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Getchell M, Mantaring EJ, Yee K, Pronyk P. Cost-effectiveness of sub-national geographically targeted vaccination programs: A systematic review. Vaccine 2023; 41:2320-2328. [PMID: 36781333 DOI: 10.1016/j.vaccine.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
Immunization is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns and increasing administrative costs create logistic and financial challenges, especially in resource-limited settings. Sub-national geographic targeting of vaccination programs is a potential strategy for governments to reduce the impact of infectious disease outbreaks while optimizing resource allocation and reducing costs, promoting sustainability of critically important national immunization plans. We conducted a systematic review of peer-reviewed literature to identify studies that investigated the cost-effectiveness of geographically targeted sub-national vaccination programs, either through routine immunization or supplementary immunization activities. A total of 16 studies were included in our review, covering nine diseases of interest: cholera, dengue, enterotoxigenic Escherichia coli (ETEC), hepatitis A, Japanese encephalitis, measles, rotavirus, Shigella and typhoid fever. All studies modelled cost-effectiveness of geographically targeted vaccination. Despite the variation in study design, disease focus and country context, studies generally found that in countries where a heterogenous burden of disease exists, sub-national geographic targeting of vaccination programs in areas of high disease burden was more cost-effective than a non-targeted strategy. Sensitivity analysis revealed that cost-effectiveness was most sensitive to variations in vaccine price, vaccine efficacy, mortality rate, administrative and operational costs, discount rate, and treatment costs. This systematic review identified several key characteristics related to geographic targeting of vaccination, including the vaccination strategy used, variations in modelling parameters and their impact on cost-effectiveness. Additional research and guidance is needed to support the appropriateness and feasibility of geographically targeted vaccination and to determine what country context would make this a viable complement to routine immunization programs.
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Affiliation(s)
- Marya Getchell
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | | | - Kaisin Yee
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Paul Pronyk
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
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Lee HY, Oh J, Heo J, Abraha A, Perkins JM, Lee JK, Tran TGH, Subramanian SV. Association between maternal literacy and child vaccination in Ethiopia and southeastern India and the moderating role of health workers: a multilevel regression analysis of the Young Lives study. Glob Health Action 2019; 12:1581467. [PMID: 30957685 PMCID: PMC6461100 DOI: 10.1080/16549716.2019.1581467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/30/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Child vaccination coverage in low- and middle-income countries is still far from complete, mainly among marginalized people such as children with illiterate mothers. OBJECTIVE This study aims to examine the association between maternal literacy and immunization status of children in Ethiopia and southeastern India (Andhra Pradesh and Telangana) and test whether state-run health centers and community health workers moderate that association. METHODS This study is based on cross-sectional data from samples of children in Ethiopia and India, collected as part of round 2 within the Young Lives study (2006). Multilevel logistic regression was conducted to estimate the association between maternal literacy and the completion of four kinds of child vaccinations. We further tested for cross-level interactions between state-run health centers or community health workers and maternal literacy. Estimates were adjusted for several individual- and household-level demographic and socioeconomic factors. RESULTS Literate mothers were more likely to complete all four kinds of vaccinations for their children compared to illiterate mothers in Ethiopia (Odds Ratio (OR)=4.84, Confidence Interval (CI)=1.75-13.36). Presence of a health center was positively associated with completed vaccinations in India only (OR = 6.60, CI = 1.57-27.70). A cross-level interaction between community health workers and maternal literacy on the vaccination completion status of children was significant in Ethiopia only (OR = 0.29, CI = 0.09-0.96). CONCLUSIONS Our findings suggest that increased availability of community health workers may reduce the child vaccination gap for illiterate mothers, depending on the country context.
