Assessment of the health impacts of H1N1 vaccination

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Scope

  • What was the overall health impact of the H1N1 vaccination in Finland in 2009-2010?
  • Given current knowledge, which was the better decision between vaccinating as happened versus vaccinating no-one?

Definition

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Causal diagram.
Decisions
  • Vaccination decision
    • Vaccinate everyone (observed vaccination coverage)
    • Vaccinate no-one (0 vaccination coverage)
Variables
Indicators
  • DALYs from narcolepsy caused by vaccination
  • DALYs from having swine flu (~staying at home for 5 days)
  • DALYs from deaths caused by swine flu


Result

Show results


Results

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Distributions of the results for the different scenarios/decisions.
  • From initial results it would appear like swine flu is more significant than narcolepsy in terms of DALYs.
    • Vaccinating as planned would result in approximately 1850 DALYs due to swine flu and narcolepsy combined.
    • Vaccinating no-one would result in approximately 4400 DALYs due to swine flu.
  • Probability of swine flu variable is revealed by both the sensitivity- and Value of information-analyses to have the most impact on the outcome.
    • The VOI analysis also reveals that further knowledge about the uncertain variables in the model is only worth up to ~80 DALYs, when considering the decision by age group, and less than 1 DALY when considering the decision as on/off as defined in the decision variable above. Which is only a small fraction of the total DALYs.

Statements: Pandemrix should not be used any more anywhere because its narcolepsy risk is too high.

Resolution: Not accepted. Pandemrix is still an effective and safe vaccine. However, due to precautionary reasons, other alternatives should be used when available, because the occurrence of narcolepsy is not understood. R↻

Conclusions

Given current knowledge, the decision to vaccinate the whole population was better than not vaccinating anyone. Results of the Value of information analysis suggest that further knowledge about the variables considered would not have changed the decision. The total impact of the swine flu pandemic and related narcolepsy cases in terms of DALYs is a lot smaller than those of radon or moisture damage for instance.

R code

  • Basic model
    • Uncertainties of ERF of vaccine on narcolepsy, fraction of all cases represented by lab confirmed cases and probability of catching swine flu are implemented.

+ Show code

See also

References