Papers by Germaine Hanquet
136 p.ill.,The post-intensive care syndrome (PICS) is not specific to COVID-19. In the months aft... more 136 p.ill.,The post-intensive care syndrome (PICS) is not specific to COVID-19. In the months after discharge, it can occur in more than half of the patients that have stayed in intensive care for a serious pathology. Given the current COVID-19 pandemic, it is very likely that its incidence will increase in the coming months. PICS can cause three types of symptoms: physical (extreme muscle weakness), psychological (anxiety, depression, post-traumatic stress disorder), and cognitive (memory loss, loss of verbal fluency, attention and executive functioning disorders). Psychological symptoms can also be observed in the relatives of the patients (PICS-F for ‘Family’). Since PICS is not well known outside the limited circle of intensivists, KCE conducted a rapid review of the literature for primary caretakers to identify the main risk factors and the evidence for possible interventions. We have also identified a series of 6 practical tools. They will enable general practitioners to detec...
England and Wales (United Kingdom), invasive disease from non-PCV7 serotypes (NVT) increased. Adj... more England and Wales (United Kingdom), invasive disease from non-PCV7 serotypes (NVT) increased. Adjusted serotype-specifi c incidences among children <15 years of age were compared between 1999–2002 (prevaccine) and 2005–2006 (postmarketing). Vaccine coverage increased
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
and Thierry van den Berg* We report the isolation and characterization of a highly pathogenic avi... more and Thierry van den Berg* We report the isolation and characterization of a highly pathogenic avian influenza A/H5N1 virus from Crested Hawk-Eagles smuggled into Europe by air travel. A screening performed in human and avian contacts indicated no dissemination occurred. Illegal movements of birds are a major threat for the introduction of highly pathogenic avian influenza. compartment during both flights. When interviewed, the Thai man declared that he “bought the eagles on a major Bangkok market, a few days before departure, as a present for [his] brother living in Belgium. ” The eagles reportedly had no contact with domestic animals before departure. A few days later, a Belgian falconer declared he had ordered the eagles and offered €7,500 for each bird. Necropsy and further testing were carried out at the Veterinary and Agrochemical Research Centre (virologic procedures according to EU Council Directive 92/40/EEC of 19 May 1992). Both eagles had enteritis, and 1 had bilateral pne...
Weekly releases (1997–2007), 2006
Since the first human cases of influenza A/H5N1 were widely reported from Turkey in early January... more Since the first human cases of influenza A/H5N1 were widely reported from Turkey in early January, many European patients with suspected influenza
Vaccine, 2011
Rotavirus vaccines were introduced in Belgium in 2006 and recommended in the universal schedule i... more Rotavirus vaccines were introduced in Belgium in 2006 and recommended in the universal schedule in January 2007. We measured the impact of rotavirus vaccination through an active laboratory-based surveillance system. In 2008, the number of laboratory confirmed rotavirus cases declined by 61.4% (95% CI 60.2-62.6%) compared to the 2005-2006 pre-vaccination period, with the highest decline in children <1 year (80.1%; 95% CI 78.7-81.4%). The rotavirus season was delayed compared to pre-vaccination seasons. Laboratory data provide a crude estimation of vaccination impact, but analysis of in-patient data will be needed to assess the impact on severe disease.
Authors' conclusions Meningococcal disease is a devastating disease, which can be rapidly fat... more Authors' conclusions Meningococcal disease is a devastating disease, which can be rapidly fatal and has important long-term impact on the life of those affected and their parents/caregivers. This cost-effectiveness study did not integrate the full extent of human suffering due to IMD. Decisions on vaccine policies are obviously based on several factors, including impact on individuals and the society, and cost-effectiveness is only one of these factors. Nevertheless, cost-effectiveness models throw a useful light on the opportunity (if any) of the different vaccination options. These models have shown that the introduction of a routine immunisation programme with 4CMenB can reduce meningococcal disease in Belgium, but involves a high frequency of adverse events, though principally mild and transient, following vaccination. If the vaccine does not disrupt group B carriage the greatest number of cases are averted through routine combined infant and adolescent routine vaccination p...
