Cost calculator for mass vaccination response to a US college campus outbreak of serogroup B meningococcal disease

Serogroup B (MenB) is the leading cause of meningococcal disease among 16- to 23-year-olds in the United States and has been responsible for all 10 college outbreaks between 2011 and 2017. Outbreak-associated costs levy a substantial and unforeseen burden on colleges/universities and surrounding communities, in part because they involve collaboration with local and state health departments to develop points-of-dispensing (PODs) outbreak response plans and rapid mass vaccination of a large at-risk student population. The MenB outbreak at Providence College in 2015 was used as a case study to develop an Excel-based Meningococcal Outbreak Cost Calculator that uses target populations for mass vaccination to estimate the costs and resources associated with a meningococcal disease outbreak response. Resources include labor, medical supply, and other nonlabor costs (eg, vaccine-related adverse event costs) over an 18-month period following the outbreak declaration. Based on the actual Providence College population partially or fully vaccinated with MenB-FHbp (Trumenba®, Bivalent rLP2086) (3-dose schedule), the calculator estimated aggregate direct costs of $1,350,963 over 18 months post-outbreak for 4,418 individuals. For planned full vaccination of the enrolled undergraduate population (4,795 individuals), the tool estimated total costs of $1,798,399. In both cases, the majority of costs were for medical supplies (88%-89%) and contract services (7%-9%). This calculator can help to plan a mass vaccination campaign for MenB outbreak control, and underscores the need to vaccinate pre-emptively against diverse disease-causing strains before an outbreak occurs.

683. Cost Calculator for Mass Vaccination Response to a US College Campus Outbreak of Serogroup B Meningococcal Disease

Background

US college students are at increased risk for serogroup B meningococcal disease (MenB). MenB caused ~57% of meningococcal disease cases among 16- to 23-year-olds in 2016, and was responsible for 10 US college outbreaks from 2011−2017 involving 41 cases and an at-risk population of ~182,000 enrolled undergraduates. Outbreaks cause disruptive anxiety among university communities and implementing a mass vaccination response imposes an often unforeseen financial burden. This study aimed to enumerate costs incurred during a points-of-dispensing, mass vaccination response to a US campus MenB outbreak.

Methods

The 2015 MenB outbreak at Providence College was used as a case study to develop an Excel-based (Microsoft, Redmond, WA) cost calculator to capture costs and resources associated with a MenB outbreak response. The calculator has user-modifiable inputs related to the vaccine-eligible population, accounts for each vaccination event and vaccine dose (Figure 1), and estimates direct costs (2016 USD) during 18 months post-outbreak. Potential/expected costs computed (assuming 100% vaccine coverage) were compared with estimated actual costs incurred during the outbreak, using a micro-costing approach.

Results

The estimated total cost for full vaccination of 4,795 eligible individuals was $1,798,399 ($375.06/person); based on actual vaccinations received, the cost calculator computed $1,350,963 in aggregate direct costs ($636.05/person fully vaccinated) (Table 1). In both analyses, medical supplies were the majority of costs (88–89%), followed by labor resources (7–9%).

Conclusion

This cost calculator quantifies the direct cost of a mass vaccination response to one campus MenB outbreak. Although the cost estimates herein are higher than previously reported, the calculator does not account for follow-up costs or productivity losses and therefore underestimates the true economic burden of a campus MenB outbreak. This outbreak response cost calculator can be used to aid in response planning and highlights the need to shift the public health response from outbreak control to prevention by proactive, pre-emptive vaccination using available licensed meningococcal vaccines.

Disclosures

E. M. La, RTI Health Solutions (RTI-HS): Employee and RTI-HS is an independent scientific research organization which was retained pursuant to a contract with Pfizer to conduct the research services which are the subject of this presentation/abstract., Salary and The RTI-HS employees who worked on this project did not receive compensation from Pfizer or any other organization, other than RTI-HS salaries.. S. E. Talbird, RTI Health Solutions (RTI-HS): Employee and RTI-HS is an independent scientific research organization which was retained pursuant to a contract with Pfizer to conduct the research services which are the subject of this presentation/abstract., Salary and The RTI-HS employees who worked on this project did not receive compensation from Pfizer or any other organization, other than RTI-HS salaries.. J. Fain, Pfizer Inc.: Employee at time of Study and Employee, Salary. L. Huang, Pfizer: Employee and Shareholder, Salary and Stocks. A. Srivastava, Pfizer: Employee and Shareholder, Salary and Stocks.

