BMC Medicine

BackgroundTwo RSV immunisations products: a maternal vaccine, Abrysvo, and a long-acting monoclonal antibody, nirsevimab, both designed to prevent RSV illness in infants, have recently become available. Modelling evidence is required to inform how to optimally use these products in immunisation programs to reduce the burden of RSV in young children. MethodsWe extend a dynamic transmission model calibrated to RSV-hospitalisation data of children aged < 5 years in temperate Western Australia (WA)...

Embedding equity into vaccine eligibility is essential for reducing health inequalities. Yet, adult vaccine eligibility in most European countries is primarily based on fixed age thresholds, prioritising cost-effectiveness. This approach risks excluding the most vulnerable populations living in deprived communities with poorer health and shorter survival into older age. Extending eligibility based on clinical risk partially addresses this gap. Higher rates of underdiagnosis and delayed diagnosis...

The seasonal circulation of respiratory syncytial virus (RSV) in countries such as Japan, together with the transient nature of passive immunity conferred to infants via maternal vaccination or monoclonal antibody administration, may warrant a differential strategy for those born during the RSV inter-seasonal period. Maximal effectiveness may be achieved by deferring immunisation of this cohort from birth until entry into their first RSV season using catch-up administration of monoclonal antibod...

ObjectivesNon-communicable diseases (NCDs) account for almost 90% of deaths in Europe, yet comparative estimates of the productivity costs associated with premature NCD mortality across diseases and countries remain limited. This study estimates and compares productivity losses attributable to cardiovascular disease (CVD) and cancer mortality among working-age populations across Europe. Population-based data were used to estimate productivity costs for CVD and cancer deaths across 30 European co...

ObjectiveIn England, since 2022, large businesses providing food in the out-of-home sector are required to display calorie information for non-prepacked food and non-alcoholic drink items. This study estimates long-term cost-effectiveness of the policy by extrapolating real-world evidence on short-term policy effects in England. DesignThe lifetime health economic impacts of calorie labelling were simulated using a microsimulation model. The analysis adopted a health systems perspective to compa...

BackgroundHigh-dose inactivated influenza vaccination (HD-IIV) demonstrates superior effectiveness versus standard-dose vaccination (SD-IIV) in adults aged [&ge;]60 years. A recent meta-analysis integrated complementary evidence sources of representing over 85 million individuals across 14 influenza seasons. MethodsA previously developed model was updated using life-time horizon and societal perspective. Updated parameters included demographics, costs, hospitalization rates, and relative vaccin...

BackgroundRespiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain. MethodsWe updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts)...

BackgroundInfluenza vaccination prevents influenza and influenza-like illness (ILI) in children, but its potential influence on susceptibility to other respiratory viruses remains unclear. We aimd to evaluate the relationships between influenza/ILI, non-influenza respiratory virus (NIRV) infections, and influenza vaccination in children. MethodsWe conducted a retrospective cohort study using real-world data from the Italian Pedianet pediatric network, including children aged 6 months to 14 year...

COVID-19 remains a substantial public health challenge in the Netherlands. Next-generation COVID-19 vaccine, mRNA-1283, is approved in the European Union, with potential for higher relative vaccine efficacy compared with originally-licensed COVID-19 vaccines. Its potential public health and economic impact, in adults [&ge;]60 years and high-risk 18-59 years, was modelled versus no vaccination and originally-licensed mRNA-1273 and BNT162b2, adapting a published static Markov model with 1-year tim...

BackgroundOlder age is widely considered a risk factor for post-acute sequelae of SARS-CoV-2 infection (PASC), typically attributed to immunosenescence and inflammaging. However, whether this association reflects intrinsic biological ageing or accumulated comorbidity burden remains unclear, with implications for clinical risk stratification. MethodsWe conducted a retrospective cohort study using the Precision PASC Research Cohort (P2RC) from Mass General Brigham, comprising 133,792 COVID-19 pat...

Health metrics and modelling capacity have expanded to address present burden and burden attributable to risk factors in the past. There remains a gap in accessible tools that estimate avoidable burden; --that is, the future health and economic impacts of preventive and treatment interventions. This paper describes and demonstrates the Health Interventions Impact Calculator (HIIC), a free web-based analysis and visualisation tool that allows for rapid estimation of the future health and economi...

