The Knowledge Hub

Immunizing children against rotavirus in Palestine can save money and prevent severe cases of gastroenteritis

An economic analysis in Palestine found that including rotavirus in the routine immunization program is a cost-effective intervention in children under 5 years old. The study estimated that between 2016–2025, rotavirus vaccination in Palestine has the potential to avert approximately 101,000 severe episodes of rotavirus gastroenteritis cases. Avoiding these treatment costs could lead to estimated savings of approximately $14 million for the health system and approximately $22 million for the society (in 2018 US dollars).

Debellut F, Jaber S, Bouzya Y et al.. 2020. Introduction of rotavirus vaccination in Palestine: An evaluation of the costs impact and cost-effectiveness of ROTARIX and ROTAVAC. PLoS ONE. 15(2).

Mobile health teams in Afghanistan improved immunization coverage in remote and conflict-affected areas, benefiting mothers and children

In Afghanistan, delivering health services through sustained, scheduled mobile health teams in remote and conflict-affected villages improved coverage of maternal and child health interventions, including immunization. The proportion of children under 1 year receiving their first dose of measles vaccine was higher in districts that had received mobile health team services for at least the previous 3 years (73.8%) compared to control districts in the same province (57.3%). The researchers concluded that incorporating mobile clinics into health system infrastructure in a systematic way can effectively improve health for hard to reach mothers and children in remote and conflict-affected areas.

Edmond K, Yousufi K, Naziri M et al.. 2020. Mobile outreach health services for mothers and children in conflict-affected and remote areas: A population-based study from Afghanistan. Archives of Disease in Childhood. 105(1).

A study in Jordan found that a proactive vaccination campaign has maintained high immunity rates, even with an influx of refugees

The results of a 2016 cross-sectional polio serosurvey found that the Jordan Ministry of Health’s proactive campaign to locate and vaccinate high-risk populations has been successful in maintaining high population immunity — even with a recent influx of refugees from Syria. The study included a community sample of 479 children under 5 years living in areas of Jordan identified as high risk due to being hard-to-reach, having high numbers of refugees, and lower vaccine coverage (under 90%). Polio immunity was found to be over 96% for polio types 1, 2, and 3 even for children living in refugee camps.

Farag NH, Wannemuehler K, Weldon W et al.. 2020. Estimating population immunity to poliovirus in Jordan’s high-risk areas. Human Vaccines & Immunotherapeutics. 16(3).

Immunization against rotavirus is cost-effective, especially in poorer regions, saving lives and reducing disabilities

According to a cost-effectiveness study of rotavirus vaccination in Pakistan, the vaccine would be the most cost-effective in the poorer provinces of Sindh and Balochistan (that also have the highest rates of death from rotavirus)- with a cost per disability-adjust life year averted $155-$167 compared to almost $600 in the wealthier region of Islamabad. Within all regions, vaccination was the most cost-effective among the two poorest income groups (quintiles), and was almost 12 times more cost-effective in the poorest households in the most marginalized region than in the wealthiest households in the most advantaged region (cost/DALY averted of $76 vs. $897).

Rheingans R, Anderson JD, Bagamian KH et al.. 2018. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 36(51).

Expanding rotavirus vaccination coverage in Pakistan would greatly reduce deaths, especially among the poorest children

A cost-effectiveness analysis of rotavirus vaccination in Pakistan found that, if rotavirus vaccination coverage was equally high across regions and income groups, the percent reduction in deaths due to rotavirus would be 4 times greater in the highest risk regions than in the lowest-risk regions, and would be 3-4 times greater among children in the poorest versus the wealthiest households.

Expanding vaccination coverage among the poorest and most vulnerable children would substantially increase the overall impact of rotavirus immunization in Pakistan.

Rheingans R, Anderson JD, Bagamian KH et al.. 2018. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 36(51).

Efforts to eradicate polio have also led to improved access to other vaccines

The expertise and assets gained through efforts to eradicate polio at least partially explain the improvement between 2013 and 2015 in vaccination coverage of DPT3 in six out of ten “focus” countries of the Polio Eradication Endgame strategic plan. This includes substantial increases in vaccination rates in India, Nigeria, and Ethiopia, which, combined, reduced the number of children not fully vaccinated with DPT by 2 million in 2 years.

van den Ent MMVX, Mallya A, Sandhu H et al.. 2017. Experiences and lessons from polio eradication in 10 focus countries of the polio endgame strategic plan. Journal of Infectious Diseases. 216(1).

Investment in disease surveillance in areas of conflict can prevent new outbreaks of vaccine-preventable diseases

The development and successful implementation of a coordinated, multi-country plan in response to a wild polio outbreak in Syria and Iraq halted the outbreak within 6 months. The response, which involved strengthening acute flaccid paralysis surveillance and more than 70 synchronized mass polio vaccination campaigns in 8 Middle Eastern countries (reaching >27 million children), could serve as a model for responding to disease outbreaks in areas affected by conflict and political instability.

Mbaeyi C, Ryan MJ, Smith P et al.. 2017. Response to a large polio outbreak in a setting of conflict- Middle East, 2013-2015. Morbidity and Mortality Weekly Report. 66(8).

Armed conflict can lead to outbreaks of polio

An outbreak of wild polio virus began two years after the onset of the civil war in Syria and subsequently spread to Iraq, causing a total of 38 cases (36 in Syria). Factors leading to the outbreak included a decline in polio surveillance and in polio vaccination coverage (from 83% for 3 doses of oral polio vaccine pre-war in Syria to 47-52%).

Mbaeyi C, Ryan MJ, Smith P et al.. 2017. Response to a large polio outbreak in a setting of conflict- Middle East, 2013-2015. Morbidity and Mortality Weekly Report. 66(8).

Rotavirus vaccine in conflict areas saves lives and is cost-effective, even with low coverage rates

A two-dose schedule of rotavirus vaccine was estimated to be cost-effective in Somalia, where more than 20 years of civil conflict have significantly damaged the health system and vaccine coverage is exceedingly low. Researchers estimate that in 2012, routine use of rotavirus vaccine, even at low coverage rates, would have averted nearly 25% of deaths due to rotavirus diarrhea in Somali children under one year of age.

Gargano, L. M., Tate, J. E., Parashar, U. D., et al.. 2015. Comparison of impact and cost-effectiveness of rotavirus supplementary and routine immunization in a complex humanitarian emergency, Somali case study.. Conflict and health. 9(5).

Mothers with higher education are more likely to vaccinate their children, leading to better immunization rates

A study conducted in Pakistan, designed to explore the association of maternal education and empowerment with childhood polio vaccination, showed that mothers with more education are more likely to vaccinate their children – 74% of children of mothers with higher education were completely vaccinated compared to 67% of those with primary education and only 47% of those with no education.

Khan, M.T., Zaheer, S., Shafique, K.. 2017. Maternal education, empowerment, economic status, and child polio vaccination uptake in Pakistan: a population based cross sectional study. BJM Open. 7(3).