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Modelling Hospitalisation Ratios for Febrile Convulsions and Severe Varicella Under Combined Measles, Mumps, Rubella, and Varicella (MMRV-Priorix-Tetra™) Compared to Separate MMR + V Vaccination.

Bauchau V, Van Holle L, Cohen C - Drug Saf (2015)

Bottom Line: The aim was to demonstrate how to put the increased FC risk associated with MMRV into perspective by comparing it with the lower V-coverage risk associated with MMR + V.A model, based on several assumptions and integrating parameters from heterogeneous data sources relevant to Germany, was developed to evaluate hospitalisation ratios (HRs; ratios between yearly numbers of varicella-related hospitalisation days prevented by MMRV and yearly numbers of FC-related hospitalisation days attributed to MMRV, both compared with MMR + V).MMRV use instead of MMR + V can substantially reduce the number of hospitalisation days, despite increased FC risk when MMRV is used as a first dose of measles-containing vaccine.

View Article: PubMed Central - PubMed

Affiliation: GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium. vincent.g.bauchau@gsk.com.

ABSTRACT

Introduction: Measles, mumps, rubella, and varicella combination vaccines (MMRV) facilitate varicella vaccination uptake compared with separate administration of measles, mumps, and rubella vaccine (MMR) with varicella vaccine (V). However, the risk of developing febrile convulsions (FC) is higher in children vaccinated with MMRV.

Objectives: The aim was to demonstrate how to put the increased FC risk associated with MMRV into perspective by comparing it with the lower V-coverage risk associated with MMR + V.

Methods: FC and varicella burdens were measured by total numbers or duration of hospitalisations. A model, based on several assumptions and integrating parameters from heterogeneous data sources relevant to Germany, was developed to evaluate hospitalisation ratios (HRs; ratios between yearly numbers of varicella-related hospitalisation days prevented by MMRV and yearly numbers of FC-related hospitalisation days attributed to MMRV, both compared with MMR + V). A sensitivity analysis estimated HR under different scenarios beyond the German experience.

Results: For parameter values compatible with the German experience, where MMRV (Priorix-Tetra™, GSK, Belgium) was introduced in 2006, the model predicted that transitioning from MMR + V to MMRV would induce 225 vaccine-related FC hospitalisation days whilst preventing 1976 varicella-related hospitalisation days per year. The HR estimated by Monte Carlo simulations was 8.5 (95 % confidence interval: 1.99-25.22). A sensitivity analysis on two key parameters suggested that transitioning from MMR + V to MMRV would be favourable in situations where MMRV use would significantly impact varicella vaccination uptake.

Conclusions: MMRV use instead of MMR + V can substantially reduce the number of hospitalisation days, despite increased FC risk when MMRV is used as a first dose of measles-containing vaccine.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of the two competing vaccination schemes and their associated risks and benefits as selected for the current analysis. *The (small) fraction of the total population who is not properly vaccinated against MMR. FC febrile convulsions, MMR measles, mumps, and rubella vaccine, MMRV measles, mumps, rubella, and varicella vaccine, V varicella vaccine
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Fig1: Schematic representation of the two competing vaccination schemes and their associated risks and benefits as selected for the current analysis. *The (small) fraction of the total population who is not properly vaccinated against MMR. FC febrile convulsions, MMR measles, mumps, and rubella vaccine, MMRV measles, mumps, rubella, and varicella vaccine, V varicella vaccine

Mentions: While combined MMRV vaccines can potentially increase the number of FC cases, they can decrease the number of varicella cases through increased coverage for the V component. Here, we present an attempt to assess the net result of these two opposing effects (Fig. 1). This comparison would ideally be made by counting the hospitalisations for FC and varicella, and their duration, in a number of large populations randomly allocated to MMRV and MMR + V schemes, over several years, and with everything else being equal. As this is hardly feasible, we selected a modelling approach and the recent experience in Germany as a starting point. In Germany, a general varicella immunisation for infants from the age of 11 months was introduced in 2004, followed by the subsequent recommendation of a second vaccine dose at 15–23 months of age in 2009. Priorix-Tetra™ was licensed in July 2006, and both vaccination schemes (MMR + V and MMRV) have been widely used; this has favoured comparison between the two vaccination regimens in a previous study conducted by the Bremen Institute for Epidemiology and Prevention Research [15]. In our analysis, we first used German data to put the increased risk of FC associated with MMRV (Priorix-Tetra™) into perspective by comparing it with the higher risk of varicella infection associated with the MMR + V regimen. Then, we expanded this analysis to other scenarios beyond the German experience.Fig. 1


Modelling Hospitalisation Ratios for Febrile Convulsions and Severe Varicella Under Combined Measles, Mumps, Rubella, and Varicella (MMRV-Priorix-Tetra™) Compared to Separate MMR + V Vaccination.

