Liparis rubescens sp. nov. (Orchidaceae) from Thailand

In the context of an ongoing revision of the orchid genus Liparis in Thailand, we describe and illustrate a new species under the name L. rubescens Tetsana, H. A. Pedersen & Sridith. Morphologically, it is particularly similar to L. dumaguetensis Ames from the Philippines, but it differs in the shape of the lateral sepals and in several characters of the labellum. Among the Liparis species already known from Thailand, L. atrosanguinea Ridl. bears a certain resemblance to the new species, but not so much as to make misidentifications likely. So far, L. rubescens is only known from Khao Nan National Park in the southern Thai province of Nakhon Si Thammarat, but we suggest that it should also be searched for in other parts of peninsular Thailand, southernmost Myanmar and Peninsular Malaysia.     

Seasonal Influenza Vaccination for Children in Thailand: A Cost-Effectiveness Analysis

Background

Seasonal influenza is a major cause of mortality worldwide. Routine immunization of children has the potential to reduce this mortality through both direct and indirect protection, but has not been adopted by any low- or middle-income countries. We developed a framework to evaluate the cost-effectiveness of influenza vaccination policies in developing countries and used it to consider annual vaccination of school- and preschool-aged children with either trivalent inactivated influenza vaccine (TIV) or trivalent live-attenuated influenza vaccine (LAIV) in Thailand. We also compared these approaches with a policy of expanding TIV coverage in the elderly.

Methods and Findings

We developed an age-structured model to evaluate the cost-effectiveness of eight vaccination policies parameterized using country-level data from Thailand. For policies using LAIV, we considered five different age groups of children to vaccinate. We adopted a Bayesian evidence-synthesis framework, expressing uncertainty in parameters through probability distributions derived by fitting the model to prospectively collected laboratory-confirmed influenza data from 2005-2009, by meta-analysis of clinical trial data, and by using prior probability distributions derived from literature review and elicitation of expert opinion. We performed sensitivity analyses using alternative assumptions about prior immunity, contact patterns between age groups, the proportion of infections that are symptomatic, cost per unit vaccine, and vaccine effectiveness. Vaccination of children with LAIV was found to be highly cost-effective, with incremental cost-effectiveness ratios between about 2,000 and 5,000 international dollars per disability-adjusted life year averted, and was consistently preferred to TIV-based policies. These findings were robust to extensive sensitivity analyses. The optimal age group to vaccinate with LAIV, however, was sensitive both to the willingness to pay for health benefits and to assumptions about contact patterns between age groups.

Conclusions

Vaccinating school-aged children with LAIV is likely to be cost-effective in Thailand in the short term, though the long-term consequences of such a policy cannot be reliably predicted given current knowledge of influenza epidemiology and immunology. Our work provides a coherent framework that can be used for similar analyses in other low- and middle-income countries.     

Systematic review of economic evaluations of preparedness strategies and interventions against influenza pandemics

Background

Although public health guidelines have implications for resource allocation, these issues were not explicitly considered in previous WHO pandemic preparedness and response guidance. In order to ensure a thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted.

Methods

The search was performed in September 2011 using 10 electronic databases, 2 internet search engines, reference list screening, cited reference searching, and direct communication with relevant authors. Full and partial economic evaluations considering both costs and outcomes were included. Conversely, reviews, editorials, and studies on economic impact or complications were excluded. Studies were selected by 2 independent reviewers.

Results

44 studies were included. Although most complied with the cost effectiveness guidelines, the quality of evidence was limited. However, the data sources used were of higher quality in economic evaluations conducted after the 2009 H1N1 pandemic. Vaccination and drug regimens were varied. Pharmaceutical plus non-pharmaceutical interventions are relatively cost effective in comparison to vaccines and/or antivirals alone. Pharmaceutical interventions vary from cost saving to high cost effectiveness ratios. According to ceiling thresholds (Gross National Income per capita), the reduction of non-essential contacts and the use of pharmaceutical prophylaxis plus the closure of schools are amongst the cost effective strategies for all countries. However, quarantine for household contacts is not cost effective even for low and middle income countries.

Conclusion

The available evidence is generally inconclusive regarding the cost effectiveness of preparedness strategies and interventions against influenza pandemics. Studies on their effectiveness and cost effectiveness should be readily implemented in forthcoming events that also involve the developing world. Guidelines for assessing the impact of disease and interventions should be drawn up to facilitate these studies.     

Character intercorrelation and the potential role of phenotypic plasticity in orchids: a case study of the epiphyte Liparis resupinata

Character intercorrelation was studied in a natural population of the epiphytic orchid Liparis resupinata in northern Thailand, and patterns of morphological variation in relation to the local growth environment of individual plants were mapped. Massive occurrence of character intercorrelation was detected, but clone size only influenced few characters of individual flowering shoots. Variation in vegetative and floral organs was largely independent, but two cases differed from the general pattern: (1) the only character not defined by size (distance between apices of lateral sepals) exhibited largely independent variation; (2) ovary length was positively correlated with nearly all other characters. Major groups of vegetative and floral characters were found to covary with different combinations of ecological parameters. Although our study does not document the existence of phenotypic plasticity in L. resupinata, the overall patterns observed would be congruent with a scenario involving phenotypic plasticity. No positive correlation between variability and apparent morphological susceptibility to environmental influence was found; but floral characters were generally less variable and covaried with more ecological parameters than vegetative characters. Based on our observations, we make a few methodological recommendations for morphometric studies of species complexes.