Assessment of the Clinical and Economic Impact of Different Immunization Protocols of Measles, Mumps, Rubella and Varicella in Internationally Adopted Children.

Sara Boccalini,Angela Bechini,Cecilia Maria Alimenti,Paolo Bonanni,Elena Chiappini,Luisa Galli

doi:10.3390/vaccines8010060

Sara Boccalini, Angela Bechini + Show 4 more

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https://doi.org/10.3390/vaccines8010060

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Journal: Vaccines	Publication Date: Feb 1, 2020
Citations: 4	License type: CC BY 4.0

Affiliation: University of Florence, Meyer Children's Hospital

Abstract

The appropriate immunization of internationally adopted children (IAC) is currently under debate and different approaches have been suggested. The aim of this study is to evaluate the clinical and economic impact of different strategies of measles, mumps, rubella, and varicella (MMRV) immunization in IAC in Italy. A decision analysis model was developed to compare three strategies: presumptive immunization, pre-vaccination serotesting and vaccination based on documentation of previous immunization. Main outcomes were the cost of strategy, number of protected IAC, and cost per child protected against MMRV. Moreover, the incremental cost-effectiveness ratio (ICER) was calculated. The strategy currently recommended in Italy (immunize based on documentation) is less expensive. On the other hand, the pre-vaccination serotesting strategy against MMRV together, improves outcomes with a minimum cost increase, compared with the presumptive immunization strategy and compared with the comparator strategy. From a cost-effectiveness point of view, vaccination based on serotesting results in being the most advantageous strategy compared to presumptive vaccination. By applying a chemiluminescent immunoassay test, the serology strategy resulted to be clinically and economically advantageous. Similar results were obtained excluding children aged <1 year for both serology methods. In conclusion, based on our analyses, considering MMRV vaccine, serotesting strategy appears to be the preferred option in IAC.

Highlights

Appropriate immunization of internationally adopted children (IAC) is currently under debate and different approaches have been suggested [1]
Considering MMRV, pre-vaccination serotesting compared to immunization based on documentation in IAC improves outcomes with a minimal cost increase, while the presumptive immunization strategy is the most expensive and it is associated with a number of protected children lower than pre-vaccination serotesting
[26], in our analysis, the cost-saving of this strategy was minimal compared to the benefits of serotesting strategy, performing enzyme-linked immunosorbent assay (ELISA) serology

Summary

Introduction

Appropriate immunization of internationally adopted children (IAC) is currently under debate and different approaches have been suggested [1]. Three possible approaches to vaccinate IAC have been described [1,2]. The first approach is to assess and accept reliable documentation of previous vaccinations and immunize the child, following the local schedule [3]. In order to assess the reliability of vaccine documentation, physicians should evaluate the dates of vaccine administration, the number of doses administered, intervals between doses, and the IAC age at the time of administration. This is the strategy recommended in Italy.

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