Innovations en vaccinologie: enjeux et perspectives pour l'Afrique

La vaccination est incontestablement l'une des interventions de santé publique les plus efficaces et les plus rentables qui soient. Les vaccins continuent de révolutionner notre capacité à prévenir les maladies et à améliorer la santé. Avec toutes les avancées technologiques, nous sommes en mesure d'étendre les avantages des vaccins à plus de gens et de fournir une meilleure protection contre les maladies infectieuses mortelles. Toutefois, avec le développement incessant de nouvelles souches microbiennes à travers le monde, la recherche en vaccinologie se doit d'innover continuellement. D'énormes progrès ont été réalisés pour améliorer la couverture vaccinale et introduire de nouveaux vaccins en Afrique. De nouveaux types de vaccins associés à des outils de vectorisation, d'administration et de délivrance spécifiques mais aussi des adjuvants susceptibles de moduler finement la réponse immunitaire sont attendus dans le futur. En Afrique, il est nécessaire de développer une approche régionale afin de répondre efficacement aux nombreux défis. Une meilleure information, la formation des personnels de santé en vaccinologie et des recherches bien ciblées sont les clés des futurs accomplissements dans le domaine

Cost of a human papillomavirus vaccination project, Zimbabwe

Objective To determine the cost of Zimbabwe's human papillomavirus (HPV) vaccination demonstration project. Methods The government of Zimbabwe conducted the project from 2014­2015, delivering two doses of HPV vaccine to 10-year-old girls in two districts. School delivery was the primary vaccination strategy, with health facilities and outreach as secondary strategies. A retrospective cost analysis was conducted from the provider perspective. Financial costs (government expenditure) and economic costs (financial plus the value of existing or donated resources including vaccines) were calculated by activity, per dose and per fully immunized girl. Results The project delivered 11 599 vaccine doses, resulting in 5724 fully immunized girls (5540 at schools, 168 at health facilities and 16 at outreach points). The financial cost for service delivery per fully immunized girl was United States dollars (US$) 5.34 in schools, US$ 34.90 at health facilities and US$ 288.63 at outreach; the economic costs were US$ 17.39, US$ 41.25 and US$ 635.84, respectively. The mean financial cost per dose was US$ 19.76 and per fully immunized girl was US$ 40.03 (economic costs were US$ 45.00 and US$ 91.19, respectively).The largest number of doses delivered (5788) occurred during the second vaccination round (the second group's first dose concurrently delivered with the first group's second dose), resulting in the lowest financial and economic service delivery costs per dose: US$ 1.97 and US$ 6.79, respectively. Conclusion The mean service delivery cost was lower in schools (primary strategy) and when more girls were vaccinated in each round, demonstrating scale efficiency

The Costs of Delivering Human Papillomavirus Vaccination to Grade 4 Learners in KwaZulu-Natal; South Africa

BACKGROUND:The national human papillomavirus (HPV) vaccination roll-out in South Africa provides two doses of Cervarix to all female Grade 4 learners in state schools. This study estimated the costs of vaccinating all learners in KwaZulu-Natal Province (females or males and females) using either the two- or three-dose strategies for both the bivalent and quadrivalent vaccines.OBJECTIVE:To determine costs of the HPV vaccination programme in KwaZulu-Natal.METHODS:Costs were determined adapting World Health Organization vaccination costing guidelines. RESULTS:The 2014 current cost of delivering three doses of Gardasil was ZAR510 per learner. The projected cost of delivering Cervarix to female learners at two or three doses over the period 2014 - 2018; adjusted for inflation; was ZAR172 717 342 and ZAR250 048 426; respectively. Similarly; the cost for Gardasil at these doses was ZAR197 482 200 and ZAR287 194 361; respectively. For male and female learners the cost for Cervarix over this period at two or three doses was ZAR337 101 132 and ZAR540 150 713; respectively. Similarly; the cost for Gardasil at these doses was ZAR426 597 971 and ZAR620 392 784; respectively. Accounting for population variation for females over 5 years; the cost of two doses of Cervarix ranged from ZAR168 888 677 to ZAR 176 545 977 at the lower and upper 95% confidence intervals (CIs); respectively. For three doses the cost ranged from ZAR244 505 544 to ZAR255 591 263 at the lower and upper 95% CIs; respectively. Similarly; the cost for two doses of Gardasil ranged from ZAR193 104 566 to ZAR201 859 798. For three doses the cost ranged from ZAR280 828 057 to ZAR293 560 614. CONCLUSION:This study gives decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the HPV vaccination programme

Acceptability of Human Papilloma Vrus Vaccine and Cervical Cancer Screening among Female Health-Care Workers in Enugu; Southeast Nigeria

Background: Cervical cancer; a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure; and secondarily through screening and treatment of identified precancerous lesions. Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu; southeastern Nigeria. Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH); Enugu; Nigeria. Statistical analysis was both descriptive and inferential at 95confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant. Results: The awareness of screening for cervical cancer (91) was significantly higher than that of the HPV vaccine (62.7) [odds ratio (OR): 0.17; 95 confidence interval (CI): 0.09-0.30]. However; the acceptability rate of the HPV vaccine (91.0) was significantly higher than that of cervical screening (71.4) (OR: 4.04;95 CI: 1.94-8.42)]. Only 25 (14.1) of the health-care workers had done cervical screening; but 30 (49.2) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening; cost and availability of HPV vaccine was a major deterrent for the latter. Conclusion: With more public enlightenment; available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high