Publication Type: Paper/Poster Proposal
Abstract: Hepatitis A and Hepatitis B are both viral diseases affecting the liver, however they are transmitted via different means and often result in different spectra of health effects once infected. Vaccinations are available for each of these diseases. It is hypothesized that many lay people are not familiar with differences between Hepatitis A and Hepatitis B and may confuse them due to the similarity of their names. For this paper, we report the results of an experiment that was conducted in the fall of 2004 embedded within a retrospective study of childhood vaccination to determine whether reports of Hepatitis A vaccination were influenced by the inclusion of questions about Hepatitis B vaccination.

This random-digit-dial survey was conducted with parents of children between 2.5 and 15 years of age. Parents were asked for reports of childhood vaccinations, permission to contact medical care providers to obtain data on these vaccinations, and the demographic characteristics of the household. Interviews were completed with 650 households, representing approximately 1,200 children, in Arizona and Oregon. These states were chosen because of their high incidence rates of hepatitis A. For those cases where parental permission was obtained, medical care providers were contacted to obtain vaccination records for the children.

We further investigate whether these vaccination reports differ by demographic characteristics, the number and age of children, presence of shot records, and the number of vaccination providers. We extend this analysis by also investigating the accuracy of the reports of Hepatitis A vaccinations from parents who were also asked the Hepatitis B questions. Finally, we compare parent and provider reports of Hepatitis A vaccinations.

Publication Type: Abstract
Abstract: Rationale: Rotavirus is the leading cause of severe acute gastroenteritis in children <5 years of age worldwide. It is estimated that, each year, 350,000-600,000 children die of rotavirus infection, 2 million are hospitalized and 25 million require an outpatient visit, meaning that the disease burden is great and it is a significant generator of costs to the health care sector, to families and to the society as a whole. A new rotavirus vaccine was recently licensed, and Brazil was the first country to implement a universal vaccination program.

Objectives: The aim of this study was to estimate the cost-effectiveness of a universal rotavirus immunization program in an infant population in Brazil.

Methodology: A decision tree used published and unpublished sources of local rotavirus disease incidence, health care expenditure, vaccine coverage, efficacy, and price. A sensitivity analysis using case scenarios toward and against vaccination was performed in some variables. The QALYs were calculated multiplying the life expectancy of this population by the quality weight for the health state. Future costs were discounted to present value. Estimates were made from the societal perspective.

Results: A universal rotavirus vaccination program could prevent 14,362 domiciliary cases, 11,127 outpatient cases and 1,258 hospitalization cases. It also could avert approximately, 26,746 diarrhea episodes, and 78 deaths among these children. The cost per case and death averted would be $1,487 and $512,635, respectively. And a QALY gained would cost $10,614.

Conclusions: A rotavirus vaccination program is cost-effective depending on the vaccine price, mortality and morbidity incidences. In Brazil, a developing country, the disease burden is high; therefore one should put more emphasis on the possible health benefits gained with such a program, instead of just considering the economic benefits.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: “Vaccines” (more technically, immunotherapies) are being developed that may stimulate the immune system to intercept drugs (nicotine, cocaine, etc.) before they reach the user’s brains. Treating dependent users is likely to be highly cost-effective. Preventive applications with non-using teen-agers raise ethical issues (e.g., parents coercing reluctant teens into receiving injections) and may be highly cost-ineffective from a societal perspective, even if the treatments are FDA-approved safe and effective. The federal government has relatively few tools at its disposal for controlling “off label” prescription of FDA-approved drugs, so, depending on the outcomes of clinical trials, there could conceivably be a de facto choice between denying these innovative treatments to drug dependent individuals who need them and allowing their wasteful and possibly even destructive use on adolescents. Whether or not this nightmare scenario comes to pass, exploring the possibilities now may uncover ways of finessing this dilemma and raise more general points concerning the development and regulation of pharmaceuticals.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The paper explores how HPV vaccine advocacy coalitions evolved into coalitions of service providers when they failed to achieve their state legislative policy goals.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The mass media are often criticized for inadequately presenting health risk information to the public. This paper argues, however, that decisions to include risk information represent a fundamental tension between norms of objectivity and government accountability on one end and “mobilizing” journalism on the other. The paper explores this tension in the context of the autism-vaccine controversy. Implications for journalism ethics and risk communication are discussed.