Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo |
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| Affiliation: | 1. Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA;2. Institute for Disease Modeling, Bellevue, WA, USA;3. Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo;4. Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo;5. Polio Program, Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA;6. Kinshasa School of Public Health, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of Congo;7. Institute Nationale de Recherche Biomedicale, Kinshasa, Democratic Republic of Congo;8. Department of Health Policy and Management, UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA, USA;1. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;2. Laboratorio Nacional de Virologia, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua;3. Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua;4. Sustainable Sciences Institute, Managua, Nicaragua;5. Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720, USA;1. Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia;2. Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia;1. Institute of Bacterial Infections and Zoonoses at the Friedrich-Loeffler-Institute, Federal Research Institute for Animal Health, Naumburger Str. 96a, D-07743 Jena, Germany;2. Institute of Molecular Pathogenesis at the Friedrich-Loeffler-Institute, Federal Research Institute for Animal Health, Naumburger Str. 96a, D-07743 Jena, Germany;1. Solina Center for International Development and Research, SCIDaR, Abuja, Nigeria;2. Kano State Primary Health Care Management Board, Kano, Nigeria;3. eHealth Africa, Kano, Nigeria |
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| Abstract: | IntroductionOne of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose.MethodsWe modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children.ResultsCompared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million.DiscussionVaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved. |
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| Keywords: | Measles Immunization Democratic Republic of Congo Vaccine-preventable diseases Cost-effectiveness |
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