Table 2.
Outbreak containment strategies and costs
| Reference | Location, year | Containment strategy | Total number of cases | Number receiving chemoprophylaxis or drug, unit costa | Number vaccinated, vaccine type, unit costa | Volunteer costs, medical staff costsa | Public health campaign costsa | Total costa | Cost per IMD casea |
|---|---|---|---|---|---|---|---|---|---|
| Small containment strategies (all among high-income countries) | |||||||||
| Houck et al. [29] | Washington state, USA, 1989–1991 | Chemoprophylaxis (rifampin) was offered to all contacts of patients | 40 CC, 5 PC | 4,100, NR | 22,801, $29 each | NR | NR | $661,229b for vaccines | $14,694 vaccine cost |
| Watson [13] | Jacksonville, North Carolina, USA, 1990 | Vaccination of students, close contacts, and parents | 3 | NR | 656 (midpoint cost $33, range $10–$56) | NR | NR | $21,588 ($6,570–$36,606)b for vaccines | $7,196 vaccine cost |
| Imrey et al. [40] | Champaign-Urbana, Illinois, USA, 1991 | Vaccination of undergraduate students | 9 | NR | 16,000 (midpoint cost $33, range $10–$56) | NR | NR | $526,539 ($160,251–$892,828)b for vaccines | $58,504 vaccine cost |
| Hendricks [13] | Harris County, Texas, USA, 1991 | Vaccination of students and staff | 4 | NR | 1,150 (midpoint cost $33, range $10–$56) | NR | NR | $37,845 ($11,518–$64,172)b for vaccines | $9,461 vaccine cost |
| Banerji et al. [30] | Ottawa, Ontario and Hull, Quebec, Canada, 1991–1992 | Patients seen in the ED and clinically considered at moderate risk for meningococcal disease received a single intravenous dose of ceftriaxone 80 mg/kg | 10 CC | Drugs: 101 ceftriaxone doses, $124 each | NR | NR | NR | $12,524b for ceftriaxone | $1,252 antibiotics cost |
| Edmond et al. [41] | Johnson County, Iowa, USA, 1992 | Vaccination of all university students | 5 | NR | 18,000 (midpoint cost $33, range $10–$56) | NR | NR | $592,357 ($180,283–$1,004,431)b for vaccines | $118,471 vaccine cost |
| Kurland [13] | Storrs, Connecticut, USA, 1993 | Vaccination of students younger than 30 years | 3 | NR | 12,364 (midpoint cost $33, range $10–$56) | NR | NR | $406,883 ($123,834–$689,933)b for vaccines | $135,628 vaccine cost |
| Irwin et al. [31] | Trent, England, UK, 1995–1996 | Chemoprophylaxis and vaccination of school | 7 CC, 1 SC | NR | Direct contacts: 2 school targets: 15,980 people (92 %), total cost of drugs and preparation $44,562 | Medical staff: $227,267 | NR | $557,028 (8 days) | $69,629 total cost ($8,704 vaccine cost) |
| Tolomeo et al. [32] | Hamilton-Wentworth region, Canada, 1996 | Immunize vaccine-eligible students of the entire school, alert media, area physicians, hospitals, and other community partners | 3 CC | 18, NR | 1,453 | NR | 37 Health Dept staff, 4 nursing staff, $39,805 | $39,805 excludes vaccine costs and supplies (5 days) | $13,268 public health cost |
| Robinson et al. [34] | Victoria, Australia, 1999 | Chemoprophylaxis for close contacts, vaccination of school staff and students | 3 CC | Community: 3,712 rifampicin capsules, $6 for 100 capsules; total $228 for rifampicin | 1,530 (95 % coverage), $36,948 vaccine | Medical staff: $4,958 vaccination campaign | $5,014 medical officers, nursing staff, administration, and media | $42,254 | $14,085 total cost ($12,316 vaccine cost) |
| Large containment strategies among high-income countries | |||||||||
| Oakes [42] | Magnolia, Mississippi, USA, 1990 | Vaccinated children aged 2–18 in school district and teachers | 3 | NR | 8,500 (midpoint cost $33, range $10–$56) | NR | NR | $279,009 ($85,133–$474,315)b for vaccines | $93,003 vaccine cost |
| CDC [13] | Butte, Montana, USA, 1992 | Vaccinated county residents aged 1–17 | 7 | NR | 7,000 (midpoint cost $33, range $10–$56) | NR | NR | $230,361 ($70,110–$390,612)b for vaccines | $32,909 vaccine cost |
