Parent du Châtelet I, Gessner B D, da Silva A
Association pour l'Aide à la Médecine Préventive, 28 rue du Docteur Roux, 75724 Cedex 15, Paris, France.
Vaccine. 2001 May 14;19(25-26):3420-31. doi: 10.1016/s0264-410x(01)00066-4.
For epidemic meningitis control in sub-Saharan Africa, the World Health Organization recommends a strategy of emergency vaccination with meningococcal A + C polysaccharide vaccine when epidemic thresholds are exceeded. An alternative strategy for areas without effective surveillance systems is mass preventive campaigns before outbreaks occur. A model was formulated to simulate epidemics and to compare the cost-effectiveness of these two strategies for the district of Matam, Senegal, where an actual preventive campaign was performed during 1997. The preventive strategy prevented 59% of the cases compared to 49% for the emergency strategy. The cost per case prevented was US$59 for the preventive strategy and US$133 for the reactive strategy, and the preventive strategy saved US$0.20 per habitant. Preventive meningococcal vaccination through mass campaigns prevented more outcomes at a lower cost, provided that the occurrence of an epidemic could be predicted within 3 years and that the vaccination coverage rates for the preventive and standard strategies were > 70% and < 94%, respectively. Sub-Saharan African countries without effective surveillance systems should consider mass preventive campaigns while awaiting an affordable conjugate vaccine.
为控制撒哈拉以南非洲地区的流行性脑膜炎，世界卫生组织建议，当超过流行阈值时，采用A + C群脑膜炎球菌多糖疫苗进行应急接种的策略。对于没有有效监测系统的地区，另一种策略是在疫情爆发前开展大规模预防接种活动。我们建立了一个模型来模拟疫情，并比较这两种策略在塞内加尔马塔姆地区的成本效益，该地区在1997年开展了一次实际的预防接种活动。预防策略预防了59%的病例，而应急策略为49%。预防策略每预防一例病例的成本为59美元，反应性策略为133美元，预防策略每位居民节省0.20美元。如果能在3年内预测到疫情的发生，且预防策略和标准策略的疫苗接种覆盖率分别> 70%和< 94%，那么通过大规模预防接种活动进行预防性脑膜炎球菌疫苗接种可以以更低的成本预防更多的病例。在等待可负担得起的结合疫苗期间，没有有效监测系统的撒哈拉以南非洲国家应考虑开展大规模预防接种活动。