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Affiliation(s)
- Hwa-Young Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Takemi Program in International Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Juhwan Oh
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Atakelti Abraha
- Ethiopian Health Insurance Agency, Ministry of Health, Addis Ababa, Ethiopia
| | - Jessica M. Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jong-Koo Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Thi Giang Huong Tran
- International Cooperation Department of Vietnam, Ministry of Health, Hanoi, Vietnam
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Park M, Jit M, Wu JT. Cost-benefit analysis of vaccination: a comparative analysis of eight approaches for valuing changes to mortality and morbidity risks. BMC Med 2018; 16:139. [PMID: 30180901 PMCID: PMC6123970 DOI: 10.1186/s12916-018-1130-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 07/17/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is increasing interest in estimating the broader benefits of public health interventions beyond those captured in traditional cost-utility analyses. Cost-benefit analysis (CBA) in principle offers a way to capture such benefits, but a wide variety of methods have been used to monetise benefits in CBAs. METHODS To understand the implications of different CBA approaches for capturing and monetising benefits and their potential impact on public health decision-making, we conducted a CBA of human papillomavirus (HPV) vaccination in the United Kingdom using eight methods for monetising health and economic benefits, valuing productivity loss using either (1) the human capital or (2) the friction cost method, including the value of unpaid work in (3) human capital or (4) friction cost approaches, (5) adjusting for hard-to-fill vacancies in the labour market, (6) using the value of a statistical life, (7) monetising quality-adjusted life years and (8) including both productivity losses and monetised quality-adjusted life years. A previously described transmission dynamic model was used to project the impact of vaccination on cervical cancer outcomes. Probabilistic sensitivity analysis was conducted to capture uncertainty in epidemiologic and economic parameters. RESULTS Total benefits of vaccination varied by more than 20-fold (£0.6-12.4 billion) across the approaches. The threshold vaccine cost (maximum vaccine cost at which HPV vaccination has a benefit-to-cost ratio above one) ranged from £69 (95% CI £56-£84) to £1417 (£1291-£1541). CONCLUSIONS Applying different approaches to monetise benefits in CBA can lead to widely varying outcomes on public health interventions such as vaccination. Use of CBA to inform priority setting in public health will require greater convergence around appropriate methodology to achieve consistency and comparability across different studies.
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Affiliation(s)
- Minah Park
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong SAR, People's Republic of China
| | - Mark Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong SAR, People's Republic of China
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong SAR, People's Republic of China.
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Haddison EC, Abdullahi LH, Muloiwa R, Hussey GD, Kagina BM. Comparison of school based and supplemental vaccination strategies in the delivery of vaccines to 5-19 year olds in Africa - a systematic review. F1000Res 2017; 6:1833. [PMID: 29375814 PMCID: PMC5765397 DOI: 10.12688/f1000research.12804.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 02/03/2023] Open
Abstract
Background: Some vaccine preventable diseases (VPDs) still remain a public health burden in many African countries. The occurrence of VPDs in all age groups has led to the realization of the need to extend routine immunisation services to school age children, adolescents and adults. Supplemental immunisation activities (SIAs) and school based vaccinations (SBVs) are common strategies used to complement the expanded programme on immunisation (EPI). This review aimed to assess the effectiveness of SIAs compared to SBVs in the administration of vaccines to 5-19 year olds in Africa. Methods: Systematic review methods were used to address our study aim. Several electronic databases were searched up to March 30, 2017 for primary studies investigating the delivery of vaccines via SIAs or SBVs to 5-19 year olds. This search was complemented by browsing reference lists of potential studies obtained from search outputs. Outcomes considered for inclusion were: vaccination coverage, costs of the strategy or its effect on routine immunisation services. Results: Out of the 4938 studies identified, 31 studies met the review inclusion criteria. Both SIAs and SBVs showed high vaccination coverage. However, the SIAs reported higher coverage than SBVs: 91% (95% CI: 84%, 98%) versus 75% (95% CI: 67%, 83%). In most settings, SBVs were reported to be more expensive than SIAs. The SIAs were found to negatively affect routine immunisation services. Conclusions: Both SIAs and SBVs are routinely used to complement the EPI in the delivery of vaccines in Africa. In settings where school enrolment is suboptimal, as is the case in many African countries, our results show SIAs may be more effective in reaching school age children and adolescents than SBVs. Our results re-iterate the importance of evaluating systematic evidence to best inform African authorities on the optimal vaccine delivery strategies targeting school age children and adolescents.
