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Evaluating the costs of cholera illness and cost-effectiveness of a single dose oral vaccination campaign in Lusaka, Zambia
Tannia Tembo | Michelo Simuyandi | Kanema Chiyenu | Anjali Sharma | Obvious N. Chilyabanyama | Clara Mbwili-Muleya | Mazyanga Lucy Mazaba | Roma Chilengi
Date of Publication:
In 2016, for the very first time, the Ministry of Health in Zambia implemented a reactive outbreak response to control the spread of cholera and vaccinated at-risk populations with a single dose of Shancol—an oral cholera vaccine (OCV). This study aimed to assess the costs of cholera illness and determine the cost-effectiveness of the 2016 vaccination campaign.
From April to June 2017, we conducted a retrospective cost and cost-effectiveness analysis in three peri-urban areas of Lusaka. To estimate costs of illness from a household perspective, a systematic random sample of 189 in-patients confirmed with V. cholera were identified from Cholera Treatment Centre registers and interviewed for out-of-pocket costs. Vaccine delivery and health systems costs were extracted from financial records at the District Health Office and health facilities. The cost of cholera treatment was derived by multiplying the subsidized cost of drugs by the quantity administered to patients during hospitalisation. The cost-effectiveness analysis measured incremental cost-effectiveness ratio—cost per case averted, cost per life saved and cost per DALY averted—for a single dose OCV.
The mean cost per administered vaccine was US$1.72. Treatment costs per hospitalized episode were US$14.49–US$18.03 for patients ≤15 years old and US$17.66–US$35.16 for older patients. Whereas households incurred costs on non-medical items such as communication, beverages, food and transport during illness, a large proportion of medical costs were borne by the health system. Assuming vaccine effectiveness of 88.9% and 63%, a life expectancy of 62 years and Gross Domestic Product (GDP) per capita of US$1,500, the costs per case averted were estimated US$369–US$532. Costs per life year saved ranged from US$18,515–US$27,976. The total cost per DALY averted was estimated between US$698–US$1,006 for patients ≤15 years old and US$666–US$1,000 for older patients.
The study determined that reactive vaccination campaign with a single dose of Shancol for cholera control in densely populated areas of Lusaka was cost-effective.
Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia
Eva Ferreras | Elizabeth Chizema-Kawesha | Alexandre Blake | Orbrie Chewe | John Mwaba | Gideon Zulu | Marc Poncin | Ankur Rakesh | Anne-Laure Page | Savina Stoitsova | Caroline Voute | Florent Uzzeni | Hugues Robert | Micaela Serafini | Belem Matapo | Jose-María Eiros | Marie-Laure Quilici | Lorenzo Pezzoli | Andrew S. Azman | Sandra Cohuet | Iza Ciglenecki | Kennedy Malama | Francisco J. Luquero
Date of Publication:
February 8, 2018
New England Journal of Medicine
Killed oral cholera vaccines (OCVs) are part of the standard response package to a cholera outbreak, although the two-dose regimen of vaccines that has been prequalified by the World Health Organization (WHO) poses challenges to timely and efficient reactive vaccination campaigns. Recent data suggest that the first dose alone provides short-term protection, similar to that of two doses, which may largely dictate the effect of OCVs during epidemics. A cholera outbreak was detected in Lusaka, Zambia, in February 2016, after a period of 4 years without a reported case of cholera. An emergency reactive vaccination campaign was implemented in April 2016, targeting more than 500,000 persons who were at high risk for cholera in Lusaka (population, >2 million persons). The Ministry of Health, with support from Médecins sans Frontières and the WHO, implemented a single-dose campaign to quell the epidemic rapidly, in view of the insufficient number of vaccine doses that were available in the global stockpile to complete a two-dose campaign. We conducted a matched case–control study to quantify the short-term effectiveness of a single-dose OCV regimen (Shanchol) between April 25, 2016, and June 15, 2016. Our results show the short-term effectiveness of a single dose of OCV delivered during an outbreak. Although additional work is needed to determine the protection provided by a single-dose vaccine in young children and persons not previously exposed to cholera, the duration of protection provided by a single-dose regimen, and an appropriate interval for the administration of a second dose, our results support the use of single-dose regimens to improve responses during a cholera outbreak.
Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia
Marc Poncin | Gideon Zulu | Caroline Voute | Eva Ferreras | Clara Mbwili Muleya | Kennedy Malama | Lorenzo Pezzoli | Jacob Mufunda | Hugues Robert | Florent Uzzeni | Francisco J Luquero | Elizabeth Chizema | Iza Ciglenecki
Date of Publication:
Bulletin of the World Health Organization
This study aimed to describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting. In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization to organize a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1,700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated. Overall, vaccination teams administered 424,100 doses of vaccine to an estimated target population of 578,043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$ 0.41 per dose. We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.