title: Comparison of cost-effectiveness of preventive and reactive mass immunization campaigns against meningococcal meningitis in West Africa: a theoretical modeling analysis.
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.
authors.affiliation: Association pour l'Aide à la Médecine Préventive, 28 rue du Docteur Roux, 75724 Cedex 15, Paris, France. iparent@compuserve.com
authors.forename: I
authors.initials: I
authors.lastname: Parent du Châtelet
authors.forename: B D
authors.initials: BD
authors.lastname: Gessner
authors.forename: A
authors.initials: A
authors.lastname: da Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007114:Immunization / Q000191:economics*; D007223:Infant; D008585:Meningitis, Meningococcal / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D008962:Models, Theoretical; D012675:Senegal / Q000453:epidemiology; D012680:Sensitivity and Specificity
chemical_list: D022401:Meningococcal Vaccines