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Affiliation(s)
- Eposi C Haddison
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leila H Abdullahi
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Thompson KM, Odahowski CL. Systematic Review of Health Economic Analyses of Measles and Rubella Immunization Interventions. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1297-1314. [PMID: 25545778 DOI: 10.1111/risa.12331] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Economic analyses for vaccine-preventable diseases provide important insights about the value of prevention. We reviewed the literature to identify all of the peer-reviewed, published economic analyses of interventions related to measles and rubella immunization options to assess the different types of analyses performed and characterize key insights. We searched PubMed, the Science Citation Index, and references from relevant articles for studies in English and found 67 analyses that reported primary data and quantitative estimates of benefit-cost or cost-effectiveness analyses for measles and/or rubella immunization interventions. We removed studies that we characterized as cost-minimization analyses from this sample because they generally provide insights that focused on more optimal strategies to achieve the same health outcome. The 67 analyses we included demonstrate the large economic benefits associated with preventing measles and rubella infections using vaccines and the benefit of combining measles and rubella antigens into a formulation that saves the costs associated with injecting the vaccines separately. Despite the importance of population immunity and dynamic viral transmission, most of the analyses used static models to estimate cases prevented and characterize benefits, although the use of dynamic models continues to increase. Many of the analyses focused on characterizing the most significant adverse outcomes (e.g., mortality for measles, congenital rubella syndrome for rubella) and/or only direct costs, and the most complete analyses present data from high-income countries.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, 32832, USA
- College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Cassie L Odahowski
- Kid Risk, Inc, 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, 32832, USA
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Thompson KM, Odahowski CL. The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1357-1382. [PMID: 26249331 DOI: 10.1111/risa.12459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
National and global health policymakers require good information about the costs and benefits of their investments in measles and rubella immunization programs. Building on our review of the existing measles and rubella health economics literature, we develop inputs for use in regional and global models of the expected future benefits and costs of vaccination, treatment, surveillance, and other global coordination activities. Given diversity in the world and limited data, we characterize the costs for countries according to the 2013 World Bank income levels using 2013 U.S. dollars (2013$US). We estimate that routine immunization and supplemental immunization activities will cost governments and donors over 2013$US 2.3 billion per year for the foreseeable future, with high-income countries accounting for 55% of the costs, to vaccinate global birth cohorts of approximately 134 million surviving infants and to protect the global population of over 7 billion people. We find significantly higher costs and health consequences of measles or rubella disease than with vaccine use, with the expected disability-adjusted life year (DALY) loss for case of disease generally at least 100 times the loss per vaccine dose. To support estimates of the economic benefits of investments in measles and/or rubella elimination or control, we characterize the probabilities of various sequelae of measles and rubella infections and vaccine adverse events, the DALY inputs for health outcomes, and the associated treatment costs. Managing measles and rubella to achieve the existing and future regional measles and rubella goals and the objectives of the Global Vaccine Action Plan will require an ongoing commitment of financial resources that will prevent adverse health outcomes and save the associated treatment costs.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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Kagina BM, Wiysonge CS, Machingaidze S, Abdullahi LH, Adebayo E, Uthman OA, Hussey GD. The use of supplementary immunisation activities to improve uptake of current and future vaccines in low-income and middle-income countries: a systematic review protocol. BMJ Open 2014; 4:e004429. [PMID: 24549166 PMCID: PMC3932000 DOI: 10.1136/bmjopen-2013-004429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Immunisation coverage data in low-income and middle-income countries (LMICs) suggest that more strategies need to be implemented to achieve and sustain optimal vaccine uptake. Among possible strategies to improve immunisation coverage are supplementary immunisation activities (SIAs). We are therefore interested in conducting a systematic review to assess whether SIAs complement routine immunisation programmes to improve vaccination coverage and prevent disease outbreaks. METHODS Our systematic review will focus on studies conducted in LMICs. With the help of an information specialist, we will search for eligible studies in PubMed, Web of Science, Scopus, Africa-Wide, Cochrane Library, WHOLIS, CINAHL, PDQ-Evidence as well as reference lists of relevant publications. Additionally, we will contact relevant organisations such as WHO and GAVI. Two authors will independently extract data from eligible studies and independently assess risk of bias by assessing the adequacy of study characteristics. The primary meta-analysis will use random effects models due to expected interstudies heterogeneity. Dichotomous data will be analysed using relative risk and continuous data using weighted mean differences (or standardised mean differences), both with 95% CIs. DISCUSSION The findings from this systematic review will be discussed in the context of strengthening routine childhood immunisation services, routine adolescent immunisation services and introduction of future vaccines against tuberculosis and HIV/AIDS. STUDY STRENGTHS Unbiased selection of many studies conducted in different settings. This will strengthen the validity of the review results. STUDY LIMITATIONS Heterogeneity of the study settings of the low-income, lower-middle-income and upper-middle-income countries as well as heterogeneity in study designs.
