this investment is projected to generate economic benefits of 815 million US dollars over the productive lives of the beneficiaries. Each dollar invested would yield more than 13 US dollars in economic returns. Sensitivity analysis was conducted for the total cost, cost-effectiveness, and economic returns on investing in the BPHS nutrition interventions.

OBJECTIVE: Three vaccines are available to Taiwanese young girls for cervical cancer (CC) prevention. Here we evaluate the cost-effectiveness of the two-dose (2D) AS04-adjuvanted HPV-16/18 vaccine (2D-AS04-HPV-16/18v)+screening compared with a screening programme alone, with 2D human papillomavirus 6/11/16/18 vaccine (2D-4vHPVv)+screening, and with 2D/three-dose (3D) human papillomavirus 6/11/16/18/31/33/45/52/58 vaccine (9vHPVv)+screening, for Taiwan universal mass vaccination. METHODS: A static Markov cohort model simulated the natural history of human papillomavirus (HPV) infection and CC screening for a 12-year-old cohort of Taiwanese girls (N=120,000). The model ran in 1-year cycles over the cohort's lifetime. Vaccine efficacy irrespective of HPV type was considered in the analysis for each vaccine. Input data were obtained from published literature, local databases, government reports and websites, and expert opinion. The analysis incorporated direct medical costs only, with an annual discount rate of 3.0%. The threshold was determined as 1 Gross Domestic Product per capita (New Taiwan dollar [NT$] 727,818; year 2016). RESULTS: The 2D-AS04-HPV-16/18v+screening yielded 0.0365 quality-adjusted life year (QALY) gained at an additional cost of NT$ 5,770 per person compared with the screening programme alone. This resulted in an incremental cost-effectiveness ratio well below the threshold. Compared with 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening, discounted results demonstrated additional QALYs gained at lower cost for 2D-AS04-HPV-16/18v+screening, making it dominant over both 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening. CONCLUSIONS: Vaccinating Taiwanese girls with 2D-AS04-HPV-16/18v in addition to screening to prevent CC is cost-effective compared with using a screening programme alone and the dominant option compared with 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening.