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Selective Hepatitis B Birth-Dose Vaccination in São Tomé and Príncipe: A Program Assessment and Cost-Effectiveness Study

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  • 1 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia;
  • | 2 Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia;
  • | 3 São Tomé and Príncipe Ministry of Health, São Tomé, São Tomé and Príncipe;
  • | 4 São Tomé and Príncipe Country Office, World Health Organization, São Tomé, São Tomé and Príncipe;
  • | 5 Regional Office for Africa, World Health Organization, Brazzaville, Congo;
  • | 6 Expanded Programme on Immunizations, World Health Organization, Geneva, Switzerland
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São Tomé and Príncipe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.

Author Notes

Address correspondence to José E. Hagan, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop H-24, Atlanta, GA 30329. E-mail: esp3@cdc.gov

Financial support: This study was funded by the Centers for Disease Control and Prevention and by the World Health Organization.

Authors’ addresses: José E. Hagan, Taiwo O. Abimbola, Sarah W. Pallas, and Minal K. Patel, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: esp3@cdc.gov, iip2@cdc.gov, xgx4@cdc.gov, and hgo9@cdc.gov. Elizabeth Carvalho and Vladimir Souza, São Tomé and Príncipe Ministry of Health, São Tomé, São Tomé and Príncipe, E-mails: bethmaria74@lotuail.com and vladimirsousa-@hotmail.com. Maria Queresma dos Anjos, World Health Organization, Luanda, Angola, E-mail: quaresmam@who.int. M. Carole Tevi Benissan and Stephanie Shendale, Expanded Programme on Immunizations, World Health Organization, Geneva, Switzerland, E-mails: tevibenissanc@who.int and shendales@who.int. Karen Hennessey, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: keh7@cdc.gov.

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