Short summary

The Bandim Health project in Guinea-Bissau have conducted several studies of the non-specific effects of the measles vaccine finding that the vaccine seems to reduce childhood mortality and morbidity not related to measles infection. The measles vaccine is given to protect against measles. Thus, with measles being close to eliminated many places the measles vaccine may be phased out over the next 20 years. We will assess the cost-effectiveness of measles vaccination as a means of reducing overall mortality and morbidity.

Rationale

The official vaccine program in Guinea-Bissau dictates that all children between 9 and 12 months of age are eligible for measles vaccination. In practice, eligible children only receive the vaccine if six or more children are present at the same time. The reason for this restrictive vial policy is that each measles vial contains ten doses of vaccine. After preparation (dilution with sterile water), the vaccine is valid for six hours and vaccination of less than six children within this time frame would mean significant vaccine wastage.

Many studies have shown a beneficial effect of the measles vaccine on child mortality- and morbidity. Restricting vial opening to only take place if six or more children are present has entailed that up to 1/3 of the children in Guinea-Bissau are unvaccinated at 12 months of age. Further, the restrictive vial policy means that mothers often go to the health centers in vain to get their children vaccinated.

The effect of the restrictive vial policy on child mortality- and morbidity is presently being studied in rural Guinea-Bissau (the MVEPI study). All children between 12 months and three years of age, who are measles unvaccinated, are cluster-randomized by village to be measles vaccinated by the Bandim Health Project's mobile team or to not be vaccinated according to national policy. The children are followed by BHP until 5 years of age to assess differences in mortality and morbidity according to intervention status.

The present study is a cost-effectiveness analysis of the restrictive vial policy, with special emphasis on the costs incurred by the mother of the restrictive vial policy. Thus, we plan to estimate the costs of taking a child for vaccination, as well as the costs of vaccinating a child at the health center. We will be performing sensitivity analyses according to number of doses used pr. vial.

Description of the cohort

The cohort comprises the 2009 birth cohort in rural Guinea-Bissau, from the clusters followed by the Bandim Health Project in Guinea-Bissau.

Data and biological material

All children born or moving into the clusters followed by the Bandim health Project are registered by the field assistants at first visit after birth/movement into the study area. The children are then visited every six months by local field assistants and vital status, vaccination status and other parameters are registered.

Collaborating researchers and departments

Research Center for Vitamins and Vaccines Bandim Health Project London School of Hygiene and Tropical Medicine

• Senior Lecturer Ulla Griffiths