Medical Direction, Complejo Asistencial de Ávila, Ávila, Spain.
Carlos III University, Madrid, Spain.
BMC Infect Dis. 2024 Aug 5;24(1):779. doi: 10.1186/s12879-024-09637-x.
The objective of this study is to estimate the burden of selected immunization-preventable infectious diseases in Spain using the Burden of Communicable Diseases in Europe (BCoDE) methodology, as well as focusing on the national immunization programme and potential new inclusions.
The BCoDE methodology relies on an incidence and pathogen-based approach to calculate disease burden via disability-adjusted life year (DALY) estimates. It considers short and long-term sequelae associated to an infection via outcome trees. The BCoDE toolkit was used to populate those trees with Spanish-specific incidence estimates, and de novo outcome trees were developed for four infections (herpes zoster, rotavirus, respiratory syncytial virus [RSV], and varicella) not covered by the toolkit. Age/sex specific incidences were estimated based on data from the Spanish Network of Epidemiological Surveillance; hospitalisation and mortality rates were collected from the Minimum Basic Data Set. A literature review was performed to design the de novo models and obtain the rest of the parameters. The methodology, assumptions, data inputs and results were validated by a group of experts in epidemiology and disease modelling, immunization and public health policy.
The total burden of disease amounted to 163.54 annual DALYs/100,000 population. Among the selected twelve diseases, respiratory infections represented around 90% of the total burden. Influenza exhibited the highest burden, with 110.00 DALYs/100,000 population, followed by invasive pneumococcal disease and RSV, with 25.20 and 10.57 DALYs/100,000 population, respectively. Herpes zoster, invasive meningococcal disease, invasive Haemophilus influenza infection and hepatitis B virus infection ranked lower with fewer than 10 DALYs/100,000 population each, while the rest of the infections had a limited burden (< 1 DALY/100,000 population). A higher burden of disease was observed in the elderly (≥ 60 years) and children < 5 years, with influenza being the main cause. In infants < 1 year, RSV represented the greatest burden.
Aligned with the BCoDE study, the results of this analysis show a persisting high burden of immunization-preventable respiratory infections in Spain and, for the first time, highlight a high number of DALYs due to RSV. These estimates provide a basis to guide prevention strategies and make public health decisions to prioritise interventions and allocate healthcare resources in Spain.
本研究旨在使用欧洲传染病负担（BCoDE）方法学估算西班牙部分可通过免疫预防的传染病的负担，同时重点关注国家免疫规划和潜在的新增疫苗可预防疾病。
BCoDE 方法学采用基于发病率和病原体的方法，通过残疾调整生命年（DALY）估算来计算疾病负担。它通过后果树考虑与感染相关的短期和长期后遗症。使用 BCoDE 工具包用西班牙特定的发病率估算值填充这些树，为工具包未涵盖的四种感染（带状疱疹、轮状病毒、呼吸道合胞病毒[RSV]和水痘）开发了新的后果树。基于西班牙流行病学监测网络的数据估计了年龄/性别特异性发病率；从最低基本数据集收集了住院和死亡率数据。对文献进行了回顾，以设计新模型并获得其余参数。流行病学和疾病建模、免疫和公共卫生政策方面的专家组对方法、假设、数据输入和结果进行了验证。
疾病总负担为 163.54 个/10 万人年 DALY。在所选择的十二种疾病中，呼吸道感染约占总负担的 90%。流感的负担最高，为 110.00 个/10 万人年，其次是侵袭性肺炎球菌病和 RSV，分别为 25.20 和 10.57 个/10 万人年。带状疱疹、侵袭性脑膜炎球菌病、侵袭性流感嗜血杆菌感染和乙型肝炎病毒感染的排名较低，每人每年少于 10 个 DALY，而其余感染的负担有限（<1 个/10 万人年）。老年人（≥60 岁）和儿童<5 岁的疾病负担较高，流感是主要原因。在婴儿<1 岁时，RSV 是最大的负担。
与 BCoDE 研究一致，本分析结果显示西班牙免疫预防呼吸道感染的负担仍然很高，并且首次强调了由 RSV 引起的大量 DALY。这些估计为指导预防策略和做出公共卫生决策提供了依据，以便在西班牙优先干预措施和分配医疗保健资源。
