Suchergebnisse

Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission by 2030, but the disease persists in several low-income countries. We couple transmission and health outcomes models to examine the cost-effectiveness of four gHAT elimination strategies in five settings – spanning low- to high-risk – of the Democratic Republic of Congo. Alongside passive screening in fixed health facilities, the strategies include active screening at average or intensified coverage levels, alone or with vector control with a scale-back algorithm when no cases are reported for three consecutive years. In high or moderate-risk settings, costs of gHAT strategies are primarily driven by active screening and, if used, vector control. Due to the cessation of active screening and vector control, most investments (75-80%) are made by 2030 and vector control might be cost-saving while ensuring elimination of transmission. In low-risk settings, costs are driven by passive screening, and minimum-cost strategies consisting of active screening and passive screening lead to elimination of transmission by 2030 with high probability.

Typhoid fever is an acute systemic infectious disease responsible for an estimated 12-20 million illnesses and over 150 000 deaths annually. In March, 2018, a new recommendation was issued by WHO for the programmatic use of typhoid conjugate vaccines in endemic countries. Health economic analyses of typhoid vaccines have informed funding decisions and national policies regarding vaccine rollout. However, by focusing only on averted typhoid cases and their associated costs, traditional cost-effectiveness analyses might underestimate crucial benefits of typhoid vaccination programmes, because the potential effect of typhoid vaccines on the treatment of patients with non-specific acute febrile illnesses is not considered. For every true case of typhoid fever, three to 25 patients without typhoid disease are treated with antimicrobials unnecessarily, conservatively amounting to more than 50 million prescriptions per year. Antimicrobials for suspected typhoid might therefore be an important selective pressure for the emergence and spread of antimicrobial resistance globally. We propose that large-scale, more aggressive typhoid vaccination programmes-including catch-up campaigns in children up to 15 years of age, and vaccination in lower incidence settings-have the potential to reduce the overuse of antimicrobials and thereby reduce antimicrobial resistance in many bacterial pathogens. Funding bodies and national governments must therefore consider the potential for broad reductions in antimicrobial use and resistance in decisions related to the rollout of typhoid conjugate vaccines.