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Bull World Health Organ. 1995;73(5):589-95.

Evaluation of house-to-house versus fixed-site oral poliovirus vaccine delivery strategies in a mass immunization campaign in Egypt.

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National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.


Among poliomyelitis eradication activities recommended by WHO are national immunization days. Most campaigns have delivered oral poliovirus vaccine (OPV) from fixed sites, reaching 80-90% of target populations. Although house-to-house vaccination provides nearly universal coverage, countries have been reluctant to use this approach because it is considered more costly and logistically difficult. To quantify the cost-effectiveness of both these strategies, we compared the vaccine coverage and vaccination costs per child for house-to-house and fixed-site delivery (38% and 13% higher, respectively), the costs per child vaccinated were similar. This was due primarily to the high coverage levels achieved in house-to-house delivery (100% versus 86%) and the reduced vaccine wastage. Vaccinating children at highest risk of infection was only 25-50% as expensive on a per child basis using house-to-house delivery, since such children were less likely to visit fixed sites. These findings may not be generalizable to other countries where labour costs are higher and the population density lower; however, house-to-house delivery may prove to be the most cost-effective eradication strategy by ensuring universal access to immunization.


In a 1993 mass immunization campaign in Egypt, the vaccine coverage rate and per child vaccination costs were compared for house-to-house versus fixed-site oral poliovirus vaccine (OPV) delivery. House-to-house delivery achieved 100% OPV coverage, compared to about 86% for fixed-site delivery (p 0.01). The cost for house-to-house vaccination was 25% higher than for fixed-site vaccination in urban areas, while they were similar in rural areas. Regardless of delivery approach, the cost of vaccine made up around 75% of the total cost of the campaign. In urban areas, the cost per child vaccinated was similar for both fixed-site and house-to-house vaccinations ($0.11). In rural areas, it was higher for fixed-site delivery than for house-to-house delivery ($0.14 vs. $0.11). Costs of fixed-site delivery for children who received either zero or 1 dose of OPV prior to the campaign were around 2-4 times higher than those of house-to-house delivery in both urban and rural areas. OPV wastage for both delivery approaches was the same (around 25%) in urban areas, while it was much higher for fixed-site vaccination than for house-to-house vaccination (41.5% vs. 23.5%). For fixed-site vaccinations, the youngest and oldest children, children with less than 3 OPV doses, and children without vaccination cards were less likely to be vaccinated than their counterparts (p 0.01). These findings suggest that, in Egypt, house-to-house delivery may be the most cost-effective strategy to achieve universal coverage and thus to eradicate polio.

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