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Too Much of a Good Thing? When to Stop Catch-Up Vaccination

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  • David W. Hutton
  • Margaret L. Brandeau

Abstract

During the 20th century, deaths from a range of serious infectious diseases decreased dramatically due to the development of safe and effective vaccines. However, infant immunization coverage has increased only marginally since the 1960s, and many people remain susceptible to vaccine-preventable diseases. “Catch-up vaccination†for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as newborn vaccination rates increase, catch-up vaccination becomes less attractive: the number of susceptible people decreases, so the cost to find and vaccinate each unvaccinated person may increase; in addition, the number of infected individuals decreases, so each unvaccinated person faces a lower risk of infection. This article presents a general framework for determining the optimal time to discontinue a catch-up vaccination program. We use a cost-effectiveness framework: we consider the cost per quality-adjusted life year gained of catch-up vaccination efforts as a function of newborn immunization rates over time and consequent disease prevalence and incidence. We illustrate our results with the example of hepatitis B catch-up vaccination in China. We contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on future disease incidence. The latter approach is likely to be simpler for decision makers to understand and implement because of lower data requirements.

Suggested Citation

  • David W. Hutton & Margaret L. Brandeau, 2013. "Too Much of a Good Thing? When to Stop Catch-Up Vaccination," Medical Decision Making, , vol. 33(7), pages 920-936, October.
    • Handle: RePEc:sae:medema:v:33:y:2013:i:7:p:920-936
    DOI: 10.1177/0272989X13493142
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    References listed on IDEAS

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    1. World Bank, 2008. "World Development Indicators 2008," World Bank Publications - Books, The World Bank Group, number 11855.
    2. Brenzel, Logan & Claquin, Pierre, 1994. "Immunization programs and their costs," Social Science & Medicine, Elsevier, vol. 39(4), pages 527-536, August.
    3. World Bank, 2007. "World Development Indicators 2007," World Bank Publications - Books, The World Bank Group, number 8150.
    4. Mark A. Miller & Laura McCann, 2000. "Policy analysis of the use of hepatitis B, Haemophilus influenzae type b‐, Streptococcus pneumoniae‐conjugate and rotavirus vaccines in national immunization schedules," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 19-35, January.
    5. World Bank, 2008. "World Development Indicators 2008," World Bank Publications - Books, The World Bank Group, number 28241.
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    Cited by:

    1. Margaret L. Brandeau, 2016. "Creating impact with operations research in health: making room for practice in academia," Health Care Management Science, Springer, vol. 19(4), pages 305-312, December.

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