Table 4.
The characteristics and results of studies which compared oral cholera vaccine vaccination in different strategies.
| Author | Naficy 199817 | Jeuland and Cook 200926 | Jeuland and Lucas 200924 | Troeger 201422 | Smalley 201521 |
|---|---|---|---|---|---|
| Comparator | 1) Preemptive treatment (PT) + Preemptive vaccination (PV) | 1) School-based vaccination for age 5–14 | With or without user fee for: | 1) Non-selective countrywide | Vaccination target strategies: |
| 2) Reactive treatment (RT) + Reactive vaccination (RV) | 2) School-based vaccination for age 1–14 | 1) School-based vaccination for age 5–14 | 2) Non-selective high -risk districts | 1) By age and region | |
| 3) PT + RV | 3) Community-based for all age groups | 2) School-based vaccination for age 1–14 | 3) Children <15 years | 2) Age only | |
| 4) RT + PV | 3) Community-based for all age groups | 4) Children < 15 years (with differing vaccine efficacy) | 3) Region only | ||
| 5) Hotspot targeted | by varying: | ||||
| 6) Poor access to treatment population targeted | Vaccine price, CFR, Years of investment | ||||
| Type of model; Herd effect | Static; No | Static; Yes | Static; Yes | Dynamic; Yes | Mixed integer programming model; No |
| Cost-effectiveness threshold defined? | No | Yes | NA | Yes | Yes |
| Results | The incremental cost per case was lower when vaccination started at the inception of refugee camp (preemptively) compared to after outbreak (reactively). | Cost-effective for all options when herd protection was included. | Positive benefit-cost ratio for all options when herd protection was included. | All except option 1 was cost-effective. | When CFR was 0.5%, all options were cost-effective when vaccine price was USD0.9/dose and the investment was < 8 years (20million doses/year) |
| Incidence (per 1,000 population per year) | NS | Varied by age: | Varied by age: | Varied by risk: | Varied by age and risk: |
| 0.3 – 7.2 | 1.4 – 17.6 | 2.1 – 10 | 0.6 – 11 | ||
| Coverage | 70–80% | 80% | 53–61% | 0–100% | NS |
| Effectiveness | 80% in the first 6 months and 0–50% thereafter (varied by age) | 60% in year 1 and 2, 50% in year 3 | 55%, reduced by 17% in year 3 | Overall 65% (42–74% by age) | Overall 65% (42–74% by age) |
| Cost per fully immunized person (USD 2015) | 1.56 | 2.54–3.68 | 2.70 | 5.16, 10.32 (Poor access to treatment) | 4 |
NA, Not applicable; NS, Not specified.