Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-21T15:41:11.344Z Has data issue: false hasContentIssue false
  • English
  • Français

Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia

Published online by Cambridge University Press:  10 June 2015

Lisa M. Gargano ,
Rana Hajjeh  and
Susan T. Cookson
Lisa M. Gargano*
Affiliation:
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
Rana Hajjeh
Affiliation:
Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
Susan T. Cookson
Affiliation:
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
*
Correspondence: Lisa M. Gargano, MPH, PhD 4770 Buford Highway Atlanta, Georgia 30341 USA E-mail: lisa.gargano@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia.

Problem

This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency.

Methods

An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values.

Results

Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden.

Conclusions

The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child’s life, cost is reasonable, and herd immunity is possible.

GarganoLM, HajjehR, CooksonST. Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia. Prehosp Disaster Med. 2015;30(4):110.

Keywords

cost-effectivenessHaemophilus influenzae type bhumanitarian emergencyPCV10Streptococcus pneumoniae
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 4 , August 2015 , pp. 402 - 411
Copyright
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. United Nations High Commissioer for Refugees. UNHCR Global Trends 2012. http://unhcr.org/globaltrendsjune2013/UNHCR GLOBAL TRENDS 2012_V08_web.pdf. Accessed May 26, 2014.Google Scholar
2. Connolly, MA, Gayer, M, Ryan, MJ, Salama, P, Spiegel, P, Heymann, DL. Communicable diseases in complex emergencies: impact and challenges. Lancet. 2004;364(9449):1974-1983.Google Scholar
3. Connolly, MA, Heymann, DL. Deadly comrades: war and infectious diseases. Lancet. 2002;360(Suppl):s23-s24.Google Scholar
4. Black, RE, Morris, SS, Bryce, J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226-2234.Google Scholar
5. Rudan, I, Boschi-Pinto, C, Biloglav, Z, Mulholland, K, Campbell, H. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization. 2008;86(5):408-416.CrossRefGoogle ScholarPubMed
6. O’Brien, KL, Wolfson, LJ, Watt, JP, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374(9693):893-902.Google Scholar
7. Watt, JP, Wolfson, LJ, O’Brien, KL, et al. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet. 2009;374(9693):903-911.Google Scholar
8. GAVI Alliance. Haemophilus influenzae type b vaccine support. http://www.gavialliance.org/support/nvs/hib/. Accessed May 4, 2014.Google Scholar
9. GAVI Alliance. Pneumococcal vaccine support. http://www.gavialliance.org/support/nvs/pneumococcal/. Accessed May 4, 2014.Google Scholar
10. Menkhaus, K. Governance without government in Somalia: spoilers, state building, and the politics of coping. Int Secr. 2006;31(3):74-106.Google Scholar
11. UNICEF. UNICEF sends in health experts to prevent cholera epidemic in Somalia. http://www.unicef.org/infobycountry/somalia_59971.html. Accessed October 31, 2012.Google Scholar
12. Centers for Disease Control and Prevention. Poliomyelitis outbreak in Somalia and Kenya, 2013. Releve epidemiologique hebdomadaire/Section d'hygiene du Secretariat de la Societe des Nations=Weekly epidemiological record/Health Section of the Secretariat of the League of Nations. 2013;88(33):349-355.Google Scholar
13. Broughton, EI. Economic evaluation of Haemophilus influenzae type B vaccination in Indonesia: a cost-effectiveness analysis. Journal of Public Health. 2007;29(4):441-448.CrossRefGoogle ScholarPubMed
14. Griffiths, UK, Clark, A, Hajjeh, R. Cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in low- and middle-income countries: regional analysis and assessment of major determinants. The Journal of Pediatrics. 2013;163(1 Suppl):S50-S59 e59.Google Scholar
15. Gupta, M, Prinja, S, Kumar, R, Kaur, M. Cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization schedule in Haryana State, India. Health Policy and Planning. 2013;28(1):51-61.Google Scholar
16. Kim, SY, Lee, G, Goldie, SJ. Economic evaluation of pneumococcal conjugate vaccination in The Gambia. BMC Infectious Diseases. 2010;10:260.Google Scholar
17. Sinha, A, Levine, O, Knoll, MD, Muhib, F, Lieu, TA. Cost-effectiveness of pneumococcal conjugate vaccination in the prevention of child mortality: an international economic analysis. Lancet. 2007;369(9559):389-396.CrossRefGoogle ScholarPubMed
