Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China

Background: There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China.
Methods: We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008–09 and 2009–10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs.
Results: The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490–$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness.
Conclusions: The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.
Keywords: Cost-effectiveness, Economic evaluation, N95 respirator, Mask, Healthcare worker

REFERENCE:
Mukerji, Shohini et al. “Cost-Effectiveness Analysis of N95 Respirators and Medical Masks to Protect Healthcare Workers in China from Respiratory Infections.” BMC Infectious Diseases 17 (2017): 464. PMC. Web. 7 Aug. 2017.

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Respirator Performance against Nanoparticles under Simulated Workplace Activities

FFRS      /      EHRS

Filtering facepiece respirators (FFRs) and elastomeric half-mask respirators (EHRs) are commonly used by workers for protection against potentially hazardous particles, including engineered nanoparticles. The purpose of this study was to evaluate the performance of these types of respirators against 10–400 nm particles using human subjects exposed to NaCl aerosols under simulated workplace activities. Simulated workplace protection factors (SWPFs) were measured for eight combinations of respirator models (2 N95 FFRs, 2 P100 FFRs, 2 N95 EHRs, and 2 P100 EHRs) worn by 25 healthy test subjects (13 females and 12 males) with varying face sizes. Before beginning a SWPF test for a given respirator model, each subject had to pass a quantitative fit test. Each SWPF test was performed using a protocol of six exercises for 3 min each: (i) normal breathing, (ii) deep breathing, (iii) moving head side to side, (iv) moving head up and down, (v) bending at the waist, and (vi) a simulated laboratory-vessel cleaning motion. Two scanning mobility particle sizers were used simultaneously to measure the upstream (outside the respirator) and downstream (inside the respirator) test aerosol; SWPF was then calculated as a ratio of the upstream and downstream particle concentrations. In general, geometric mean SWPF (GM-SWPF) was highest for the P100 EHRs, followed by P100 FFRs, N95 EHRs, and N95 FFRs. This trend holds true for nanoparticles (10–100 nm), larger size particles (100–400 nm), and the ‘all size’ range (10–400 nm). All respirators provided better or similar performance levels for 10–100 nm particles as compared to larger 100–400 nm particles. This study found that class P100 respirators provided higher SWPFs compared to class N95 respirators (P<0.05) for both FFR and EHR types. All respirators provided expected performance (i.e. fifth percentile SWPF > 10) against all particle size ranges tested.
REFERENCE:
Vo, Evanly et al. “Respirator Performance against Nanoparticles under Simulated Workplace Activities.” The Annals of occupational hygiene 59.8 (2015): 1012–1021. PMC. Web. 7 Aug. 2017.

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#WEBINAR: Contención biológica: barreras primarias y secundarias

REGISTRO:  https://goo.gl/9AbpFT

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Does #influenza pandemic preparedness and mitigation require gain‐of‐function research?

The risk and benefits of gain‐of‐function studies on influenza A have been widely debated since 2012 when the methods to create two respiratory transmissible H5N1 mutant isolates were published. Opponents of gain‐of‐function studies argue the biosecurity risk is unacceptable, while proponents cite potential uses for pandemic surveillance, preparedness and mitigation. In this commentary, we provide an overview of the background and applications of gain‐of‐function research and argue that the anticipated benefits have yet to materialize while the significant risks remain.
REFERENCE:
Adam, Dillon C. et al. “Does Influenza Pandemic Preparedness and Mitigation Require Gain‐of‐function Research?” Influenza and Other Respiratory Viruses 11.4 (2017): 306–310.

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Liquid Stressed Protective Materials and Environmental Persistence of #Ebola Virus

After the largest Ebola virus outbreak in history, experts have attempted to answer how the Zaire ebolavirus species emerged in West Africa and caused chains of human-to-human transmission. The widespread and untimely infection of Health Care Workers (HCW) in the affected countries accelerated spread of the virus within the community. Among the reasons attributed to this trend, it must be considered that HCW were exposed to the virus in their occupational environment. The contribution of environmental conditions to the spread of Ebola in West Africa was examined by investigating the effect of temperature/humidity on the virus’s environmental persistence and by modeling if saturation (liquid stress) allows for penetration of Ebola virus through personal protective equipment (PPE). Ebola-Makona virus persisted on PPE and materials found in outbreak settings for less than 72 hours at 27 °C and 80% relative humidity (RH). A difference in virus penetration was observed between dry (5%, 1/21 tests) and saturated (33%, 7/21 tests) samples of PPE. Infectious virus particles penetrated through saturated coupons of Tyvek Micro Clean, Tychem QC, whole surgical masks and N95 respirators. These findings suggest inclusion of saturation or similar liquid stress simulation in protective equipment testing standards.
REFERENCE:
Nikiforuk, Aidan M. et al. “Challenge of Liquid Stressed Protective Materials and Environmental Persistence of Ebola Virus.” Scientific Reports 7 (2017): 4388.

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A Modular High #Biosafety Field Laboratory in Sierra Leona for #Ebola

In response to Ebola virus disease outbreak in West Africa, the National Institute for Communicable Diseases in South Africa established a modular high-biosafety field Ebola diagnostic laboratory (FEDL) near Freetown, Sierra Leone. This was the sole diagnostic capacity available to respond to the overwhelming demand for Ebola diagnosis for several weeks in the Western Area of Sierra Leone. The deployment of the FEDL capacity contributed to the overall international efforts in bringing the Ebola outbreak in West Africa under control.

REFERENCE:
Paweska, Janusz T. et al. “South African Ebola Diagnostic Response in Sierra Leone: A Modular High Biosafety Field Laboratory.” Ed. Manuel Schibler. PLoS Neglected Tropical Diseases 11.6 (2017): e0005665. PMC. Web. 7 Aug. 2017.

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