1 Background
2 Method of Review
2.1 Eligibility Criteria
2.2 Information Sources and Search
2.3 Study Selection
2.4 Data Collection Process and Data Items
2.5 Synthesis of Results
3 Results
3.1 Study Selection
3.2 Outbreak Characteristics among High-Income Countries
Reference | Locationa
| Outbreak period | Serogroup (clone types) | Age and gender of infected individuals (years) | Total number infectedb (attack rate) | Number hospitalized (hospitalization rate of those infected) | Number of deaths (case fatality ratio of those infected) |
---|---|---|---|---|---|---|---|
High-income countries | |||||||
Houck et al. [29] | Washington state, USA (population of 451,212) | Jan 1989–Jun 1991 | C | Median 3 (0.17–77) | 40 CC, 5 PC (10 per 100,000) | NR | 9 (20 %) |
Oakes [42] | Magnolia, Mississippi, USA | 1990 | C | Median 7 (2–6) | 3 (120 per 100,000) | NR | NR |
Watson et al. [13] | Jacksonville, North Carolina, USA | 1990 | C | Median 7 (6–9) | 3 (477 per 100,000) | NR | NR |
Imrey et al. [40] | Champaing-Urbana, Illinois, USA | 1991 | C | Median 19 (18–21) | 9 (32 per 100,000) | NR | NR |
Hendricks [13] | Harris County, Texas, USA | 1991 | C | Median 13 (11–13) | 4 (233 per 100,000) | NR | NR |
Banerji et al. [30] | Ottawa, Ontario and Hull, Quebec, Canada (estimated combined population of 734,372) | Dec 1991–Jan 1992 | C | Adolescents | 10 CC (estimated: 1.4 per 100,000) | NR | 5 (50 %) |
CDC [13] | Butte, Montana, USA | 1992 | C | Median 1.8 (0.8–30) | 7 (21 per 100,000) | NR | NR |
Birkhead [13] | Jefferson County, New York, USA | 1992 | C | Median 12 (3–49) | 12 (11.5 per 100,000) | NR | NR |
Edmond et al. [41] | Johnson County, Iowa, USA | 1992 | C | Median 21 (18–22) | 5 (5.5 per 100,000) | NR | NR |
Jafari [13] | Carroll County, Georgia, USA | 1992 | C | Median 15 (3–66) | 11 (15 per 100,000) | NR | NR |
Zeitz [13] | Maricopa County, Arizona, USA | 1993 | C | Median 3 (0.1–58) | 31 (6 per 100,000) | NR | NR |
Wenger et al. [43] | Grayson County, Texas, USA | 1993 | C | Median 14.5 (1–45) | 14 (14 per 100,000) | NR | NR |
Kurland [13] | Storrs, Connecticut, USA | 1993 | C | Median 20 (19–21) | 3 (19 per 100,000) | NR | NR |
Mankato, Minnesota, USA (population of 55,000) | Jan–Feb 1995 | C | Mostly high school students (3–64) | 9 PC(16 per 100,000) | >5 (55.6 %) | 1 (11 %) | |
Austin et al. [14] | Illinois, USA (population of 15,000) | Feb 11–12, 1996 | C (enzyme type 24) | Boys aged 3–6 | 4 CC (205 per 100,000 for children <10 years) | 4 (100 %) | NR |
Irwin et al. [31] | Trent, England, United Kingdom (target population of 16,900 for children <19 years) | 6 cases Jan 2–16, 2 cases Dec 8, 1995–Jan 16, 1996 | C (2b, P1.25, P1.2) | Children aged 1–17 | 7 CC, 1 PC (43 per 100,000 for children <19 years) | NR | 1 (13 %) |
Tolomeo et al. [32] | Hamilton-Wentworth region, Canada (population of 400,000) | Sept 26–Nov 12 1996 | C | Secondary school students | 2 primary, 1 secondary: 3 CC (0.75 per 100,000) | 3 (100 %) | 0 (0 %) |
Krause et al. [33] | Two neighboring Florida towns, USA (population of 33,000) | Dec 12–29, 1998 | C | (2–18) | 7 CC (15 per 100,000) | NR | 1 (14 %) |
Robinson et al. [34] | Victoria, Australia (target school population of 1,600) | Aug 26–28 1999 | C (2a:nst) | High school students | 2 primary, 1 secondary: 3 CC (188 per 100,000) | NR | NR |
Renevey et al. [35] | La Gruyère, Switzerland (population of 40,000) | Nov 2000–Jan 2001 | C(P1.2,5,2a :P1.2,5) | Median 6 (4–17) | 4 primary, 3 secondary: 7 CC (10 per 100,000) | 7 (100 %) | NR |
Brooks et al. [12]c
| USA (data from the CDC) | Jul 1, 1994–Jun 30, 2002 | C (62 %) B (25 %) Y (13 %) | All age groups (39 % 6–17 years, 78 % 2–24 years) male (59%) female (41%) | 229 CC in 69 outbreaks (median 100 per 100,000: range 10 to 10,000 per 100,000) | NR | 44 (16 %) |
Weiss et al. [16] | Brooklyn, New York, USA | Nov 12, 2005–Nov 6, 2006 | C | 1–80 years | 29 primary, 2 secondary: 25 CC, 6 PC (<2 per 100,000) | NR | 8 (26 %) |
Low-income economies ($1,005 per capita or lower) | |||||||