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Affiliation(s)
- Benjamin M Kagina
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Charles S Wiysonge
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Evidence-based Health Care & Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shingai Machingaidze
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Leila H Abdullahi
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Esther Adebayo
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Olalekan A Uthman
- Centre for Evidence-based Health Care & Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Gregory D Hussey
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Muloliwa AM, Camacho LAB, Verani JFS, Simões TC, Dgedge MDC. Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011. CAD SAUDE PUBLICA 2013; 29:257-69. [PMID: 23459812 DOI: 10.1590/s0102-311x2013000200013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 10/01/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.
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Electrochemical impedimetric immunosensor for the detection of measles-specific IgG antibodies after measles infections. Biosens Bioelectron 2013; 49:32-8. [DOI: 10.1016/j.bios.2013.04.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/28/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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Bae GR, Choe YJ, Go UY, Kim YI, Lee JK. Economic analysis of measles elimination program in the Republic of Korea, 2001: a cost benefit analysis study. Vaccine 2013; 31:2661-6. [PMID: 23602654 DOI: 10.1016/j.vaccine.2013.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 03/03/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In this study, we modeled the cost benefit analysis for three different measles vaccination strategies based upon three different measles-containing vaccines in Korea, 2001. We employed an economic analysis model using vaccination coverage data and population-based measles surveillance data, along with available estimates of the costs for the different strategies. In addition, we have included analysis on benefit of reduction of complication by mumps and rubella. METHODS We evaluated four different strategies: strategy 1, keep-up program with a second dose measles-mumps-rubella (MMR) vaccine at 4-6 years without catch-up campaign; strategy 2, additional catch-up campaign with measles (M) vaccine; strategy 3, catch-up campaign with measles-rubella (MR) vaccine; and strategy 4, catch-up campaign with MMR vaccine. The cost of vaccination included cost for vaccines, vaccination practices and other administrative expenses. The direct benefit of estimated using data from National Health Insurance Company, a government-operated system that reimburses all medical costs spent on designated illness in Korea. RESULTS With the routine one-dose MMR vaccination program, we estimated a baseline of 178,560 measles cases over the 20 years; when the catch-up campaign with M, MR or MMR vaccines was conducted, we estimated the measles cases would decrease to 5936 cases. Among all strategies, the two-dose MMR keep-up program with MR catch-up campaign showed the highest benefit-cost ratio of 1.27 with a net benefit of 51.6 billion KRW. CONCLUSION Across different vaccination strategies, our finding suggest that MR catch-up campaign in conjunction with two-dose MMR keep-up program was the most appropriate option in terms of economic costs and public health effects associated with measles elimination strategy in Korea.
