Cost-benefit analyses of supplementary measles immunisation in the highly immunized population of New Zealand

As endemic measles is eliminated from countries through increased immunisation, the economic benefits of enhanced immunisation programs may come into question. New Zealand has suffered from outbreaks after measles introductions from abroad and we use it as a model system to understand the benefits of catch up immunisation in highly immunised populations. We provide cost-benefit analyses for measles supplementary immunisation in New Zealand. We model outbreaks based on estimates of the basic reproduction number in the vaccinated population (R_v, the number of secondary infections in a partially immunised population), based on the number of immunologically-naïve people at district and national levels, considering both pre- and post-catch up vaccination scenarios. Our analyses suggest that measles R_v often includes or exceeds one (0.18-3.92) despite high levels of population immunity. We calculate the cost of the first 187 confirmed and probable measles cases in 2014 to be over NZ$1 million (∼US$864,200) due to earnings lost, case management and hospitalization costs. The benefit-cost ratio analyses suggest additional vaccination beyond routine childhood immunisation is economically efficient. Supplemental vaccination-related costs are required to exceed approximately US$66 to US$1877 per person, depending on different scenarios, before supplemental vaccination is economically inefficient. Thus, our analysis suggests additional immunisation beyond childhood programs to target naïve individuals is economically beneficial even when childhood immunisation rates are high.

Regional training in public health surveillance: how far are we? An SPC perspective

"Training in applied epidemiology and public health surveillance" is one of the five strategies of Pacific Public Health Surveillance Network (PPHSN). It aims to develop a regional pool of experts in public health surveillance and response for the Pacific Islands. In 1996, the idea of a modular training programme with field-based components, involving universities, health development agencies and professional associations came up. This programme should be accredited by a training institution. From 1998 to 2001, SPC made a first move in that direction and ran two different series of subregional training sessions in surveillance, outbreak investigation and the use of Epi Info 6 software for surveillance activities. The overall objective of these training sessions was to build a critical mass of health professionals who share a common set of tools and methods for public health surveillance. SPC can also provide attachment and hands-on field training opportunities for trainees in public health practice. A memorandum of understanding was signed between SPC and FSM in 1999. The article suggests the areas of future FSM/SPC collaboration in public health surveillance: the accreditation of SPC courses by FSM; the addition of a microbiology component; the identification of opportunities for field training; and the evaluation and harmonisation of the training programme(s).

Dengue surveillance in the Pacific Islands

Adequate monitoring of dengue activity can be achieved using a combination of mosquito vector surveillance, fever surveillance, sentinel clinicians and laboratory screening. An apparent increase in fever cases or clinically suspected DF should prompt a careful clinical and laboratory investigation. If an outbreak of dengue is confirmed, health authorities will need to implement emergency community-wide control strategies. Laboratories will quickly feel the burden of clinical monitoring of cases admitted with DHF/DSS. Surveillance can change to clinical case definitions as health workers become familiar with the presenting features of DF and DHF/DSS. Criteria for hospital referral and admission must be well understood. Routine laboratory and sentinel surveillance may resume as the epidemic wanes, and should then continue indefinitely to monitor any resurgence of dengue activity.