Cost–benefit Analysis of Human Papillomavirus Vaccine in Iran

Background: Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicate that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is debated, because its potential benefits may not fit this framework. Our objective was to evaluate economic effects of HPV vaccination by cost-benefit analysis (CBA). In this case, we used bivalent and quadrivalent in Iran in 2020. Methods: We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefit: willingness to pay by discrete choice experiment; and cost of illness. Costs only included the vaccine cost. Results: The cost of two doses of bivalent and quadrivalent vaccines were US $ 29 and US $ 151, respectively (US $1 =IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ -432, and US $ 380 per person using willingness to pay approach and they were US $ 7,375 and US $ 6,590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was -15.114 and 2.512 by willingness to pay approach, and it was 258.12 and 43.51, by cost of illness approach. Conclusions: This study confirms the benefit of both the national bivalent and quadrivalent vaccination program and provide reliable evidence for policy-makers when programming HPV vaccination.

Vaccines Against Different Types of Cancer: Literature Review

According to the World Health Organization, in 2018, cancer was considered the second leading cause of death in the world, corresponding to 9.6 million deaths. Faced with this situation, some alternatives to combat tumors in some organs were developed, such as immunotherapy involving vaccines. Among the vaccines already developed, Sipuleucel-T (Provenge®) can be mentioned, that has been approved by the Food and Drug Administration in 2010 for cases of metastatic prostate cancer; prophylactic bivalent and quadrivalent vaccines to human papillomavirus; the nanoparticulate liposomal RNA vaccine, the melanoma FixVac (BNT111); peptide-based vaccines, such as carcinoembryonic antigen, and those that involve antigen-loaded dendritic cells for the treatment of colorectal cancer, as well as colorectal cancer stem cell-based vaccines and, for cases of ovarian cancer, dendritic cell vaccines. In relation to breast cancer, research is aimed at both immunotherapy with dendritic cells pulsed with tumor antigens and vaccines that have a combined therapy of dendritic cells and Natural Killer cells. In general, vaccines promote the induction of helper and cytotoxic cells to thereby eliminate tumor cells. This characteristic of using dendritic cells with tumor antigens already processed and presented on the cell surface allows the questioning about the use of the term “vaccine”, since it does not correspond to conventional vaccines. Thus, the studies carried out in this area of immunotherapy, although complex and expensive, show promise in the treatment of several types of cancer, with great possibilities of positively impacting the lives of all those who suffer from the disease.

Topical Issues of Influenza Vaccine Prevention

Influenza vaccination coverage has been expanding in recent years in Russian Federation. The topicality of influenza vaccination becomes more significant now at the beginning of seasonal increase in its prevalence, moreover, along with active immunization against coronavirus infection. Vaccination is crucial part in combined program of influenza prevention and control. Nowadays, the priority in influenza prevention is quadrivalent vaccines that can ensure the development of the most stable immunity. Russia has all the necessary resources to create and effectively implement modern influenza vaccines that meet international standards. Despite the remaining difficulties in combating influenza, preventive vaccination is by far the most effective method of protection that has proven its safety and efficacy.

Immunogenicity and Safety of the Quadrivalent Adjuvant Subunit Influenza Vaccine in Seropositive and Seronegative Healthy People and Patients with Common Variable Immunodeficiency

Background. Influenza prophylaxis with the use of quadrivalent vaccines (QIV) is increasingly being introduced into healthcare practice. Methods. In total, 32 healthy adults and 6 patients with common variable immunodeficiency (CVID) received adjuvant QIV during 2018–2019 influenza season. Depending on initial antibody titers, healthy volunteers were divided into seronegative (≤1:20) and seropositive (≥1:40). To evaluate immunogenicity hemagglutination inhibition assay was used. Results. All participants completed the study without developing serious post-vaccination reactions. Analysis of antibody titer 3 weeks after immunization in healthy participants showed that seroprotection, seroconversion levels, GMR and GMT for strains A/H1N1, A/H3N2 and B/Colorado, B/Phuket among initially seronegative and seropositive participants meet the criterion of CHMP effectiveness. CVID patients showed increase in post-vaccination antibody titer without reaching conditionally protective antibody levels. Conclusion. Adjuvant QIV promotes formation of specific immunity to vaccine strains, regardless of antibodies’ presence or absence before. In CVID patients search of new regimens should be continued.

