{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:24:59Z","timestamp":1792095899060,"version":"4.4.0"},"reference-count":52,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T00:00:00Z","timestamp":1591920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009509","name":"Kementerian Riset Teknologi Dan Pendidikan Tinggi Republik Indonesia","doi-asserted-by":"publisher","award":["391\/UN6.O\/LT\/2018"],"award-info":[{"award-number":["391\/UN6.O\/LT\/2018"]}],"id":[{"id":"10.13039\/501100009509","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9995, $4460, and $6399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.<\/jats:p>","DOI":"10.3390\/ijerph17124217","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T03:17:32Z","timestamp":1592191052000},"page":"4217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Cost-Effectiveness of Dengue Vaccination in Indonesia: Considering Integrated Programs with Wolbachia-Infected Mosquitos and Health Education"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8671-2065","authenticated-orcid":false,"given":"Auliya A.","family":"Suwantika","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Center for Health Technology Assessment, Universitas Padjadjaran, Bandung 40132, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-5286","authenticated-orcid":false,"given":"Angga P.","family":"Kautsar","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical and Pharmacy Technology, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, 9713 AV Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woro","family":"Supadmi","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neily","family":"Zakiyah","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8779-6421","authenticated-orcid":false,"given":"Rizky","family":"Abdulah","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ali","sequence":"additional","affiliation":[{"name":"Faculty of Educational Sciences, Universitas Pendidikan Indonesia, Bandung 40154, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J.","family":"Postma","sequence":"additional","affiliation":[{"name":"Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, 9713 AV Groningen, The Netherlands"},{"name":"Unit of Pharmaco-Therapy, Epidemiology &amp; Economics (PTE2), Department of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands"},{"name":"Department of Economics, Econometrics &amp; Finance, Faculty of Economics &amp; Business, Groningen, University of Groningen, 9747 AE Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,12]]},"reference":[{"key":"ref_1","unstructured":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392, 1789\u20131858."},{"key":"ref_2","unstructured":"World Health Organization (2012). Global Strategy for Dengue Prevention and Control, WHO Press."},{"key":"ref_3","unstructured":"Pan American Health Organization (2018). Integrated Management Strategy for Dengue Prevention and Control in the Region of the Americas, PAHO."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1128\/CMR.00035-09","article-title":"Dengue virus pathogenesis: An integrated view","volume":"22","author":"Martina","year":"2009","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"Bhatt","year":"2013","journal-title":"Nature"},{"key":"ref_6","first-page":"1","article-title":"The global burden of dengue: An analysis from the Global Burden of Disease Study 2013","volume":"3099","author":"Stanaway","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/S1473-3099(16)00146-8","article-title":"The global economic burden of dengue: A systematic analysis","volume":"16","author":"Shepard","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Nadjib, M., Setiawan, E., Putri, S., Nealon, J., Beucher, S., Hadinegoro, S.R., Permanasari, V.Y., Sari, K., Wahyono, T.Y.M., and Kristin, E. (2019). Economic burden of dengue in Indonesia. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007038"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bowman, L.R., Donegan, S., and McCall, P.J. (2016). Is dengue vector control deficient in effectiveness or evidence? Systematic review and meta-analysis. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004551"},{"key":"ref_10","unstructured":"Jamison, D.T., Mosley, W.H., Measham, A.R., and Bobadila, J. (1993). Dengue (with notes on yellow fever and Japanese endephalitis). Disease Control Priorities for Developing Countries, Oxford University Press for the World Bank."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.vaccine.2017.11.064","article-title":"Cost-effectiveness of dengue vaccination in ten endemic countries","volume":"36","author":"Zeng","year":"2018","journal-title":"Vaccine"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Achee, N.L., Gould, F., Perkins, T.A., Reiner, R.C., Morrison, A.C., Ritchie, S.A., Gubler, D.J., Teyssou, R., and Scott, T.W. (2015). A critical assessment of vector control for dengue prevention. