Polio inactivated vaccine costs into routine childhood immunization in Brazil.

Ana Marli Christovam Sartori,Patricia Coelho De Soárez,Margarete Paganotti Vicentine,Hillegonda Maria Dutilh Novaes,Lígia Castelloni Figueiredo Gryninger

doi:10.1590/s0034-8910.2015049005492

Abstract

OBJECTIVE To analyze the costs of vaccination regimens for introducing inactivated polio vaccine in routine immunization in Brazil.METHODS A cost analysis was conducted for vaccines in five vaccination regimens, including inactivated polio vaccine, compared with the oral polio vaccine-only regimen. The costs of the vaccines were estimated for routine use and for the “National Immunization Days”, during when the oral polio vaccine is administered to children aged less than five years, independent of their vaccine status, and the strategic stock of inactivated polio vaccine. The presented estimated costs are of 2011.RESULTS The annual costs of the oral vaccine-only program (routine and two National Immunization Days) were estimated at US$19,873,170. The incremental costs of inclusion of the inactivated vaccine depended on the number of vaccine doses, presentation of the vaccine (bottles with single dose or ten doses), and number of “National Immunization Days” carried out. The cost of the regimen adopted with two doses of inactivated vaccine followed by three doses of oral vaccine and one “National Immunization Day” was estimated at US$29,653,539. The concomitant replacement of the DTPw/Hib and HepB vaccines with the pentavalent vaccine enabled the introduction of the inactivated polio without increasing the number of injections or number of visits needed to complete the vaccination.CONCLUSIONS The introduction of the inactivated vaccine increased the annual costs of the polio vaccines by 49.2% compared with the oral vaccine-only regimen. This increase represented 1.13% of the expenditure of the National Immunization Program on the purchase of vaccines in 2011.

Highlights

With the Global Polio Eradication Initiative of the World Health Organization (WHO), the number of paralytic poliomyelitis cases decreased more than 99.0%
Five different schedules were considered as effective alternatives for including inactivated polio vaccine (IPV) in routine childhood immunization: [1] a sequential schedule with one IPV dose followed by four oral polio vaccine (OPV) doses; [2] a sequential schedule with two IPV doses followed by three OPV doses; [3] a sequential schedule with three IPV doses followed by two OPV doses; [4] an all-IPV schedule composed of four IPV doses; and [5] all-IPV schedule composed of five IPV doses
According to National Immunization Program (NIP) Coordination, 59,376,500 OPV doses were distributed for both routine immunization and National Immunization Days (NID)

Summary

Introduction

With the Global Polio Eradication Initiative of the World Health Organization (WHO), the number of paralytic poliomyelitis (polio) cases decreased more than 99.0% (from 350,000 in 125 endemic countries in 1988 to 416 cases in 2013). Four WHO regions have been certified to be polio-free; wild poliovirus type-2 was globally eliminated in 1999, and no new cases of wild poliovirus type-3 have been reported since November 2012.23. Despite huge advances toward polio eradication, achieving total success has been more difficult than anticipated. Infection continues occurring due to suboptimal effectiveness of the oral polio vaccine (OPV) in tropical countries; and, mainly due to difficulties in achieving and sustaining sufficiently high vaccine coverage, in conflict zones or difficult-toaccess areas.. Three countries (Afghanistan, Pakistan, and Nigeria) have never interrupted wild poliovirus transmission.. Three countries (Afghanistan, Pakistan, and Nigeria) have never interrupted wild poliovirus transmission.23 Viruses from these countries have caused outbreaks in neighboring countries that had already eliminated polio, such as the 2013 outbreaks in Somalia and Syria. Three countries (Afghanistan, Pakistan, and Nigeria) have never interrupted wild poliovirus transmission. Viruses from these countries have caused outbreaks in neighboring countries that had already eliminated polio, such as the 2013 outbreaks in Somalia and Syria.

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Results

Conclusion