Emerging Infectious Diseases
Cost-effectiveness analysis of rotavirus vaccination of Belgian infants KCE reports 54C Federaal ... more Cost-effectiveness analysis of rotavirus vaccination of Belgian infants KCE reports 54C Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d'expertise des soins de santé Belgian Health Care Knowledge Centre 2007 KCE reports vol 54C Title : Cost-effectiveness analysis of rotavirus vaccination of Belgian infants.
ABSTRACT Authorization of medicinal products is based on demonstration of safety and efficacy, ge... more ABSTRACT Authorization of medicinal products is based on demonstration of safety and efficacy, generally based on data from randomized clinical trials involving a limited number of patients. However, authorization of new vaccines is increasingly based on immunological surrogates of protection, and data on the clinical protection they provide are rarely available pre-licensure. Most of the information on the true clinical benefit and risks of the vaccine is then provided by post-licensure observational studies, and these play a predominant role in helping decision-making on vaccination policies. However, these observational studies may measure different types of vaccine-related effects, depending on the design and the population groups that are being compared. Furthermore, diverging terms are used today to describe the different types of vaccine-related effects; this confusion in terminology makes it difficult to discern which exposure is considered, which kind of effect is being measured by observational studies and how their findings should be interpreted. The type of post-licensure effect that is expected from a vaccine - or from a vaccination programme - and the related study designs, are rarely clarified at the level of decision-makers, whether in the regulatory world or among health authorities. Additionally, observational designs are based on a number of assumptions and requirements that are rarely met, and their findings are therefore prone to confounding and bias - which were mostly controlled by random allocation of vaccinated and unvaccinated persons in pre-licensure trials. This thesis focuses on the vaccine-related effect “impact of a vaccination programme”. This term (or “vaccination programme impact”) is often used in publications or in guidelines and some international organisations request to assess it. However, it has no standard meaning and may thus refer to different types of vaccine-related effects. Moreover, definitions and indicators for “impact” are usually not provided in the studies measuring it. The most commonly found concept of vaccination programme impact refers to a reduction in disease burden after the vaccination programme compared to its burden before the programme was implemented. But the assumptions made by using this “pre and post-vaccination” design are rarely described in the literature. The potential violations of these assumptions, how these may bias the measures of impact and how these biases should be addressed to correctly estimate vaccination programme impact are mostly overlooked in published studies. However, decision makers in the vaccine world need to know which effect is measured and which are the methodological limitations to be able to interpret and use the findings of post-licensure studies. This thesis addresses these questions and proposes methodological approaches to improve the measurement of the impact of vaccination programmes and the interpretation of its findings. In particular, it focuses on three research questions: 1. What is the impact of a vaccination programme? How can it be distinguished from vaccine efficacy and vaccine effectiveness? 2. Which methods can be used to measure the impact of vaccination programmes? Which are the assumptions that these methods make, and which are the methodological challenges involved? 3. How can the methods to measure vaccination programme impact be improved? These research questions have been addressed by reviewing published studies and international guidelines on these topics, by deriving formulas of impact in public health epidemiology, and by analysing and interpreting field research studies on the impact of two vaccines recently introduced in Belgium or in EU countries: the 7-valent pneumococcal conjugate vaccine (PCV7) and rotavirus vaccines (RV).
Clinical Infectious Diseases
Background Vaccine regulatory decision making is based on vaccine efficacy against etiologically ... more Background Vaccine regulatory decision making is based on vaccine efficacy against etiologically confirmed outcomes, which may underestimate the preventable disease burden. To quantify this underestimation, we compared vaccine-preventable disease incidence (VPDI) of clinically defined outcomes with radiologically/etiologically confirmed outcomes. Methods We performed a systematic review of efficacy trials for several vaccines (1997–2019) and report results for pneumococcal conjugate vaccines. Data were extracted for outcomes within a clinical syndrome, organized from most sensitive to most specific. VPDI was determined for each outcome, and VPDI ratios were calculated, with a clinically defined outcome (numerator) and a radiologically/etiologically confirmed outcome (denominator). Results Among 9 studies, we calculated 27 VPDI ratios; 24 had a value >1. Among children, VPDI ratios for clinically defined versus vaccine serotype otitis media were 0.6 (95% CI not calculable), 2.1 (1...