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003655"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1365-2915.2008.00740.x","article-title":"Effect of dengue vector control interventions on entomological parameters in developing countries: A systematic review and meta-analysis","volume":"22","author":"Erlanger","year":"2008","journal-title":"Med. Vet. Entomol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"O\u2019Reilly, K.M., Hendrickx, E., Kharisma, D.D., Wilastonegoro, N.N., Carrington, L.B., Elyazar, I.R.F., Kucharski, A.J., Lowe, R., Flasche, S., and Pigott, D.M. (2019). Estimating the burden of dengue and the impact of release of wMel Wolbachia-infected mosquitoes in Indonesia: A modelling study. BMC Med., 17.","DOI":"10.1186\/s12916-019-1396-4"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1186\/s13063-018-2670-z","article-title":"The AWED trial (applying Wolbachia to eliminate dengue) to assess the efficacy of Wolbachia-infected mosquito deployments to reduce dengue incidence in Yogyakarta, Indonesia: Study protocol for a cluster randomised controlled trial","volume":"19","author":"Anders","year":"2018","journal-title":"Trials"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1038\/nrmicro1969","article-title":"Wolbachia: Master manipulators of invertebrate biology","volume":"6","author":"Werren","year":"2008","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Van den Hurk, A.F., Hall-Mendelin, S., Pyke, A.T., Frentiu, F.D., McElroy, K., Day, A., Higgs, S., and O\u2019Neill, S.L. (2012). Impact of Wolbachia on infection with chikungunya and yellow fever viruses in the mosquito vector Aedes aegypti. PLoS Negl. Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001892"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.chom.2016.04.021","article-title":"Wolbachia blocks currently circulating Zika virus isolates in Brazilian Aedes aegypti mosquitoes","volume":"19","author":"Dutra","year":"2016","journal-title":"Cell Host Microbe"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1038\/nature10356","article-title":"Successful establishment of Wolbachia in Aedes populations to suppress dengue transmission","volume":"476","author":"Hoffmann","year":"2011","journal-title":"Nature"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sulistyawati, S., Astuti, F.D., Umniyati, S.R., Satoto, T.B.T., Lazuardi, L., Nilsson, M., Rocklov, J., Andersson, C., and Holmner, A. (2019). Dengue vector control through community empowerment: Lessons learned from a community-based study in Yogyakarta, Indonesia. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16061013"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.enfcli.2018.11.013","article-title":"The effectiveness of health education using audiovisual media on increasing family behavior in preventing dengue hemorrhagic fever (DHF)","volume":"29","author":"Arneliwati","year":"2019","journal-title":"Enfermeria Clinica"},{"key":"ref_22","unstructured":"Statistics Indonesia (2013). Indonesia Population Projection 2010\u20132035, Statistics Indonesia."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Prayitno, A., Taurel, A.F., Nealon, J., Satari, H.I., Karyanti, M.R., Sekartini, R., Soedjatmiko, S., Gunardi, H., Medise, B.E., and Sasmono, R.T. (2018). Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006467"},{"key":"ref_24","unstructured":"Ministry of Health, Republic of Indonesia Profil Kesehatan Indonesia 2009\u20132018, Ministry of Health. 2009\u20132018."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kosasih, H., Alisjahbana, B., Nurhayati, Q.d.M., Rudiman, I.F., Widjaja, S., Antonjaya, U., Novriani, H., Susanto, N.H., Jusuf, H., and Susanto, N.H. (2016). The Epidemiology, Virology and Clinical Findings of Dengue Virus Infections in a Cohort of Indonesian Adults in Western Java. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004390"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Utama, I.M.S., Lukman, N., Sukmawati, D.D., Alisjahbana, B., Anggraini, A., Murniati, D., Utama, I.M.G.D.L., Puspitasari, D., Kosasih, H., and Laksono, I. (2019). Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007785"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Da Silveira, L.T.C., Tura, B., and Santos, M. (2019). Systematic review of dengue vaccine efficacy. BMC Infect., 19.","DOI":"10.1186\/s12879-019-4369-5"},{"key":"ref_28","unstructured":"World Health Organization (2019, August 03). Dengue Vaccine: WHO Position Paper\u2014September 2018. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/274315\/WER9336.pdf?ua=1."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Carrasco, L.R., Lee, L.K., Lee, V.J., Ooi, E.E., Shepard, D.S., Thein, T.L., Gan, V., Cook, A.R., Lye, D., and Ng, L.C. (2011). Economic impact of dengue illness and the cost-effectiveness of future vaccination programs in Singapore. PLoS Negl. Trop. Dis., 5.","DOI":"10.1371\/journal.pntd.0001426"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.4269\/ajtmh.16-0194","article-title":"Dengue dynamics and vaccine cost-effectiveness analysis in the Philippines","volume":"95","author":"Shim","year":"2016","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","unstructured":"Ministry of Health, Republic of Indonesia (2019, August 03). Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan. Available online: https:\/\/www.depkes.go.id\/resources\/download\/peraturan\/pmk-59-thn-2014-ttg-standar-tarif-jkn.pdf."},{"key":"ref_32","unstructured":"Forbes (2020, March 01). Mosquito Wars\u2014A Big Win in Australia Brings Hopeful News for Southern US. Available online: https:\/\/www.forbes.com\/sites\/judystone\/2018\/08\/03\/mosquito-wars-a-big-win-in-australia-brings-hopeful-news-to-florida-and-southern-us\/#3f7078fa3069."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Stahl, H.C., Butenschoen, V.M., Tran, H.T., Gozzer, E., Skewes, R., Mahendradhata, Y., Runge-Ranziger, S., Kroeger, A., and Farlow, A. (2013). Cost of dengue outbreaks: Literature review and country case studies. