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Cost-effectiveness of using environmental surveillance to target the roll-out typhoid conjugate vaccine

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Hagedorn, Brittany L, Gauld, Jillian, Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405 and Hu, Hao (2020) 'Cost-effectiveness of using environmental surveillance to target the roll-out typhoid conjugate vaccine'. Vaccine, Vol 38, Issue 7, pp. 1661-1670.

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Abstract

Typhoid conjugate vaccine (TCV) has been shown to be costeffective in some settings, but to make the most of limited healthcare funds, the WHO recommends that decisions about when and where to introduce TCV should be based on local evidence of transmission. Further, Gavi, The Vaccine Alliance, recommends that countries request TCV funding based on epidemiological data from within-country. Since few countries have reliable case reporting, we considered environmental surveillance as a decision-support tool for vaccine introduction choices. Environmental surveillance methods are still in development and this analysis assesses its potential as a decision support tool. We combined a disease transmission simulation model with an economic model, to quantify the value of surveillance. The disease transmission model is fit to historical case reporting from Blantyre, Malawi. The economic model takes a social perspective and incorporates the cost of environmental surveillance, vaccination, and both direct and indirect cost of care for acute typhoid cases. We find that the use of time-limited environmental
surveillance to differentiate low- from high-endemicity areas is low cost relative to potential savings, especially if it is paired with a locally targeted vaccination campaign. These findings are robust to the uncertainty of cost model parameters and underlying endemicity.

Item Type: Article
Subjects: QW Microbiology and Immunology > Immunotherapy and Hypersensitivity > QW 805 Vaccines. Antitoxins. Toxoids
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Sanitation. Environmental Control > General Sanitation and Environmental Control > WA 670 General works
WC Communicable Diseases > Infection. Bacterial Infections > Enteric Infections > WC 270 Typhoid fever
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.vaccine.2019.12.061
Depositing User: Julie Franco
Date Deposited: 09 Jan 2020 11:52
Last Modified: 14 Feb 2020 16:37
URI: https://archive.lstmed.ac.uk/id/eprint/13470

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