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Prehosp Disaster Med. 2015 Aug;30(4):402-11. doi: 10.1017/S1049023X15004781. Epub 2015 Jun 10.

Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia.

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1Division of Global Health Protection,Center for Global Health,Centers for Disease Control and Prevention,Atlanta,GeorgiaUSA.
2Division of Bacterial Diseases,National Center of Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,GeorgiaUSA.



Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia. Problem This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency.


An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values.


Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden.


The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child's life, cost is reasonable, and herd immunity is possible.


ARI acute respiratory infection; CFR case fatality rate; DALY disability-adjusted life-year; GAVI Global Alliance for Vaccines and Immunization; GDP gross domestic product; Haemophilus influenzae type b; Hib Haemophilus influenzae type b; ICER incremental cost-effectiveness ratio; IDP internally displaced person; PCV10; PCV10 pneumococcal conjugate vaccine 10; SIA supplemental immunization activity; Streptococcus pneumoniae; UN United Nations; UNHCR United Nations High Commissioner for Refugees; UNICEF UN Children’s Fund; WHO World Health Organization; cost-effectiveness; humanitarian emergency

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