Comparison of cost-effectiveness of preventive and reactive mass immunization campaigns against meningococcal meningitis in West Africa: a theoretical modeling analysis
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Abstract
For epidemic meningitis control in sub-Saharan Africa, the World Health Organization
recommends a strategy of emergency vaccination with meningococcal A + C polysaccharide
vaccine when epidemic thresholds are exceeded. An alternative strategy for areas without
effective surveillance systems is mass preventive campaigns before outbreaks occur.
A model was formulated to simulate epidemics and to compare the cost-effectiveness
of these two strategies for the district of Matam, Senegal, where an actual preventive
campaign was performed during 1997. The preventive strategy prevented 59% of the cases
compared to 49% for the emergency strategy. The cost per case prevented was US$59
for the preventive strategy and US$133 for the reactive strategy, and the preventive
strategy saved US$0.20 per habitant. Preventive meningococcal vaccination through
mass campaigns prevented more outcomes at a lower cost, provided that the occurrence
of an epidemic could be predicted within 3 years and that the vaccination coverage
rates for the preventive and standard strategies were > 70% and < 94%, respectively.
Sub-Saharan African countries without effective surveillance systems should consider
mass preventive campaigns while awaiting an affordable conjugate vaccine.