title: Economics of cardiac adverse events after smallpox vaccination: lessons from the 2003 US Vaccination Program.
abstract: Of >39,000 civilian public health responders vaccinated against smallpox in 2003, 203 reported cardiovascular adverse events (CAEs). An association exists between the US vaccinia strain and myocarditis and/or pericarditis ("myo/pericarditis" [MP]). Other associations are inconclusive. We used surveillance and follow-up survey data of CAE case patients to estimate the resources used during the 2003 smallpox vaccination program and used a probabilistic model to estimate the potential costs of CAEs in a mass vaccination campaign. For every million adult vaccinees, 3001 CAEs (including 351 MP cases) would occur, with >92% in revaccinees. CAEs would require a median of 5934 outpatient visits, 1786 emergency department visits, 533 days in general wards, 132 days in intensive care units, 5484 cardiac enzymes tests, 3504 electrocardiograms, 3049 chemistry tests, 2828 complete blood counts, and 1444 transthoracic echocardiograms, among other procedures. CAEs would reduce productivity (15,969 work days lost) and cost $11 per vaccinee. In a mass vaccination campaign, the care of a sizable number of CAEs would be resource intensive.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. IOrtegaSanchez@cdc.gov
authors.forename: Ismael R
authors.initials: IR
authors.lastname: Ortega-Sanchez
authors.forename: Mercedes M
authors.initials: MM
authors.lastname: Sniadack
authors.forename: Gina T
authors.initials: GT
authors.lastname: Mootrey
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D023482:Bioterrorism / Q000517:prevention & control; D002959:Civil Defense / Q000458:organization & administration; D003365:Costs and Cost Analysis; D003625:Data Collection; D004189:Disaster Planning / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007117:Immunization, Secondary / Q000009:adverse effects*; D008297:Male; D032541:Mass Vaccination / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009205:Myocarditis / Q000191:economics* / Q000209:etiology / Q000628:therapy; D010493:Pericarditis / Q000191:economics* / Q000209:etiology / Q000628:therapy; D018571:Sentinel Surveillance; D012899:Smallpox / Q000517:prevention & control*; D012900:Smallpox Vaccine / Q000009:adverse effects*; D014481:United States
chemical_list: C078786:DryVax vaccine; D012900:Smallpox Vaccine