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Priority during a meningitis epidemic: vaccination or treatment?
H Veeken1, K Ritmeijer, B Hausman
1Medical Department, Médecins sans Frontières-Holland, Amsterdam, Netherlands. hans_veeken@amsterdam.msf.org
Bulletin of the World Health Organization
|July 2, 1998
Summary
During a 1995-1996 meningitis epidemic in Nigeria, case management proved more cost-effective than mass vaccination. Prioritizing treatment is crucial for saving lives in areas with weak surveillance systems.
Area of Science:
- Epidemiology
- Public Health
- Health Economics
Background:
- A severe meningitis epidemic struck northern Nigeria from November 1995 to May 1996, resulting in over 75,000 cases and 8,440 deaths.
- The case fatality rate (CFR) was 11%, highlighting the urgent need for effective interventions.
Purpose of the Study:
- To analyze the cost-effectiveness of an assistance program implemented by Médecins sans Frontières and the Nigerian government.
- To compare the cost per death averted by improved case management versus mass vaccination during the epidemic.
Main Methods:
- The study focused on Katsina State, one of the three most affected states, to conduct a cost analysis.
- Intervention costs included case management, surveillance, and mass vaccination efforts.
- Cost-effectiveness was evaluated based on the cost per death averted for each strategy.
Main Results:
- Both case management (US$35 per case) and mass vaccination (US$0.64 per vaccination) were found to be efficient interventions.
- Improved case treatment averted a death at an estimated cost of US$396.
- Mass vaccination averted a death at a significantly higher estimated cost of US$6000, largely due to its late initiation.
Conclusions:
- Case management demonstrated superior cost-effectiveness in averting deaths compared to mass vaccination during this meningitis epidemic.
- The delayed start of vaccination significantly impacted its cost-effectiveness.
- In regions with inadequate surveillance systems, such as much of sub-Saharan Africa, prioritizing curative programs during epidemics is recommended.