Objectives: Health economic evaluations (HEEs) of vaccines are commonly considered during immuniz... more Objectives: Health economic evaluations (HEEs) of vaccines are commonly considered during immunization introduction decision-making processes in most industrialized countries. Despite the availability of guidelines advocating more standardization for such HEEs, there are still several infection/immunization-specific particularities that are debated in the scientific community. An international expert-workshop was convened to identify good practices for (i) how to conduct HEEs of vaccines and (ii) how to consider results of HEE in vaccine introduction decision-making. Methods: A systematic literature search was conducted to identify prevailing opinions and remaining issues of HEE in vaccination. Twentytwo experts in the field of health economics and immunization decision-making were invited to a workshop and were asked to answer a survey-questionnaire based on the systematic literature search beforehand to inform the preparation of group work sessions (GWS). In GWS, issues focusing on 'mathematical modeling', 'health economics', and 'decision-making' were discussed and summarized. Results: The GWS (based on systematic literature search) included topics such as cost-components, quality of life (QoL), discounting, and perspectives leading to suggestions such as including caregiver QoL impact and applying decreasing time-related discount rates. Since vaccination often causes indirect effects, the use of dynamic models is required and exceptions should be justified. In order to facilitate transparent decision-making, the results of HEE should present parameter and methodological uncertainty as well as cumulative and time-specific figures. The majority of countries in Europe use results from HEEs in an informal judgment-process without willingness to pay (WTP) threshold. The expert-group emphasized that transparency should be maximized in decisionmaking process. Conclusions: The deliberations led to suggestions on several HEE issues. However, vaccines not always need to be considered differently in HEE since other interventions might share similar characteristics. Transparency in the conduct and presentation of HEE, and subsequent decision-making is essential, especially in the absence of explicit WTP thresholds.
Epidemiology and Infection, 2012
SUMMARYIn a Belgian wool-processing factory, living anthrax spores were found in raw goat hair an... more SUMMARYIn a Belgian wool-processing factory, living anthrax spores were found in raw goat hair and air dust, but confirmed anthrax cases had never been reported. Anthrax vaccines are not licensed nor recommended in Belgium. We conducted a B. anthracis seroprevalence study to investigate risk factors associated with positive serology and advise on protective measures. Overall 12·1% (8/66) employees were seropositive; 30% of persons processing raw goat hair and 20% of persons sorting raw goat hair were seropositive compared to 3% in less exposed jobs [adjusted prevalence ratio (aPR) 44·4, P=0·001; aPR 14·5, P=0·016, respectively). The number of masks used per day was protective (aPR 0·3, P=0·015). Results suggest a dose–response association for those processing raw goat hair. Host-related factors probably played a role as antibody response varied from person to person within an exposure group. Workers exposed to raw goat hair should be offered higher protection against anthrax and hav...
Eurosurveillance …, 1812
Germaine Hanquet 1 (g. hanquet@ iph. fgov. be), Véronique Gilbert 2, Angélique Covas 3, Olivier V... more Germaine Hanquet 1 (g. hanquet@ iph. fgov. be), Véronique Gilbert 2, Angélique Covas 3, Olivier Vandenberg 3, Anne Dediste 3, Michèle Gérard 3, Patrick De Mol 4, Monique Coppens 3, Daniel Reynders 5 and Carl Suetens 1
Thorax, Jan 24, 2018
Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through... more Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies. For each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011-2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 - IRR)*100. After five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI -4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes includ...
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Papers by Germaine Hanquet