Varaine et al. [36] | Guinea, Africa (population of 1,709,705) | Nov 1992–Jul 1993 | A (4.21, P1.9, clone III-1) and C | Classified as 0–4, 5–15, >14 years | 2,435 PC (142 per 100,000) | NR | 319 deaths (13 %) |
daSilva et al. [37] | Senegal, West Africa (population of 258,413) | 1995–96 | NR | NR | 1995: 33,047 (27,771 per 100,000) 1996: 153,655 (59,461 per 100,000) | NR | NR |
Ahmad [38] | Nanoro, Burkina Faso, Africa (estimated population of 33,530) | 2002 | W135 | NR | 1,500 PC (estimated: 4,474 per 100,000) | NR | 300 deaths (20 %) |
3.3 Costs for Small Outbreak Containment Strategies in High-Income Countries
Reference | Location, year | Containment strategy | Total number of cases | Number receiving chemoprophylaxis or drug, unit costa
| Number vaccinated, vaccine type, unit costa
| Volunteer costs, medical staff costsa
| Public health campaign costsa
| Total costa
| Cost per IMD casea
|
---|---|---|---|---|---|---|---|---|---|
Small containment strategies (all among high-income countries) | |||||||||
Houck et al. [29] | Washington state, USA, 1989–1991 | Chemoprophylaxis (rifampin) was offered to all contacts of patients | 40 CC, 5 PC | 4,100, NR | 22,801, $29 each | NR | NR | $661,229b for vaccines | $14,694 vaccine cost |
Watson [13] | Jacksonville, North Carolina, USA, 1990 | Vaccination of students, close contacts, and parents | 3 | NR | 656 (midpoint cost $33, range $10–$56) | NR | NR | $21,588 ($6,570–$36,606)b for vaccines | $7,196 vaccine cost |
Imrey et al. [40] | Champaign-Urbana, Illinois, USA, 1991 | Vaccination of undergraduate students | 9 | NR | 16,000 (midpoint cost $33, range $10–$56) | NR | NR | $526,539 ($160,251–$892,828)b for vaccines | $58,504 vaccine cost |
Hendricks [13] | Harris County, Texas, USA, 1991 | Vaccination of students and staff | 4 | NR | 1,150 (midpoint cost $33, range $10–$56) | NR | NR | $37,845 ($11,518–$64,172)b for vaccines | $9,461 vaccine cost |
Banerji et al. [30] | Ottawa, Ontario and Hull, Quebec, Canada, 1991–1992 | Patients seen in the ED and clinically considered at moderate risk for meningococcal disease received a single intravenous dose of ceftriaxone 80 mg/kg | 10 CC | Drugs: 101 ceftriaxone doses, $124 each | NR | NR | NR | $12,524b for ceftriaxone | $1,252 antibiotics cost |
Edmond et al. [41] | Johnson County, Iowa, USA, 1992 | Vaccination of all university students | 5 | NR | 18,000 (midpoint cost $33, range $10–$56) | NR | NR | $592,357 ($180,283–$1,004,431)b for vaccines | $118,471 vaccine cost |
Kurland [13] | Storrs, Connecticut, USA, 1993 | Vaccination of students younger than 30 years | 3 | NR | 12,364 (midpoint cost $33, range $10–$56) | NR | NR | $406,883 ($123,834–$689,933)b for vaccines | $135,628 vaccine cost |
Irwin et al. [31] | Trent, England, UK, 1995–1996 | Chemoprophylaxis and vaccination of school | 7 CC, 1 SC | NR | Direct contacts: 2 school targets: 15,980 people (92 %), total cost of drugs and preparation $44,562 | Medical staff: $227,267 | NR | $557,028 (8 days) | $69,629 total cost ($8,704 vaccine cost) |
Tolomeo et al. [32] | Hamilton-Wentworth region, Canada, 1996 | Immunize vaccine-eligible students of the entire school, alert media, area physicians, hospitals, and other community partners | 3 CC | 18, NR | 1,453 | NR | 37 Health Dept staff, 4 nursing staff, $39,805 | $39,805 excludes vaccine costs and supplies (5 days) | $13,268 public health cost |
Robinson et al. [34] | Victoria, Australia, 1999 | Chemoprophylaxis for close contacts, vaccination of school staff and students | 3 CC | Community: 3,712 rifampicin capsules, $6 for 100 capsules; total $228 for rifampicin | 1,530 (95 % coverage), $36,948 vaccine | Medical staff: $4,958 vaccination campaign | $5,014 medical officers, nursing staff, administration, and media | $42,254 | $14,085 total cost ($12,316 vaccine cost) |
Large containment strategies among high-income countries | |||||||||
Oakes [42] | Magnolia, Mississippi, USA, 1990 | Vaccinated children aged 2–18 in school district and teachers | 3 | NR | 8,500 (midpoint cost $33, range $10–$56) | NR | NR | $279,009 ($85,133–$474,315)b for vaccines | $93,003 vaccine cost |