Relative Effectiveness of Influenza Vaccines Among the United States Elderly, 2018–2019

Background Studies among individuals ages ≥65 years have found a moderately higher relative vaccine effectiveness (RVE) for the high-dose (HD) influenza vaccine compared with standard-dose (SD) products for most seasons. Studies during the A(H3N2)-dominated 2017–2018 season showed slightly higher RVE for the cell-cultured vaccine compared with SD egg-based vaccines. We investigated the RVE of influenza vaccines among Medicare beneficiaries ages ≥65 years during the 2018–2019 season. Methods This is a retrospective cohort study using inverse probability of treatment weighting and Poisson regression to evaluate RVE in preventing influenza hospital encounters. Results Among 12 777 214 beneficiaries, the egg-based adjuvanted (RVE, 7.7%; 95% confidence interval [CI], 3.9%–11.4%) and HD (RVE, 4.9%; 95% CI, 1.7%–8.1%) vaccines were marginally more effective than the egg-based quadrivalent vaccines. The cell-cultured quadrivalent vaccine was not significantly more effective than the egg-based quadrivalent vaccine (RVE, 2.5%; 95% CI, −2.4% to 7.3%). Conclusions We did not find major effectiveness differences between licensed vaccines used among the elderly during the 2018–2019 season. Consistent with prior research, we found that the egg-based adjuvanted and HD vaccines were slightly more effective than the egg-based quadrivalent vaccines.

Intensive Care Admissions and Associated Severity of Influenza B Versus A During Influenza B Vaccine–mismatched Seasons

Patients admitted to hospital with influenza B and A in Jerusalem, Israel, during the 2015–2016 and 2017–2018 influenza seasons demonstrated similar rates of intensive care unit (ICU) admission and associated disease severity. Most (63%) influenza B ICU patients received influenza B–mismatched trivalent vaccine. These findings call into question the equivalence of trivalent and quadrivalent vaccines in preventing severe influenza B.

Relative Effectiveness of Cell-Cultured and Egg-Based Influenza Vaccines Among Elderly Persons in the United States, 2017–2018

Background The low influenza vaccine effectiveness (VE) observed during the A(H3N2)-dominated 2017–2018 season may be due to vaccine virus adaptation to growth in eggs. We compared the effectiveness of cell-cultured and egg-based vaccines among Medicare beneficiaries. Methods Retrospective cohort study on Medicare beneficiaries aged ≥65 years who received an influenza vaccine (cell-cultured, egg-based quadrivalent; egg-based high-dose, adjuvanted, or standard-dose trivalent) during the 2017–2018 season. We used Poisson regression to evaluate relative VE (RVE) in preventing influenza-related hospital encounters. Results Of >13 million beneficiaries, RVE for cell-cultured vaccines relative to egg-based quadrivalent vaccines was 10% (95% confidence interval [CI], 7%–13%). In a midseason interim analysis, this estimate was 16.5% (95% CI, 10.3%–22.2%). In a 5-way comparison, cell-cultured (RVE, 11%; 95% CI, 8%–14%) and egg-based high-dose (RVE, 9%; 95% CI, 7%–11%) vaccines were more effective than egg-based quadrivalent vaccines. Conclusions The modest VE difference between cell-cultured and egg-based vaccines only partially explains the low overall VE reported by the Centers for Disease Control and Prevention, suggesting that egg adaptation was not the main contributor to the low VE found among individuals aged ≥65 years. The midseason interim analysis we performed demonstrates that our methods can be used to evaluate VE actively during the influenza season.