Pneumonia prevention: Cost-effectiveness analyses of two vaccines among refugee children aged under two years, Haemophilus influenzae type b-containing and pneumococcal conjugate vaccines, during a humanitarian emergency, Yida camp, South Sudan

Vaccine. 2017 Jan 11;35(3):435-442. doi: 10.1016/j.vaccine.2016.11.070. Epub 2016 Dec 15.


By September 2013, war between Sudan and South Sudan resulted in >70,000 Sudanese refugees and high pneumonia incidence among the 20,000 refugees in Yida camp, South Sudan. Using Médecins Sans Frontières (MSF)-provided data and modifying our decision-tree models, we estimated if administering Haemophilus influenzae type b (Hib)-containing (pentavalent vaccine, also with diphtheria pertussis and tetanus [DPT] and hepatitis B) and pneumococcal conjugate (PCV) vaccines were cost-effective against hospitalized pneumonia. Among children <2years old, compared with no vaccination, one- and two-doses of combined Hib-containing and PCV would avert an estimated 118 and 125 pneumonia cases, and 8.5 and 9.1 deaths, respectively. The cost per Disability-Adjusted-Life-Year averted for administering combined one- and two-doses was US$125 and US$209, respectively. MSF demonstrated that it was possible to administer these vaccines during an emergency and our analysis found it was highly cost-effective, even with just one-dose of either vaccine. Despite unknown etiology, there is strong field and now economic rationale for administering Hib and PCV during at least one humanitarian emergency.

Keywords: Cost-effectiveness; Haemophilus influenzae type b; Hib vaccine; Humanitarian emergency; PCV; Routine immunization; South Sudan; Streptococcus pneumoniae; Supplemental immunization activity.

MeSH terms

  • Cost-Benefit Analysis*
  • Diphtheria-Tetanus-Pertussis Vaccine / administration & dosage
  • Diphtheria-Tetanus-Pertussis Vaccine / economics*
  • Diphtheria-Tetanus-Pertussis Vaccine / immunology*
  • Haemophilus Vaccines / administration & dosage
  • Haemophilus Vaccines / economics*
  • Haemophilus Vaccines / immunology*
  • Hepatitis B Vaccines / administration & dosage
  • Hepatitis B Vaccines / economics*
  • Hepatitis B Vaccines / immunology*
  • Humans
  • Infant
  • Infant, Newborn
  • Pneumococcal Vaccines / administration & dosage
  • Pneumococcal Vaccines / economics*
  • Pneumococcal Vaccines / immunology*
  • Pneumonia, Bacterial / economics*
  • Pneumonia, Bacterial / prevention & control*
  • Refugees
  • South Sudan
  • Vaccines, Conjugate / administration & dosage
  • Vaccines, Conjugate / economics
  • Vaccines, Conjugate / immunology


  • Diphtheria-Tetanus-Pertussis Vaccine
  • Haemophilus Vaccines
  • Hepatitis B Vaccines
  • Pneumococcal Vaccines
  • Vaccines, Conjugate
  • diphtheria-tetanus-acellular pertussis-Hib-hepatitis B vaccine