Bauchau V, Van Holle L, Cohen C - Drug Saf (2015)

Schematic representation of the two competing vaccination schemes and their associated risks and benefits as selected for the current analysis. *The (small) fraction of the total population who is not properly vaccinated against MMR. FC febrile convulsions, MMR measles, mumps, and rubella vaccine, MMRV measles, mumps, rubella, and varicella vaccine, V varicella vaccine
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4608986&req=5

Fig1: Schematic representation of the two competing vaccination schemes and their associated risks and benefits as selected for the current analysis. *The (small) fraction of the total population who is not properly vaccinated against MMR. FC febrile convulsions, MMR measles, mumps, and rubella vaccine, MMRV measles, mumps, rubella, and varicella vaccine, V varicella vaccine
Mentions: While combined MMRV vaccines can potentially increase the number of FC cases, they can decrease the number of varicella cases through increased coverage for the V component. Here, we present an attempt to assess the net result of these two opposing effects (Fig. 1). This comparison would ideally be made by counting the hospitalisations for FC and varicella, and their duration, in a number of large populations randomly allocated to MMRV and MMR + V schemes, over several years, and with everything else being equal. As this is hardly feasible, we selected a modelling approach and the recent experience in Germany as a starting point. In Germany, a general varicella immunisation for infants from the age of 11 months was introduced in 2004, followed by the subsequent recommendation of a second vaccine dose at 15–23 months of age in 2009. Priorix-Tetra™ was licensed in July 2006, and both vaccination schemes (MMR + V and MMRV) have been widely used; this has favoured comparison between the two vaccination regimens in a previous study conducted by the Bremen Institute for Epidemiology and Prevention Research [15]. In our analysis, we first used German data to put the increased risk of FC associated with MMRV (Priorix-Tetra™) into perspective by comparing it with the higher risk of varicella infection associated with the MMR + V regimen. Then, we expanded this analysis to other scenarios beyond the German experience.Fig. 1

Bottom Line: The aim was to demonstrate how to put the increased FC risk associated with MMRV into perspective by comparing it with the lower V-coverage risk associated with MMR + V.A model, based on several assumptions and integrating parameters from heterogeneous data sources relevant to Germany, was developed to evaluate hospitalisation ratios (HRs; ratios between yearly numbers of varicella-related hospitalisation days prevented by MMRV and yearly numbers of FC-related hospitalisation days attributed to MMRV, both compared with MMR + V).MMRV use instead of MMR + V can substantially reduce the number of hospitalisation days, despite increased FC risk when MMRV is used as a first dose of measles-containing vaccine.

View Article: PubMed Central - PubMed

Affiliation: GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium. vincent.g.bauchau@gsk.com.

ABSTRACT

Introduction: Measles, mumps, rubella, and varicella combination vaccines (MMRV) facilitate varicella vaccination uptake compared with separate administration of measles, mumps, and rubella vaccine (MMR) with varicella vaccine (V). However, the risk of developing febrile convulsions (FC) is higher in children vaccinated with MMRV.

Objectives: The aim was to demonstrate how to put the increased FC risk associated with MMRV into perspective by comparing it with the lower V-coverage risk associated with MMR + V.

Methods: FC and varicella burdens were measured by total numbers or duration of hospitalisations. A model, based on several assumptions and integrating parameters from heterogeneous data sources relevant to Germany, was developed to evaluate hospitalisation ratios (HRs; ratios between yearly numbers of varicella-related hospitalisation days prevented by MMRV and yearly numbers of FC-related hospitalisation days attributed to MMRV, both compared with MMR + V). A sensitivity analysis estimated HR under different scenarios beyond the German experience.

Results: For parameter values compatible with the German experience, where MMRV (Priorix-Tetra™, GSK, Belgium) was introduced in 2006, the model predicted that transitioning from MMR + V to MMRV would induce 225 vaccine-related FC hospitalisation days whilst preventing 1976 varicella-related hospitalisation days per year. The HR estimated by Monte Carlo simulations was 8.5 (95 % confidence interval: 1.99-25.22). A sensitivity analysis on two key parameters suggested that transitioning from MMR + V to MMRV would be favourable in situations where MMRV use would significantly impact varicella vaccination uptake.

Conclusions: MMRV use instead of MMR + V can substantially reduce the number of hospitalisation days, despite increased FC risk when MMRV is used as a first dose of measles-containing vaccine.

No MeSH data available.


Related in: MedlinePlus