CDC [13] | Butte, Montana, USA, 1992 | Vaccinated county residents aged 1–17 | 7 | NR | 7,000 (midpoint cost $33, range $10–$56) | NR | NR | $230,361 ($70,110–$390,612)b for vaccines | $32,909 vaccine cost |
Birkhead [13] | Jefferson County, New York, USA, 1992 | Vaccinated county residents aged 2–29 | 13 | NR | 40,000 (midpoint cost $33, range $10–$56) | NR | NR | $1,316,349 ($400,628–$2,232,069)b for vaccines | $101,258 vaccine cost |
Jafari [13] | Carroll County, Georgia, USA, 1992 | Vaccinated county residents aged 2–29 | 11 | NR | 20,000 (midpoint cost $33, range $10–$56) | NR | NR | $658,174 ($200,314–$1,116,035)b for vaccines | $59,834 vaccine cost |
Zeitz [13] | Maricopa County, Arizona, USA, 1992 | Vaccinated residents of southcentral Phoenix aged 2–9 | 31 | NR | 55,250 (midpoint cost $33, range $10–$56) | NR | NR | $1,818,206 ($553,367–$3,083,046)b for vaccines | $58,652 vaccine cost |
Wenger et al. [43] | Grayson County, Texas, USA, 1993 | Vaccinated county residents aged 2–29 | 14 | NR | 11,200 (midpoint cost $33, range $10–$56) | NR | NR | $368,578 ($112,176–$624,979)b for vaccines | $26,327 vaccine cost |
Osterholm [15] | Mankato, Minnesota, USA, 1995 | Chemoprophylaxis rifampin and vaccination of 30,000 | 9 PC | NR | 30,000, $1,477,511 | Medical staff: 23 days, 18 h per day | Phone bank set up | $1,477,511 for vaccine cost | $164,168 vaccine cost |
Austin et al. [14] | Illinois, USA, 1996 | Chemoprophylaxis and vaccination of all children aged 2 years to in the 8th grade in town | 4 PC | NR | Direct contacts: 3,500 (86–94 % coverage), NR | NR | NR | $105,484 or $7 per town resident | $26,371 |
Krause et al. [33] | Florida, USA, 1998 | Chemoprophylaxis of contacts, vaccination of contacts and community for ages 2–22 | 7 CC | 484, rifampicin, ciprofloxacin, or ceftriaxone | 13,535 Menommune quadrivalent polysaccharide vaccine, $321,733 (65 % of total cost) | Medical staff: $98,995 (20 % of total cost) | $29,431 (6 % of total cost) | $494,974 (2 weeks) | $70,711 total cost ($45,962 vaccine cost) |
Renevey et al. [35] | La Gruyère, Switzerland, 2000–2001 | Vaccinated all aged 2–17 years | 7 CC | NR | 9,731 polysaccharide vaccines $60 per vaccine, $582,835 total vaccine cost | $54,483 | NR | $637,319 | $91,046 total cost ($83,262 vaccine cost) |
Weiss et al. [16] | Brooklyn, New York, USA, 2005–2006 | Vaccination of adults >18 years living in 1 of 4 central Brooklyn zip codes with history of illicit drug use and household contacts | 25 CC, 6 PC | NR | 2,763 MCV4, NR | NR | NR | $1,081,627 (94 days) | $34,891 |
Large containment strategies among low-income countries | |||||||||
Varaine et al. [36] | Guinea, Africa, 1992–1993 | Target population of people over the age of 1 in districts where rates exceeded 5/100,000 | 2,435 PC | NR | 629,913 A/C polysaccharide vaccine, vaccine cost $258,108 (59 % of total cost, 14 % injection material) | NR | 3,000 person workdays (16 % logistics, 11 % wages of total cost) | $437,471 | $180 total cost ($106 vaccine cost) |
daSilva et al. [37] | Senegal, West Africa, 1995–1996 | NR | 33,047 (1995) 153,655 (1996) | NR | 85,925, $0.46/ polysaccharide A/C meningococcal and yellow fever vaccine (calculated cost of $39,526) | $4,360 Coordination, supervision, procurement, transport, social mobilization, paper | NR | $58,363 | $0.31 total cost ($1.20 vaccine cost) |
Ahmad [38] | Nanoro, Burkina Faso, Africa, 2002 | Vaccination of people in Burkina Faso’s Nanoro district | 1,500 PC | NR | 135,000, trivalent A/C/W135 vaccine, $1/dose, $135,000 total | NR | NR | Donations of $9,726,937 | $6,485 total cost ($90 vaccine cost) |
Economic classification and containment type | Average cost per containment | Range of cost per containment | Average cost per IMD case | Range of cost per containment |
---|---|---|---|---|
High-income countries | ||||
$299,641 | $42,254–$557,028 | $41,857 | $14,085–$69,629 | |
$579,851 | $105,484–$1,081,627 | $55,755 | $26,371–$91,046 | |
Low-income countries | ||||
$3,407,590 | $58,363–$9,726,937 | $2,222 | $0.31–$6,465 |