Veeken H, Ritmeijer K, Hausman B
Medical Department, Médecins sans Frontières-Holland, Amsterdam, Netherlands.
Bull World Health Organ. 1998;76(2):135-41.
From November 1995 to May 1996, a meningitis epidemic occurred in northern Nigeria. More than 75,000 cases and 8440 deaths (case fatality rate (CFR), 11%) were recorded. Médecins sans Frontières, in cooperation with the Nigerian government, carried out an assistance programme (support to case management, surveillance and mass vaccination) in three states (Bauchi, Kano, Katsina) where 75% of cases occurred. Cost analysis of this assistance in Katsina State reveals that case management and mass vaccination were efficient: US$ 35 per case treated and US$ 0.64 per vaccination. There was, however, a remarkable difference in cost-effectiveness between the two strategies. The cost per death averted by improved case treatment was estimated to be US$ 396, while the cost per death averted by vaccination was estimated to be US$ 6000. In large part this difference is attributed to the late start of vaccination: more than 6 weeks after the epidemic threshold had been passed. During meningitis epidemics in countries where surveillance systems are inadequate, such as in most of sub-Saharan Africa, curative programmes should have priority.
1995年11月至1996年5月，尼日利亚北部发生了一场脑膜炎疫情。记录了超过75000例病例和8440例死亡（病死率（CFR）为11%）。无国界医生组织与尼日利亚政府合作，在病例发生率达75%的三个州（包奇、卡诺、卡齐纳）开展了一项援助计划（支持病例管理、监测和大规模疫苗接种）。对卡齐纳州这项援助的成本分析显示，病例管理和大规模疫苗接种是有效的：每治疗一例花费35美元，每接种一剂花费0.64美元。然而，这两种策略在成本效益上存在显著差异。通过改善病例治疗避免一例死亡的成本估计为396美元，而通过疫苗接种避免一例死亡的成本估计为6000美元。这种差异在很大程度上归因于疫苗接种开始得较晚：在疫情阈值过去6周多之后才开始。在撒哈拉以南非洲大部分地区等监测系统不完善的国家发生脑膜炎疫情期间，治疗方案应具有优先地位。
