Prioritization of risk groups for influenza vaccination in resource limited settings - A case study from South Africa

Meredith L McMorrow, Stefano Tempia, Sibongile Walaza, Florette K Treurnicht, Wayne Ramkrishna, Eduardo Azziz-Baumgartner, Shabir A Madhi, Cheryl Cohen, Meredith L McMorrow, Stefano Tempia, Sibongile Walaza, Florette K Treurnicht, Wayne Ramkrishna, Eduardo Azziz-Baumgartner, Shabir A Madhi, Cheryl Cohen

Abstract

Background: Due to competing health priorities, low- and middle-income countries (LMIC) may need to prioritize between different influenza vaccine risk groups. Risk group prioritization may differ in LMIC based upon programmatic feasibility, country-specific prevalence of risk conditions and influenza-associated morbidity and mortality.

Methods: In South Africa, we collected local disease burden data (both published and unpublished) and published vaccine efficacy data in risk groups and healthy adults. We used these data to aid policy makers with risk group prioritization for influenza vaccination. We used the following formula to assess potential vaccine averted disease in each risk group: rate of influenza-associated hospitalization (or death) per 100,000 population * influenza vaccine efficacy (VE). We further estimated the cost per hospital day averted and the cost per year of life saved by influenza vaccination.

Results: Pregnant women, HIV-infected adults, and adults and children with tuberculosis disease had among the highest estimates of hospitalizations averted per 100,000 vaccinated and adults aged 65 years and older had the highest estimated deaths averted per 100,000 vaccinated. However, when assessing both the cost per hospital day averted (range: USD148-1,344) and the cost per year of life saved (range: USD112-1,230); adults and children with TB disease, HIV-infected adults and pregnant women had the lowest cost per outcome averted.

Discussion: An assessment of the potential disease outcomes averted and associated costs may aid policymakers in risk group prioritization for influenza vaccination.

Keywords: Hospitalization; Influenza; Mortality; South Africa; Vaccine policy.

Conflict of interest statement

Conflicts of interest

Dr. Shabir Madhi has received grants from the US Centers for Disease Control and Prevention, the Bill and Melinda Gates Foundation, Pfizer, GlaxoSmithKline and Novartis, and personal fees from the Bill and Melinda Gates Foundation. Dr. Cheryl Cohen has received grants from the US Centers for Disease Control and Prevention and Sanofi Pasteur and travel expenses paid by Parexel. The remaining authors have no conflict of interest to report.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

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Source: PubMed

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