CASE 20: Preventing Hib disease in Chile and the Gambia

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How do we know

An evaluation study provided the impact data for The Gambia, and was based on surveillance data from hospitals and a vaccine coverage survey using WHO cluster sampling technique.


Health Condition: Worldwide, Hib disease is the leading cause of bacterial meningitis in children under 5, and the second most common cause of bacterial pneumonia deaths in this age group. It kills an estimated 450,000 children every year and causes some 2 million cases of disease. Researchers in Chile estimated that the incidence of Hib disease in Santiago during the late 1980s was 32 per 100,000 infants under 6 months of age, and 63 per 100,000 in infants aged 6 to 11 months. The proportion of chil­dren who died after contracting the disease was relatively high at 16 percent. In The Gambia, just over 200 children per 100,000 developed Hib meningitis in 1990.

Intervention or Program: Chile's Ministry of Health introduced the Hib vaccine into the routine immunization program for babies in 1996. The Gambia began administering the vaccine routinely as part of the national immunization program in 1997.

Impact: The incidence of Hib meningitis in Chile fell by 91 percent and that of pneumonia and other forms of Hib disease fell by 80 percent. The number of children developing Hib meningitis in The Gambia dropped almost tenfold, from 200 per 100,000 to 21 per 100,000 in the 12-month period after the start of routine immunization. In the last two years of the study, there were just two cases.

Cost and Cost-Effectiveness: The government of Chile has paid $3.39 million for the combined DTP-Hib vaccine, a figure that represents nearly 23 percent of the total immunization budget and 0.7 percent of the government health expenditure. In Chile, the price per dose is $3, and the government saves an estimated $78 for each case of Hib prevented. Sanofi Pasteur’s donation of the vaccines in The Gambia helped make the immunizations possible there, and financial support from the Global Alliance for Vaccines and Immunization will help sustain the program through 2008.