| Birkhead [13] | Jefferson County, New York, USA, 1992 | Vaccinated county residents aged 2–29 | 13 | NR | 40,000 (midpoint cost $33, range $10–$56) | NR | NR | $1,316,349 ($400,628–$2,232,069)b for vaccines | $101,258 vaccine cost |
| Jafari [13] | Carroll County, Georgia, USA, 1992 | Vaccinated county residents aged 2–29 | 11 | NR | 20,000 (midpoint cost $33, range $10–$56) | NR | NR | $658,174 ($200,314–$1,116,035)b for vaccines | $59,834 vaccine cost |
| Zeitz [13] | Maricopa County, Arizona, USA, 1992 | Vaccinated residents of southcentral Phoenix aged 2–9 | 31 | NR | 55,250 (midpoint cost $33, range $10–$56) | NR | NR | $1,818,206 ($553,367–$3,083,046)b for vaccines | $58,652 vaccine cost |
| Wenger et al. [43] | Grayson County, Texas, USA, 1993 | Vaccinated county residents aged 2–29 | 14 | NR | 11,200 (midpoint cost $33, range $10–$56) | NR | NR | $368,578 ($112,176–$624,979)b for vaccines | $26,327 vaccine cost |
| Osterholm [15] | Mankato, Minnesota, USA, 1995 | Chemoprophylaxis rifampin and vaccination of 30,000 | 9 PC | NR | 30,000, $1,477,511 | Medical staff: 23 days, 18 h per day | Phone bank set up | $1,477,511 for vaccine cost | $164,168 vaccine cost |
| Austin et al. [14] | Illinois, USA, 1996 | Chemoprophylaxis and vaccination of all children aged 2 years to in the 8th grade in town | 4 PC | NR | Direct contacts: 3,500 (86–94 % coverage), NR | NR | NR | $105,484 or $7 per town resident | $26,371 |
| Krause et al. [33] | Florida, USA, 1998 | Chemoprophylaxis of contacts, vaccination of contacts and community for ages 2–22 | 7 CC | 484, rifampicin, ciprofloxacin, or ceftriaxone | 13,535 Menommune quadrivalent polysaccharide vaccine, $321,733 (65 % of total cost) | Medical staff: $98,995 (20 % of total cost) | $29,431 (6 % of total cost) | $494,974 (2 weeks) | $70,711 total cost ($45,962 vaccine cost) |
| Renevey et al. [35] | La Gruyère, Switzerland, 2000–2001 | Vaccinated all aged 2–17 years | 7 CC | NR | 9,731 polysaccharide vaccines $60 per vaccine, $582,835 total vaccine cost | $54,483 | NR | $637,319 | $91,046 total cost ($83,262 vaccine cost) |
| Weiss et al. [16] | Brooklyn, New York, USA, 2005–2006 | Vaccination of adults >18 years living in 1 of 4 central Brooklyn zip codes with history of illicit drug use and household contacts | 25 CC, 6 PC | NR | 2,763 MCV4, NR | NR | NR | $1,081,627 (94 days) | $34,891 |
| Large containment strategies among low-income countries | |||||||||
| Varaine et al. [36] | Guinea, Africa, 1992–1993 | Target population of people over the age of 1 in districts where rates exceeded 5/100,000 | 2,435 PC | NR | 629,913 A/C polysaccharide vaccine, vaccine cost $258,108 (59 % of total cost, 14 % injection material) | NR | 3,000 person workdays (16 % logistics, 11 % wages of total cost) | $437,471 | $180 total cost ($106 vaccine cost) |
| daSilva et al. [37] | Senegal, West Africa, 1995–1996 | NR | 33,047 (1995) 153,655 (1996) | NR | 85,925, $0.46/ polysaccharide A/C meningococcal and yellow fever vaccine (calculated cost of $39,526) | $4,360 Coordination, supervision, procurement, transport, social mobilization, paper | NR | $58,363 | $0.31 total cost ($1.20 vaccine cost) |
| Ahmad [38] | Nanoro, Burkina Faso, Africa, 2002 | Vaccination of people in Burkina Faso’s Nanoro district | 1,500 PC | NR | 135,000, trivalent A/C/W135 vaccine, $1/dose, $135,000 total | NR | NR | Donations of $9,726,937 | $6,485 total cost ($90 vaccine cost) |
CC confirmed case, ED emergency department, EMS emergency medical services, IMD invasive meningococcal disease, MCV meningococcal conjugate vaccine, NR not reported, PC probable case
aConverted to USD 2010
bVaccine cost calculated by multiplying the number of vaccinations by unit cost