Cost-benefit of mass prophylaxis with immune serum globulin to control waterborne hepatitis A: a case study

Following a point-source epidemic of more than 8,000 cases of Shigella sonnei, which was caused by a sewage-contaminated water supply, immune serum globulin (ISG) was administered to 11,306 children, aged 5 to 9 years, and to 1,338 pregnant women to prevent a possible outbreak of hepatitis A. A cost-benefit analysis showed that the estimated cost of preventing one possible case of hepatitis in a child was $362.50, and in a pregnant women $11,514. The benefit:cost ratios were 0.45 and 0.28, respectively. These relatively low ratios call for reconsideration of the guidelines that recommend ISG administration to children and pregnant women following an exposure to contaminated water.