Rapid response to a college outbreak of meningococcal serogroup B disease: Nation's first widespread use of bivalent rLP2086 vaccine

OBJECTIVE

To outline the reasoning behind use of bivalent rLP2086 in a Rhode Island college meningococcal B disease outbreak, highlighting the timeline from outbreak declaration to vaccination clinic, emphasizing that these two time points are <3 days apart.

PARTICIPANTS

Staff, faculty, and students at College X eligible for vaccination.

METHODS

An outbreak response was initiated, advantages/disadvantages of available MenB vaccines were discussed, and a vaccination clinic was coordinated.

RESULTS

Bivalent rLP2086 was chosen as the vaccination intervention. We achieved a 94% coverage rate for the first dose. To date, this intervention has prevented further cases of Neisseria meningitidis serogroup B disease at College X.

CONCLUSIONS

The close, efficient collaboration of public health stakeholders and College X led 94% of the eligible population to be safely vaccinated with at least one dose of bivalent rLP2086. This outbreak marked the first time bivalent rLP2086 was effectively used as an intervention response.

Meningococcal Carriage Evaluation in Response to a Serogroup B Meningococcal Disease Outbreak and Mass Vaccination Campaign at a College-Rhode Island, 2015-2016

Background

Serogroup B meningococcal disease caused 7 US university outbreaks during 2013-2016. Neisseria meningitidis can be transmitted via asymptomatic nasopharyngeal carriage. MenB-FHbp (factor H binding protein), a serogroup B meningococcal (MenB) vaccine, was used to control a college outbreak. We investigated MenB-FHbp impact on meningococcal carriage.

Methods

Four cross-sectional surveys were conducted in conjunction with MenB-FHbp vaccination campaigns. Questionnaires and oropharyngeal swabs were collected from students. Specimens were evaluated using culture, slide agglutination, real-time polymerase chain reaction (rt-PCR), and whole genome sequencing. Adjusted prevalence ratios (aPRs) were calculated using generalized estimating equations.

Results

During each survey, 20%-24% of participants carried any meningococcal bacteria and 4% carried serogroup B by rt-PCR. The outbreak strain (ST-9069) was not detected during the initial survey; 1 student carried ST-9069 in the second and third surveys. No carriage reduction was observed over time or with more MenB-FHbp doses. In total, 615 students participated in multiple surveys: 71% remained noncarriers, 8% cleared carriage, 15% remained carriers, and 7% acquired carriage. Ten students acquired serogroup B carriage: 3 after 1 MenB-FHbp dose, 4 after 2 doses, and 3 after 3 doses. Smoking (aPR, 1.3; 95% confidence interval [CI], 1.1-1.5) and male sex (aPR, 1.3; 95% CI, 1.1-1.5) were associated with increased meningococcal carriage.

Conclusions

Carriage prevalence on campus remained stable, suggesting MenB-FHbp does not rapidly reduce meningococcal carriage or prevent serogroup B carriage acquisition. This reinforces the need for high vaccination coverage to protect vaccinated individuals and chemoprophylaxis for close contacts during outbreaks.

Postcrisis redevelopment of sustainable healthcare systems

OBJECTIVE

Research and field experience have identified a global gap in postdisaster rebuilding of healthcare systems due to the current primary focus on returning devastated community infrastructures to predisaster conditions. Disasters, natural or man-made, present an opportunity for communities to rebuild, restructure, and redefine their predisaster states, creating more resilient and sustainable healthcare systems.

DESIGN

A model for sustainable postdisaster healthcare rebuilding was developed by bridging identified gaps in the literature on the processes of developing healthcare systems postdisaster and utilizing evidence from the literature on postdisaster community reconstruction.

RESULTS

The proposed model-the Sustainable Healthcare Redevelopment Model-is designed to guide communities through the process of recovery, and identifies four stages for rebuilding healthcare systems: (1) response, (2) recovery, (3) redevelopment, and (4) sustainable development. Implementing sustainable healthcare redevelopment involves a bottom-up approach, where community stakeholders have the ability to influence policy decisions. Relationships within internal government agencies and with public-private partnerships are necessary for successful recovery.

CONCLUSION

The Sustainable Healthcare Redevelopment Model can serve as a guideline for delivery of healthcare services following disaster or conflict and use of crisis as a window of opportunity to improve the healthcare delivery system and incorporate resilience into the healthcare infrastructure.