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A Murine Model of Group B Streptococcus Vaginal Colonization
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Comparación de estrategias de prevención para la infección neonatal por estreptococos del grupo B. Un análisis
J C Mohle-Boetani1, A Schuchat, B D Plikaytis
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333.
JAMA
|September 22, 1993
Resumen
La prevención de la enfermedad neonatal del estreptococo del grupo B (GBS) con antibióticos intraparto o la vacunación materna es rentable. Se deben explorar estrategias alternativas a la detección universal para la colonización de GBS.
Área de la Ciencia:
- Salud Pública La salud pública.
- Prevención de las enfermedades infecciosas Prevención de las enfermedades infecciosas
- Economía de la salud Economía de la salud
Sus antecedentes:
- Los antibióticos intraparto pueden prevenir la enfermedad estreptocócica neonatal del grupo B (GBS) de aparición temprana, pero la implementación se ve obstaculizada por los desafíos de detección y las incertidumbres de costos.
- El desarrollo de vacunas contra el SGB presenta una nueva vía para la prevención de enfermedades.
Objetivo del estudio:
- Evaluar la rentabilidad de las diferentes estrategias para prevenir la enfermedad neonatal por SGB en los Estados Unidos.
- Para comparar el cribado universal con antibióticos intraparto, antibióticos dirigidos sin cribado y vacunación materna.
Principales métodos:
- Se empleó un modelo de análisis de decisiones, utilizando un análisis de costo-efectividad y costo-beneficio.
- Se compararon los resultados y los costos entre la ausencia de intervención y tres estrategias de prevención: antibióticos intrapartos examinados, antibióticos intrapartos dirigidos y vacunación materna.
- Los datos de la vigilancia basada en la población de varios estados informaron las estimaciones del modelo sobre el impacto y los costos de la enfermedad.
Principales resultados:
- La profilaxis antibiótica intraparto basada en el cribado podría prevenir ~ 3300 casos de GBS neonatales anualmente, ahorrando ~ 16 millones de dólares.
- Los antibióticos dirigidos sin cribado podrían prevenir ~ 3200 casos, ahorrando ~ 66 millones de dólares, al tiempo que se evitan problemas logísticos.
- La vacunación materna (cobertura del 80%, eficacia del 80%) podría prevenir ~4100 casos al año con ~$131 millones en ahorros.
Conclusiones:
- Es probable que el cribado prenatal universal para el SGB y la quimioprofilaxis sea rentable.
- Se necesitan estrategias alternativas para las poblaciones en las que el cribado de GBS no es práctico.
- El desarrollo continuo de una vacuna contra el SGB es una prioridad de salud pública.
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