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Affiliation(s)
- Geun-Ryang Bae
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
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Ozawa S, Mirelman A, Stack ML, Walker DG, Levine OS. Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: a systematic review. Vaccine 2012; 31:96-108. [PMID: 23142307 DOI: 10.1016/j.vaccine.2012.10.103] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 10/19/2012] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions. METHODS To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit). RESULTS Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination. CONCLUSIONS This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
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Goodson JL, Chu SY, Rota PA, Moss WJ, Featherstone DA, Vijayaraghavan M, Thompson KM, Martin R, Reef S, Strebel PM. Research priorities for global measles and rubella control and eradication. Vaccine 2012; 30:4709-16. [PMID: 22549089 PMCID: PMC10321687 DOI: 10.1016/j.vaccine.2012.04.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/12/2012] [Accepted: 04/17/2012] [Indexed: 11/18/2022]
Abstract
In 2010, an expert advisory panel convened by the World Health Organization to assess the feasibility of measles eradication concluded that (1) measles can and should be eradicated, (2) eradication by 2020 is feasible if measurable progress is made toward existing 2015 measles mortality reduction targets, (3) measles eradication activities should occur in the context of strengthening routine immunization services, and (4) measles eradication activities should be used to accelerate control and elimination of rubella and congenital rubella syndrome (CRS). The expert advisory panel also emphasized the critical role of research and innovation in any disease control or eradication program. In May 2011, a meeting was held to identify and prioritize research priorities to support measles and rubella/CRS control and potential eradication activities. This summary presents the questions identified by the meeting participants and their relative priority within the following categories: (1) measles epidemiology, (2) vaccine development and alternative vaccine delivery, (3) surveillance and laboratory methods, (4) immunization strategies, (5) mathematical modeling and economic analyses, and (6) rubella/CRS control and elimination.
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Affiliation(s)
- James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
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Verguet S, Jassat W, Hedberg C, Tollman S, Jamison DT, Hofman KJ. Measles control in Sub-Saharan Africa: South Africa as a case study. Vaccine 2012; 30:1594-600. [DOI: 10.1016/j.vaccine.2011.12.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/19/2011] [Accepted: 12/23/2011] [Indexed: 10/14/2022]
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Goodson JL, Kulkarni MA, Vanden Eng JL, Wannemuehler KA, Cotte AH, Desrochers RE, Randriamanalina B, Luman ET. Improved equity in measles vaccination from integrating insecticide-treated bednets in a vaccination campaign, Madagascar. Trop Med Int Health 2012; 17:430-7. [DOI: 10.1111/j.1365-3156.2011.02953.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garrison LP, Bauch CT, Bresnahan BW, Hazlet TK, Kadiyala S, Veenstra DL. Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination. J Infect Dis 2011; 204 Suppl 1:S124-32. [PMID: 21666153 DOI: 10.1093/infdis/jir114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions. METHODS This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children's Fund countries through 2049. RESULTS Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million. CONCLUSIONS Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs.
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Affiliation(s)
- Louis P Garrison
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA 98195, USA.
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Modeling the cost-effectiveness of the integrated disease surveillance and response (IDSR) system: meningitis in Burkina Faso. PLoS One 2010; 5. [PMID: 20927386 PMCID: PMC2946913 DOI: 10.1371/journal.pone.0013044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 08/06/2010] [Indexed: 12/02/2022] Open
Abstract
Background Effective surveillance for infectious diseases is an essential component of public health. There are few studies estimating the cost-effectiveness of starting or improving disease surveillance. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa. Methodology/Principal Findings To assess the impact of the IDSR in Africa, we used pre- and post- IDSR meningococcal meningitis surveillance data from Burkina Faso (1996–2002 and 2003–2007). IDSR implementation was correlated with a median reduction of 2 weeks to peak of outbreaks (25th percentile 1 week; 75th percentile 4 weeks). IDSR was also correlated with a reduction of 43 meningitis cases per 100,000 (25th–40: 75th-129). Assuming the correlations between reductions in time to peak of outbreaks and cases are related, the cost-effectiveness of IDSR was $23 per case averted (25th-$30; 75th - cost saving), and $98 per meningitis-related death averted (25th-$140: 75th – cost saving). Conclusions/Significance We cannot absolutely claim that the measured differences were due to IDSR. We believe, however, that it is reasonable to claim that IDSR can improve the cost-effectiveness of public health surveillance.
