The Economic Case for Expanding Vaccination Coverage of Children

While childhood vaccination programs, such as WHO’s Expanded Program on Immunization, have had a dramatic impact on child morbidity and mortality worldwide, lack of coverage with several existing vaccines is responsible for large numbers of child deaths each year, mostly in developing countries. According to WHO estimates, increased coverage of three vaccines alone – pneumococcal conjugate vaccine (PCV), rotavirus vaccine (Rota), and Haemophilus influenzae type b (Hib) vaccine – could have prevented one and a half million deaths in children under five years in 2002. In deciding whether to implement interventions to expand vaccination coverage policy makers often consider economic evaluations. Past evaluations, however, have usually ignored both important vaccination benefits and potentially large cost reductions in vaccination delivery. We demonstrate for the example of benefit-cost analysis (BCA) of the Hib vaccination that past studies have mostly taken narrow evaluation perspectives, focusing on health gains, health care cost savings, and reductions in the time costs that parents incur when taking care of sick children, while ignoring other benefits, in particular, outcome-related productivity gains (Hib vaccination can prevent permanent mental and physical disabilities) behavior-related productivity gains (reductions in child mortality due to Hib can trigger changes in fertility which in turn may stimulate economic growth) and community externalities (Hib vaccination can prevent the development of antibiotic resistance and reduce the risk of Hib infections in unvaccinated persons). We further show that the costs of Hib vaccine delivery can be reduced if the monovalent Hib vaccine is replaced by combination vaccines. Such cost reductions have usually been ignored in CBA of Hib. Our analysis thus suggests that past BCAs are likely to have substantially underestimated the value of Hib vaccination, even though most have found it to be cost-beneficial. Unless future BCAs of childhood vaccinations take full account of benefits and costs, policy makers may lack sufficient information to make the right decisions on vaccination interventions.vaccination coverage, children, economics

Identification and Selection of Cases and Controls in the Pneumonia Etiology Research for Child Health Project

Methods for the identification and selection of patients (cases) with severe or very severe pneumonia and controls for the Pneumonia Etiology Research for Child Health (PERCH) project were needed. Issues considered include eligibility criteria and sampling strategies, whether to enroll hospital or community controls, whether to exclude controls with upper respiratory tract infection (URTI) or nonsevere pneumonia, and matching criteria, among others. PERCH ultimately decided to enroll community controls and an additional human immunodeficiency virus (HIV)–infected control group at high HIV-prevalence sites matched on age and enrollment date of cases; controls with symptoms of URTI or nonsevere pneumonia will not be excluded. Systematic sampling of cases (when necessary) and random sampling of controls will be implemented. For each issue, we present the options that were considered, the advantages and disadvantages of each, the rationale for the methods selected for PERCH, and remaining implications and limitations

PneumoADIP: An Example of Translational Research to Accelerate Pneumococcal Vaccination in Developing Countries

Historically, the introduction of new vaccines in developing countries has been delayed due to lack of a coordinated effort to address both demand and supply issues. The introduction of vaccines in developing countries has been plagued by a vicious cycle of uncertain demand leading to limited supply, which keeps prices relatively high and, in turn, further increases the uncertainty of demand. The Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP) is an innovative approach designed to overcome this vicious cycle and to help assure an affordable, sustainable supply of new pneumococcal vaccines for developing countries. Translational research will play an important role in achieving the goals of PneumoADIP by establishing the burden of pneumococcal disease and the value of pneumococcal vaccines at global and country levels. If successful, PneumoADIP will reduce the uncertainty of demand, allow appropriate planning of supply, and achieve adequate and affordable availability of product for the introduction of pneumococcal vaccines. This model may provide a useful example and valuable lessons for how a successful public-private partnership can improve global health

Risk Factors for Pediatric Invasive Group A Streptococcal Disease

Invasive group A Streptococcus (GAS) infections can be fatal and can occur in healthy children. A case-control study identified factors associated with pediatric disease. Case-patients were identified when Streptococcus pyogenes was isolated from a normally sterile site, and matched controls (≥2) were identified by using sequential-digit dialing. All participants were noninstitutionalized surveillance-area residents <18 years of age. Conditional regression identified factors associated with invasive disease: other children living in the home (odds ratio [OR] = 16.85, p = 0.0002) and new use of nonsteroidal antiinflammatory drugs (OR = 10.64, p = 0.005) were associated with increased risk. More rooms in the home (OR = 0.67, p = 0.03) and household member(s) with runny nose (OR = 0.09, p = 0.002) were associated with decreased risk. Among children, household-level characteristics that influence exposure to GAS most affect development of invasive disease

Rapid Assessment Tool for Haemophilus influenzae type b Disease in Developing Countries1

Haemophilus influenzae type b disease prevalence in children provides estimates of national disease prevalence

Specimen collection for the diagnosis of pediatric pneumonia.

Diagnosing the etiologic agent of pneumonia has an essential role in ensuring the most appropriate and effective therapy for individual patients and is critical to guiding the development of treatment and prevention strategies. However, establishing the etiology of pneumonia remains challenging because of the relative inaccessibility of the infected tissue and the difficulty in obtaining samples without contamination by upper respiratory tract secretions. Here, we review the published and unpublished literature on various specimens available for the diagnosis of pediatric pneumonia. We discuss the advantages and limitations of each specimen, and discuss the rationale for the specimens to be collected for the Pneumonia Etiology Research for Child Health study

Monitoring the introduction of pneumococcal conjugate vaccines into West Africa: design and implementation of a population-based surveillance system.

Routine use of pneumococcal conjugate vaccines (PCVs) in developing countries is expected to lead to a significant reduction in childhood deaths. However, PCVs have been associated with replacement disease with non-vaccine serotypes. We established a population-based surveillance system to document the direct and indirect impact of PCVs on the incidence of invasive pneumococcal disease (IPD) and radiological pneumonia in those aged 2 months and older in The Gambia, and to monitor changes in serotype-specific IPD. Here we describe how this surveillance system was set up and is being operated as a partnership between the Medical Research Council Unit and the Gambian Government. This surveillance system is expected to provide crucial information for immunisation policy and serves as a potential model for those introducing routine PCV vaccination in diverse settings