An economic evaluation of the controlled temperature chain approach for vaccine logistics: evidence from a study conducted during a meningitis A vaccine campaign in Togo

Introduction: a recent innovation in support of the final segment of the immunization supply chain is licensing certain vaccines for use in a controlled temperature chain (CTC), which allows excursions into ambient temperatures up to 40°C for a specific number of days immediately prior to administration. However, limited evidence exists on CTC economics to inform investments for labeling other eligible vaccines for CTC use. Using data collected during a MenAfriVac™ campaign in Togo, we estimated economic costs for vaccine logistics when using the CTC approach compared to full cold chain logistics (CCL) approach.Methods: we conducted the study in Togo's Central Region, where two districts were using the CTC approach and two relied on a fullCCL approach during the MenAfriVac™ campaign. Data to estimate vaccine logistics costs were obtained from primary data collected using costing questionnaires and from financial cost data from campaign microplans. Costs are presented in 2014 US dollars.Results: average logistics costs per dose were estimated at $0.026±0.032 for facilities using a CTC and $0.029±0.054 for facilities using the fullCCL approach, but the two estimates were not statistically different. However, if the facilities without refrigerators had not used a CTC but had received daily deliveries of vaccines, the average cost per dose would have increased to $0.063 (range $0.007 to $0.33), with larger logistics cost increases occurring for facilities that were far from the district.Conclusion: using the CTC approach can reduce logistics costs for remote facilities without cold chain infrastructure, which is where CTC is designed to reduce logistical challenges of vaccine distribution

Adult tetanus at the University of Port Harcourt Teaching Hospital: An analysis of 42 cases

Background: Adult tetanus is still common in Nigeria as in other developing countries where immunization programmes are poor. Recently; fee for service was introduced in tertiary medical institutions. Type of Study: Retrospective. Aim: To define the characteristics of cases of tetanus in adults admitted to the University of Port Harcourt Teaching Hospital (UPTH) from 1991 to 1995. Methods: Patients with features of tetanus were identified from ward records and the Medical Records Department. The case note were examined and analysed. The management was carried out in the general medical wards and consisted of anti-tetanus serum (ATS); crystalline penicillin; dextrose infusion; diazepam and metho carbarmol provided for by patients. Results: There were 42 patients: 26 males and 16 females. The ages ranged from 15 to 60 years (mean 29 years). The immunization history was poor. The commonest portal of entry was the lower limb (47.6). The predominant social groups were students and fishermen. There was delay in the treatment of some of the patients as a result of which 25 cases had complications such as tachycardia; pneumonia and hypertension. Nine patients had multiple complications. Twenty-one patients died on admission. Eighteen deaths occurred within the first week of admission. Conclusion: The high mortality may reflect treatment delays and lack of intensive care unit facilities. Adequate campaign for anti-tetanus immunization should be embarked upon especially for the high risk students and fishermen