Immunization of US children with Hemophilus influenzae type b polysaccharide vaccine. A cost-effectiveness model of strategy assessment

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Abstract
H. influenzae type b (HIB) is the leading cause of bacterial meningitis in the USA. Efforts are under way to develop vaccines immunogenic in children younger than 18 mo., but clinical efficacy of a previously developed HIB polysaccharide vaccine has already been established in children aged 18 mo. or older. A cost-effectiveness model was developed to evaluate immunizing USA children with this HIB polysaccharide vaccine pending development of a more immunogenic product. The model permitted comparison of the impact of alternative strategies for use of the vaccine, including universal use at 18 or 24 mo. of age, use of a 2nd dose after primary immunization and use in high-risk groups such as day-care-center attendees. Universal vaccination at 18 or 24 mo. of age resulted in similar estimates of disease prevented, as a consequence of the higher expected efficacy and duration of immunity for the vaccine when given at 24 mo. Overall, the implementation of routine childhood immunization against HIB at 18 mo. of age was the most cost-effective strategy. Universal vaccination at 18 mo. of age combined with a 2nd dose for day-care-center attendees would substantially increase the number of cases prevented, with a minimal increase in costs. Universal vaccination with a 2-dose schedule beginning at 18 mo. of age could prevent the most disease.