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-1048"},{"key":"ref_34","unstructured":"World Bank (2019, August 15). PPP Conversion Factor. Available online: https:\/\/data.worldbank.org\/indicator\/PA.NUS.PPP."},{"key":"ref_35","unstructured":"World Bank (2019, August 25). GDP Per Capita\u2014Indonesia. Available online: https:\/\/data.worldbank.org\/indicator\/NY.GDP.PCAP.CD?locations=ID."},{"key":"ref_36","unstructured":"World Health Organization (2019, August 15). WHO Guide for Standardization of Economic Evaluations of Immunization Programmes. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/69981\/WHO_IVB_08.14_eng.pdf?sequence=1."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e148","DOI":"10.1016\/S2214-109X(16)00048-6","article-title":"Zika virus outbreak in the Americas: The need for novel mosquito control methods","volume":"4","author":"Yakob","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Von Seidlein, L., Kekul\u00e9, A.S., and Strickman, D. (2017). Novel vector control approaches: The future for prevention of Zika virus transmission?. PLoS Med., 14.","DOI":"10.1371\/journal.pmed.1002219"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1038\/nature10355","article-title":"The wMel Wolbachia strain blocks dengue and invades caged Aedes aegypti populations","volume":"476","author":"Walker","year":"2011","journal-title":"Nature"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Harapan, H., Rajamoorthy, Y., Anwar, S., Bustamam, A., Radiansyah, A., Angraini, P., Fasli, R., Salwiyadi, S., Bastian, R.A., and Oktiviyari, A. (2018). Knowledge, attitude, and practice regarding dengue virus infection among inhabitants of Aceh, Indonesia: A cross-sectional study. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3006-z"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Dhimal, M., Aryal, K.K., Dhimal, M.L., Gautam, I., Singh, S.P., Bhusal, C.L., and Kuch, U. (2014). Knowledge, Attitude and Practice Regarding Dengue Fever among the Healthy Population of Highland and Lowland Communities in Central Nepal. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102028"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.vhri.2019.02.004","article-title":"Economic Evaluations of Dengue Vaccination in the Southeast Asia Region: Evidence from a Systematic Review","volume":"18","author":"Supadmi","year":"2019","journal-title":"Value Health Reg. Issues"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1586\/14760584.2014.891940","article-title":"Accelerating the introduction of rotavirus immunization in Indonesia","volume":"13","author":"Suwantika","year":"2014","journal-title":"Expert Rev. Vaccines"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.4161\/hv.29353","article-title":"Cost-effectiveness of hepatitis A vaccination in Indonesia","volume":"10","author":"Suwantika","year":"2014","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Suwantika, A.A., and Postma, M.J. (2013). Effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-1106"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.vhri.2015.10.010","article-title":"Cost-Utility Analysis of Human Papillomavirus Vaccination and Cervical Screening on Cervical Cancer Patient in Indonesia","volume":"9","author":"Setiawan","year":"2016","journal-title":"Value Health Reg. Issues"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Brady, O.J., Kharisma, D.D., Wilastonegoro, N.N., O\u2019Reilly, K.M., Hendricx, E., Bastos, L.S., Yakob, L., and Shepard, D.S. (2020). The potential cost-effectiveness of controlling dengue in Indonesia using wMel Wolbachia released at scale: A modelling study. medRxiv, Available online: https:\/\/www.medrxiv.org\/content\/10.1101\/2020.01.11.20017186v1.full.pdf.","DOI":"10.1101\/2020.01.11.20017186"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"764","DOI":"10.4269\/ajtmh.2011.10-0624","article-title":"Economic value of dengue vaccine in Thailand","volume":"84","author":"Lee","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/j.vaccine.2003.09.019","article-title":"Cost-effectiveness of a pediatric dengue vaccine","volume":"22","author":"Shepard","year":"2004","journal-title":"Vaccine"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s40273-017-0487-3","article-title":"The potential cost-effectiveness of different dengue vaccination programmes in Malaysia: A value-based pricing assessment using dynamic transmission mathematical modelling","volume":"35","author":"Shafie","year":"2017","journal-title":"Pharmacoeconomics"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/PRS.0b013e318219c171","article-title":"The Levels of Evidence and their role in Evidence-Based Medicine","volume":"128","author":"Burns","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"532","DOI":"10.4161\/hv.6.7.11278","article-title":"Performance of rotavirus vaccines in developed and developing countries","volume":"6","author":"Jiang","year":"2010","journal-title":"Hum. Vaccines"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/12\/4217\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:38:30Z","timestamp":1760175510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/12\/4217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,12]]},"references-count":52,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["ijerph17124217"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17124217","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,12]]}}}