Biology Reference
In-Depth Information
Healthcare Costs Associated with Congenital HCMV Infection:
A Compelling Argument for Vaccine Development
The economic burden on the healthcare system in caring for neurodevelopmental
disability in early childhood caused by congenital HCMV infection is substantial.
Congenital HCMV infection is the most common infectious cause of brain dam-
age in children, and HCMV causes more hearing loss in children than did
Haemophilus influenzae
meningitis in the pre-Hib vaccine era (Pass 1996). The
economic costs to society associated with congenital HCMV infection present a
compelling argument for vaccine development. In the early 1990s, the expense to
the US healthcare system associated with congenital HCMV infection was esti-
mated at approximately $1.9 billion annually, with an average cost per child of
over $300,000 (Arvin et al. 2004). Children with congenital HCMV infection often
require long-term custodial care and extensive medical and surgical interventions.
A recent economic analysis by the Institute of Medicine (IOM) examined the
theoretical cost- effectiveness of a hypothetical HCMV vaccine based on quality
adjusted life years (QALYs). QALYs quantify the acute and chronic problems
caused by an illness. Employing this model, the more severe or permanent the
sequelae, the larger the potential benefit conferred by an effective intervention will
be. Not surprisingly, a hypothetical HCMV vaccine administered to 12-year-olds
was in the level 1 group (the group for which a vaccine development strategy
would save society money), and in fact was the single most cost-effective
vaccine identified (Stratton et al. 1999). Thus, the economic benefit of HCMV
vaccination holds the highest priority for any hypothetical new vaccine.
HCMV Vaccine: What Is the Ideal Target Population?
Perinatal and Early Childhood HCMV Infection
One strategy for vaccine-mediated prevention of HCMV would be to target acquisi-
tion of primary infection in infancy and early childhood. Perinatal acquisition of
HCMV may occur by one of three different routes: exposure to HCMV in the birth
canal during labor and delivery, transmission of HCMV by blood transfusion, or
transmission by breast-feeding. In a prospective study in premature infants receiv-
ing breast milk containing HCMV, transmission was observed in 33 of 87 exposed
infants, and approximately half of these babies developed disease, including
hepatitis, neutropenia, thrombocytopenia, and sepsis-like state (Maschmann et al.
2001). It is uncertain if HCMV infection of low-birth-weight premature infants
by this route carries any risk of long-term sequelae, and highly speculative as to
whether maternal immunization programs would play a role in elimination of
transmission by breast milk in this vulnerable population.
Beyond the immediate neonatal period, an extremely important population for
primary HCMV infection - and a potential target for implementation of a vaccine
