EVALUATION OF HOUSE-TO-HOUSE VERSUS FIXED-SITE ORAL POLIOVIRUS VACCINE DELIVERY STRATEGIES IN A MASS IMMUNIZATION CAMPAIGN IN EGYPT

Among poliomyelitis eradication activities recommended by WHO are nati onal immunization days, Most campaigns have delivered oral poliovirus vaccine (OPV) from fixed sites, reaching 80-90% of target populations. Although house-to-house vaccination provides nearly universal coverag e, countries have been reluctant to use this approach because it is co nsidered more costly and logistically difficult. To quantify the cost- effectiveness of both these strategies, we compared the vaccine covera ge and vaccination costs per child for house-to-house and fixed-site d elivery in a mass campaign in Egypt. While personnel and total costs w ere higher in house-to-house delivery (38% and 13% higher, respectivel y), the costs per child vaccinated were similar. This was due primaril y to the high coverage levels achieved in house-to-house delivery (100 % versus 86%) and the reduced vaccine wastage. Vaccinating children al highest risk of infection was only 25-50% as expensive on a per child basis using house-to-house delivery, since such children were less li kely to visit fixed sites, These findings may not be generalizable to other countries where labour costs are higher and the population densi ty lower; however, house-to-house delivery may prove to be the most co st-effective eradication strategy by ensuring universal access to immu nization.