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Cost-effectiveness of a successful schistosomiasis control programme in Cambodia (1995-2006). Acta Trop 2010; 113:279-84. [PMID: 19962364 DOI: 10.1016/j.actatropica.2009.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 11/19/2009] [Accepted: 11/28/2009] [Indexed: 11/20/2022]
Abstract
Following preventive chemotherapy covering the entire population in the two endemic regions in Cambodia, the prevalence of schistosomiasis dropped from 77% in 1995 to 0.5% in 2003. The study presented here reports on the running cost of the control programme, and evaluates its cost-effectiveness and cost-benefit. Financial costs were assessed using data taken from the annual reports of the National Center for Malaria Control, the Cambodian institution responsible for the control activities. Other data were collected from interviews with provincial and district staff. The analysis was conducted from the point of views of the Cambodian Ministry of Health and that of the society, and the comparison was undertaken using the "do-nothing" option. The cost to treat an individual for the 9 years period of the implementation phase was 9.22 USD (1.02 per year), the cost for each severe infection avoided was 61.50 USD and 6531 USD for each death avoided. The drug cost corresponds on average to 17.34% of the programme's implementation cost. The cost of bringing one severely infected individual of productive age to complete productivity, was estimated at 114 USD and for 1 USD invested in the programme the return in increased productivity, for the economic system, was estimated to be 3.85 USD. The control programme demonstrated significant economical advantages. However, its costs are too high to be entirely supported by the Cambodian Ministry of Health.
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Schwarz NG, Gysels M, Pell C, Gabor J, Schlie M, Issifou S, Lell B, Kremsner PG, Grobusch MP, Pool R. Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambaréné, Gabon. Vaccine 2009; 27:5371-5. [PMID: 19616497 DOI: 10.1016/j.vaccine.2009.06.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 06/17/2009] [Accepted: 06/22/2009] [Indexed: 11/28/2022]
Abstract
The aim of this paper is to explore attitudes of mothers towards childhood vaccinations and reasons for non-attendance and non-adherence to mother-child clinics (MCCs). Forty in-depth interviews with mothers of children under 5 years of age revealed positive attitudes towards vaccination that seem at odds with the region's observed low vaccination coverage. Important reasons for MCC non-attendance included distance to the MCC, transport costs, negative experiences at MCCs (such as interactions with unfriendly staff) and mothers' feeling of shame provoked by different, often poverty-associated reasons such as attending the clinic with a dirty or poorly clothed child.
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Abstract
Remarkable progress has been made in reducing measles incidence and mortality as a consequence of implementing the measles mortality reduction strategy of the World Health Organization (WHO) and United Nations Children's Fund (UNICEF). The revised global measles mortality reduction goal set forth in the WHO-UNICEF Global Immunization Vision and Strategy for 2006–2015 is to reduce measles deaths by 90% by 2010 compared to the estimated 757,000 deaths in 2000. The possibility of measles eradication has been discussed for almost 40 years, and measles meets many of the criteria for eradication. Global measles eradication will face a number of challenges to achieving and sustaining high levels of vaccine coverage and population immunity, including population growth and demographic changes, conflict and political instability, and public perceptions of vaccine safety. To achieve the measles mortality reduction goal, continued progress needs to be made in delivering measles vaccines to the world's children.
