title: The cost and public health burden of invasive meningococcal disease outbreaks: a systematic review.
abstract: BACKGROUND
  Invasive meningococcal disease (IMD) is a serious disease with a rapid onset, high mortality rate, and risk of long-term complications. Numerous reports in the literature conclude that IMD outbreaks are associated with substantial costs to society and significant burden on communities due to the cost associated with the prevention of secondary cases.
  
  
  OBJECTIVE
  To systematically review the literature on the costs and public health burden associated with IMD outbreaks.
  
  
  METHODS
  Studies were primarily identified through searching MEDLINE and EMBASE. Reports were included if they provided cost data related to the containment of an IMD outbreak after 1990 and were written in English, French, or Spanish. Costs were converted to 2010 United States dollars. Outbreaks were categorized by low-income countries (LIC) and high-income countries (HIC) based on gross domestic product per capita. Outbreak containment strategies were classified as small (e.g., targeting members of the school/institution where the outbreak occurred) or large (e.g., targeting everyone in the community).
  
  
  RESULTS
  Sixteen articles reporting data on 93 IMD outbreaks fulfilled the eligibility criteria and were included. The majority of outbreaks occurred in HIC. Five studies reported the use of small containment strategies including targeted vaccination and chemoprophylaxis, all occurring in HIC. The average cost per small containment strategy was $299,641 and the average cost per IMD case was $41,857. Eight studies reported large containment strategies involving widespread vaccination targeting a specific age group or community. For HIC, the average cost per large containment strategy was $579,851 and the average cost per IMD case was $55,755. In LIC, the average cost per large containment strategy was $3,407,590 and the average cost per IMD case was $2,222.
  
  
  CONCLUSIONS
  IMD outbreaks were associated with substantial costs. We found that although there were numerous reports on IMD outbreaks, data on containment costs were very limited. More research in this area is warranted.
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium. andrea.anonychuk@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Anonychuk
authors.forename: Gloria
authors.initials: G
authors.lastname: Woo
authors.forename: Andrew
authors.initials: A
authors.lastname: Vyse
authors.forename: Nadia
authors.initials: N
authors.lastname: Demarteau
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
mesh_terms: D018890:Chemoprevention / Q000191:economics; D003362:Cost-Benefit Analysis; D019049:Developed Countries / Q000191:economics; D003906:Developing Countries / Q000191:economics; D004196:Disease Outbreaks / Q000191:economics* / Q000517:prevention & control / Q000706:statistics & numerical data; D017048:Health Care Costs; D006801:Humans; D008589:Meningococcal Infections / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D011634:Public Health / Q000191:economics*; D014611:Vaccination / Q000191:economics