BackgroundDeath certificates record both an underlying cause and contributing conditions, yet mortality statistics predominantly report only the underlying cause. We quantify this "hidden burden" across all ICD-10 conditions in Australian mortality data using the multiple-to-underlying ratio (MUR): total death certificate mentions divided by underlying cause deaths. MethodsWe analysed Australian Bureau of Statistics Causes of Death 2023 data (N = 187,268 registered deaths) to compute the ratio ...

BackgroundThe effects of aspirin on hepatic steatosis and fibroinflammation are unclear. The study aimed to examine the association between aspirin use and liver MRI-derived liver fat and corrected T1 (cT1). MethodsWe used UK Biobank imaging cohort data. Aspirin use was self-reported at baseline and imaging assessment, and the main exposures were aspirin use at imaging assessment and longitudinal aspirin use patterns (never users, initiators, discontinuers, vs. persistent users). Outcomes were ...

Background. Early identification of risk for hospitalisation is crucial to reducing public health burden. Immune and endocrine-related markers are robust indicators of disease in epidemiological studies, but their value has not been consistently established with severe disorders requiring hospitalisation. Patterning of biomarker expression through latent profile analysis (LPA), may improve predictive accuracy for clinical outcomes above individual biomarkers alone. Method. Four biomarkers (C-rea...

The early childhood environment influences later mental health, but it remains unclear which aspects are most important for reducing inequalities. We quantified how socioeconomic inequalities in mental health at 5 and 17 years (y) would change under hypothetical interventions on five aspects of the early childhood environment. We analysed parent-reported data from the UK Millennium Cohort Study (n=15513). Socioeconomic circumstances (SEC) were assessed using maternal education at 9 months. Menta...

BackgroundStrikingly low allocation of SARS-CoV-2 vaccine to the African Continent limits its capacity to control transmission. Characterizing the trajectory of vaccination efforts and their impact on the expected burden of SARS-CoV-2 will help planning vaccine delivery strategies, and public health interventions more broadly. As the burden is strongly age-dependent, this requires an understanding of the age-structured dynamics of susceptible individuals, accounting for the combined effects of v...

Cardiometabolic gene-target drugs such as Glucagon-Like Peptide 1 Receptor agonists are used extensively, yet risks and repurposing have not been systematically evaluated across a comprehensive set of diseases. We use Phenome-wide Mendelian Randomization to test GLP1R gene expression and Cholesteryl Ester Transfer Protein (CETP) concentration, two promising cardiometabolic drug targets, on risk of 396 diseases based on sex-specific, ancestry-specific, genome-wide association studies in UK Bioban...

ObjectiveSome evidence suggests that higher serum TSH may be a part of normal aging, but current studies are limited to 13-year follow-up. We examined TSH changes during 22 years of follow-up across the adult lifespan. DesignLongitudinal analyses of the population-based HUNT Study in Norway, with TSH measurements from 1995-97, 2006-08 and 2017-19. MethodsIn the overall population and in individuals without thyroid medication or disease, we estimated i) geometric mean serum TSH by age, integrat...

Folic acid supplementation during pregnancy is established for preventing neural tube defects, yet its broader neurodevelopmental benefits remain inconsistently observed. Folate receptor autoantibodies (FRAA) may disrupt folate transport, but population evidence is lacking. In a prospective cohort of 3,006 mother-child pairs from the Shanghai Birth Cohort, we precisely quantified maternal red blood cell 5-methyltetrahydrofolate (active folate) and FRAA levels in early pregnancy. We found that hi...

The doubly-ranked non-linear Mendelian randomization method can yield biased estimates when instrument strength varies across individuals due to gene-environment (GxE) interactions. We propose a simple strategy to mitigate this bias by modelling GxE interactions and removing the fitted GxE component from the exposure before stratification by the doubly-ranked method. In simulations, the proposed GxE correction strategy eliminated GxE-induced bias with null, linear and non-linear exposure-outcome...