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Somda ZC, Meltzer MI, Perry HN, Messonnier NE, Abdulmumini U, Mebrahtu G, Sacko M, Touré K, Ki SO, Okorosobo T, Alemu W, Sow I. Cost analysis of an integrated disease surveillance and response system: case of Burkina Faso, Eritrea, and Mali. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2009; 7:1. [PMID: 19133149 PMCID: PMC2632984 DOI: 10.1186/1478-7547-7-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 01/08/2009] [Indexed: 12/27/2022] Open
Abstract
Background Communicable diseases are the leading causes of illness, deaths, and disability in sub-Saharan Africa. To address these threats, countries within the World Health Organization (WHO) African region adopted a regional strategy called Integrated Disease Surveillance and Response (IDSR). This strategy calls for streamlining resources, tools, and approaches to better detect and respond to the region's priority communicable disease. The purpose of this study was to analyze the incremental costs of establishing and subsequently operating activities for detection and response to the priority diseases under the IDSR. Methods We collected cost data for IDSR activities at central, regional, district, and primary health care center levels from Burkina Faso, Eritrea, and Mali, countries where IDSR is being fully implemented. These cost data included personnel, transportation items, office consumable goods, media campaigns, laboratory and response materials and supplies, and annual depreciation of buildings, equipment, and vehicles. Results Over the period studied (2002–2005), the average cost to implement the IDSR program in Eritrea was $0.16 per capita, $0.04 in Burkina Faso and $0.02 in Mali. In each country, the mean annual cost of IDSR was dependent on the health structure level, ranging from $35,899 to $69,920 at the region level, $10,790 to $13,941 at the district level, and $1,181 to $1,240 at the primary health care center level. The proportions spent on each IDSR activity varied due to demand for special items (e.g., equipment, supplies, drugs and vaccines), service availability, distance, and the epidemiological profile of the country. Conclusion This study demonstrates that the IDSR strategy can be considered a low cost public health system although the benefits have yet to be quantified. These data can also be used in future studies of the cost-effectiveness of IDSR.
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Affiliation(s)
- Zana C Somda
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Wolfson LJ, Gasse F, Lee-Martin SP, Lydon P, Magan A, Tibouti A, Johns B, Hutubessy R, Salama P, Okwo-Bele JM. Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015. Bull World Health Organ 2008; 86:27-39. [PMID: 18235887 DOI: 10.2471/blt.07.045096] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 10/12/2007] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015. METHODS A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle- income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis. FINDINGS The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up. CONCLUSION In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015.
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Abstract
BACKGROUND Vaccine-preventable diseases cause more than 1 million deaths among children in developing countries every year. Although health workers are needed to do vaccinations, the role of human resources for health as a determinant of vaccination coverage at the population level has not been investigated. Our aim was to test whether health worker density was positively associated with childhood vaccination coverage in developing countries. METHODS We did cross-country multiple regression analyses with coverage of three vaccinations--measles-containing vaccine (MCV); diphtheria, tetanus, and pertussis (DTP3); and poliomyelitis (polio3)--as dependent variables. Aggregate health worker density was an independent variable in one set of regressions; doctor and nurse densities were used separately in another set. We controlled for national income per person, female adult literacy, and land area. FINDINGS Health worker density was significantly associated with coverage of all three vaccinations (MCV p=0.0024; DTP3 p=0.0004; polio3 p=0.0008). However, when the effects of doctors and nurses were assessed separately, we found that nurse density was significantly associated with coverage of all three vaccinations (MCV p=0.0097; DTP3 p=0.0083; polio3 p=0.0089), but doctor density was not (MCV p=0.7953; DTP3 p=0.7971; polio3 p=0.7885). Female adult literacy was positively associated, and land area negatively associated, with vaccination coverage. National income per person had no effect on coverage. INTERPRETATION A higher density of health workers (nurses) increases the availability of vaccination services over time and space, making it more likely that children will be vaccinated. After controlling for other determinants, the level of income does not contribute to improved immunisation coverage. Health workers can be a major constraining factor on vaccination coverage in developing countries.
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Affiliation(s)
- Sudhir Anand
- University of Oxford, Department of Economics, Oxford, UK; Harvard University, Global Equity Initiative, Cambridge, MA, USA.
| | - Till Bärnighausen
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa; Harvard School of Public Health, Department of Population and International Health, Boston, MA, USA
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Abstract
Measles remains a leading vaccine-preventable cause of child mortality worldwide, particularly in sub-Saharan Africa where almost half of the estimated 454,000 measles deaths in 2004 occurred. However, great progress in measles control has been made in resource-poor countries through accelerated measles-control efforts. The global elimination of measles has been debated since measles vaccines were first licensed in the 1960's, and this debate is likely to be renewed if polio virus is eradicated. This review discusses the pathogenesis of measles and the likelihood of the worldwide elimination of this disease.