18. Tasslimi, A, Nakamura, MM, Levine, O, Knoll, MD, Russell, LB, Sinha, A. Cost effectiveness of child pneumococcal conjugate vaccination in GAVI-eligible countries. International Health. 2011;3(4):259-269.CrossRefGoogle ScholarPubMed
19. Tate, JE, Kisakye, A, Mugyenyi, P, Kizza, D, Odiit, A, Braka, F. Projected health benefits and costs of pneumococcal and rotavirus vaccination in Uganda. Vaccine. 2011;29(17):3329-3334.Google Scholar
20. GAVI Alliance. Country hub: Somalia. http://www.gavialliance.org/country/somalia/. Accessed May 4, 2014.Google Scholar
21. SAGE. Expanding the potential impact of Haemophilus influenzae type b vaccines (Hib) by optimizing immunization schedules. http://blogs.lshtm.ac.uk/vaccineschedules/files/1.-Summary-of-evidence-on-Hib-vaccines-for-SAGE-2013.pdf. Accessed May 4, 2014.Google Scholar
22. Checchi, F, Roberts, L. Interpreting and Using Mortality Data in Humanitarian Emergencies: A Primer for Non-epidemiologists. London, United Kingdom: Humanitarian Practice Network, Overseas Development Institute; 2005.Google Scholar
23. UNICEF. Multiple Indicator Cluster Survey (MICS) 3. http://www.childinfo.org/mics3_surveys.html. Accessed May 6, 2013.Google Scholar
24. GAVI Alliance. Pentavalent vaccine support. http://www.gavialliance.org/support/nvs/pentavalent/. Accessed May 4, 2014.Google Scholar
25. World Health Organization. CHOsing Interventions that are Cost Effective (WHO-CHOICE). http://www.who.int/choice/en/. Accessed May 25, 2012.Google Scholar
26. Centers for Disease Control and Prevention. Nationwide measles vaccination campaign for children aged 6 months-12 years--Afghanistan, 2002. MMWR Morb Mortal Wkly Rep. 2003;52(16):363-366.Google Scholar
27. Centers for Disease Control and Prevention. Emergency measles control activities--Darfur, Sudan, 2004. MMWR Morb Mortal Wkly Rep. 2004;53(38):897-899.Google Scholar
28. Grais, RF, Strebel, P, Mala, P, Watson, J, Nandy, R, Gayer, M. Measles vaccination in humanitarian emergencies: a review of recent practice. Confl Health. 2011;5(1):21.Google Scholar
29. United Nations High Commissoner for Refugees. Nutrition Surveys Dadaab Refugee Camps, August/September 2011. Geneva, Switzerland: UNHCR; 2011.Google Scholar
30. Scott, A. The Pneumococcal Conjugate Vaccine Impact Study (PCVIS). http://www.kemri-wellcome.org/index.php/en/studies_inner/75. Accessed May 27, 2014.Google Scholar
31. Cornick, JE, Everett, DB, Broughton, C, et al. Invasive Streptococcus pneumoniae in children, Malawi, 2004-2006. Emerging Infectious Diseases. 2011;17(6):1107-1109.CrossRefGoogle ScholarPubMed
32. Cutts, FT, Zaman, SM, Enwere, G, et al. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomized, double-blind, placebo-controlled trial. Lancet. 2005;365(9465):1139-1146.CrossRefGoogle Scholar
33. Salomon, JA, Vos, T, Hogan, DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143.Google Scholar
34. World Health Organization. Cost-effectiveness Thresholds. http://www.who.int/choice/costs/CER_thresholds/en/index.html. Accessed October 31, 2012.Google Scholar
35. UNData. Somalia. http://data.un.org/CountryProfile.aspx?crName=Somalia-Economic. Accessed May 4, 2014.Google Scholar
36. Griffiths, UK, Clark, A, Gessner, B, et al. Dose-specific efficacy of Haemophilus influenzae type b conjugate vaccines: a systematic review and meta-analysis of controlled clinical trials. Epidemiology and Infection. 2012;140(8):1343-1355.Google Scholar
37. World Health Organization and UNICEF. Integrated Management of Childhood Illness. http://apps.who.int/iris/bitstream/10665/104772/16/9789241506823_Chartbook_eng.pdf?ua=1. Accessed October 11, 2014.Google Scholar
38. Moodley, K, Hardie, K, Selgelid, MJ, et al. Ethical considerations for vaccination programmes in acute humanitarian emergencies. Bulletin of the World Health Organization. 2013;91(4):290-297.CrossRefGoogle ScholarPubMed
39. World Health Organization, SAGE. SAGE Working Group on Vaccination in Humanitarian Emergencies. Geneva, Switzerland: World Health Organization; 2012.Google Scholar
40. Doctors Without Borders/Médecins Sans Frontières (MSF). Faces from Yida: An MSF Vaccination Campaign in South Sudan. http://www.doctorswithoutborders.org/article/faces-yida-msf-vaccination-campaign-south-sudan. Accessed June 21, 2014.Google Scholar