Cost of production of live attenuated dengue vaccines: a case study of the Instituto Butantan, Sao Paulo, Brazil.

BACKGROUND: A vaccine to prevent dengue disease is urgently needed. Fortunately, a few tetravalent candidate vaccines are in the later stages of development and show promise. But, if the cost of these candidates is too high, their beneficial potential will not be realized. The price of a vaccine is one of the most important factors affecting its ultimate application in developing countries. In recent years, new vaccines such as those for human papilloma virus and pneumococcal disease (conjugate vaccine) have been introduced with prices in developed countries exceeding $50 per dose. These prices are above the level affordable by developing countries. In contrast, other vaccines such as those against Japanese encephalitis (SA14-14-2 strain vaccine) and meningitis type A have prices in developing countries below one dollar per dose, and it is expected that their introduction and use will proceed more rapidly. Because dengue disease is caused by four related viruses, vaccines must be able to protect against all four. Although there are several live attenuated dengue vaccine candidates under clinical evaluation, there remains uncertainty about the cost of production of these tetravalent vaccines, and this uncertainty is an impediment to rapid progress in planning for the introduction and distribution of dengue vaccines once they are licensed. METHOD: We have undertaken a detailed economic analysis, using standard industrial methodologies and applying generally accepted accounting practices, of the cost of production of a live attenuated vaccine, originally developed at the US National Institutes of Health (National Institute of Allergy and Infectious Diseases), to be produced at the Instituto Butantan in Sao Paulo, Brazil. We determined direct costs of materials, direct costs of personnel and labor, indirect costs, and depreciation. These were analyzed assuming a steady-state production of 60 million doses per year. RESULTS: Although this study does not seek to compute the price of the final licensed vaccine, the cost of production estimate produced here leads to the conclusion that the vaccine can be made available at a price that most ministries of health in developing countries could afford. This conclusion provides strong encouragement for supporting the development of the vaccine so that, if it proves to be safe and effective, licensure can be achieved soon and the burden of dengue disease can be reduced.

Association between handling stress in the corral and rabies antibody titers in selenium-supplemented cattle

This study determined the correlation between serum cortisol levels and rabies antibody titers in cattle primo-vaccinated against rabies and supplemented with dietary selenium (Se). Sixty Nelore male calves (10 to 12 months old) received daily and individual dietary supplementation with 0, 3.6, 5.4 and 6.4 mg Se (groups Gc, G3.6, G5.4 and G6.4, respectively). The animals were vaccinated against rabies (day 0) and subjected to handling stress in the corral for 120 days. Blood sampling procedures were performed on days 0, 15, 30, 60, 90 and 120. Cortisol levels increased until day 90, but had dropped significantly by day 120 (P < 0.01). Rabies antibody titers on days 30 and 90 were similar among Se-supplemented groups; in the control group, rabies antibodies decreased significantly from day 30 to 60, and 90 to 120. Serum cortisol levels and antibody titers were not correlated in most of the groups or blood sampling days. A positive correlation among these variables was found only in G6.4 on days 60 (R = 0.513; P = 0.05) and 120 (R = 0.644; P = 0.009). In conclusion, repeated handling in the corral stresses cattle, but without compromising rabies humoral immune response.