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Affiliation(s)
- William J. Moss
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, 21205 Maryland USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, 21205 Maryland USA
| | - Diane E. Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, 21205 Maryland USA
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Amirfar S, Hollenberg JP, Abdool Karim SS. Modeling the Impact of a Partially Effective HIV Vaccine on HIV Infection and Death Among Women and Infants in South Africa. J Acquir Immune Defic Syndr 2006; 43:219-25. [PMID: 16951648 DOI: 10.1097/01.qai.0000230526.79341.83] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the potential impact over 10 years of a partially effective HIV vaccine in a cohort of 15-year-old adolescent girls in South Africa in terms of HIV infections and deaths prevented in mothers and infants. METHODS A computer simulation was constructed using a population of all 15-year-old adolescent girls in South Africa followed for 10 years. A partially effective vaccine is introduced into this population with the ability to reduce the HIV incidence rates of the adolescents and vertical transmission to their infants through birth and breast-feeding. At the end of this 10 year period, the number of HIV infections and death prevented in adolescents and infants is analyzed. RESULTS Using a 5% HIV incidence rate, a 50% effective vaccine decreases the number of HIV cases among adolescents by 57,653 (28.7%) and the number of cases among infants by 13,765 (28.9%) over 10 years. In addition, assuming a vaccine cost of $20 per dose, the vaccination program can save approximately $120 million for the South African government over 10 years. CONCLUSION A partially effective HIV vaccine has an important role in HIV prevention in adolescents and infants in South Africa irrespective of other public policy implementations.
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Affiliation(s)
- Sam Amirfar
- Weill Medical College and Graduate School of Medical Sciences of Cornell University, New York, NY 10021, USA.
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Grabowsky M, Farrell N, Hawley W, Chimumbwa J, Hoyer S, Wolkon A, Selanikio J. Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods. Trop Med Int Health 2005; 10:1151-60. [PMID: 16262740 DOI: 10.1111/j.1365-3156.2005.01502.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Population coverage of insecticide-treated nets (ITNs) in Africa falls well below the Abuja target of 60% while coverage levels achieved during vaccination campaigns in the same populations typically exceed 90%. Household (HH) cost of ITNs is an important barrier to their uptake. We investigated the coverage, equity and cost of linking distribution of free ITNs to a measles vaccination campaign. During a national measles vaccination campaign in Zambia, children in four rural districts were given a free ITN when they received their measles vaccination. In one urban district, children were given a voucher, which could be redeemed for a net at a commercial distribution site. About 1700 HHs were asked whether they received vaccination and an ITN during a measles campaign, as well as questions on assets (e.g. type roofing material or bicycle ownership) to assess HH wealth. Net ownership was calculated for children in each wealth quintile. In the rural areas, ITN coverage among children rose from 16.7% to 81.1% and the equity ratio from 0.32 to 0.88 and in the urban area from 50.7% to 76.2% (equity ratio: 0.66-1.19). The operational cost per ITN delivered was dollar 0.35 in the rural area with direct distribution and $1.89 in the urban areas with voucher distribution. Mass distribution of ITNs through vaccination campaigns achieves rapid, high and equitable coverage at low cost.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize important papers concerning measles disease and measles-containing vaccines published in 2004. RECENT FINDINGS Endemic measles has been successfully controlled in the Americas and, to a lesser extent, in Europe. This has been achieved with a high uptake of two doses of a measles-containing vaccine. Even in industrialized countries, where vaccine uptake is poor, for example Japan, the disease is still a significant cause of morbidity and mortality. Vaccine failure is predominantly due to primary vaccine failure, which may, in part, be genetic in origin and related to HLA type. Measles-containing vaccines have been shown to be associated with febrile convulsions, but there is no strong evidence of a link with atopy. There is considerable evidence that there is no causal relationship with autistic disorders. In spite of this, many parents and some professionals have concerns about the safety of the vaccines, which may lead to their underuse. SUMMARY It is possible to eliminate measles with a high uptake of two doses of measles-containing vaccine, but concerns about safety persist and need to be tackled. More research is required into how to do this effectively and also to elucidate the causes of vaccine failure.
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Affiliation(s)
- David Elliman
- Islington PCT and Great Ormond Street Hospital, London, UK.
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