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Uzbekistan, the most populous country in central Asia, was the first in the region to introduce rotavirus vaccine into its national immunization program. Rotarix (GlaxoSmithKline Biologicals, RV1) was introduced in June 2014, with doses recommended at age 2 and 3 months. To evaluate vaccine impact, active surveillance for rotavirus diarrhea was reestablished in 2014 at 2 hospitals in Tashkent and Bukhara which had also performed surveillance during the pre-vaccine period 2005−2009. Children aged

Oral poliovirus vaccine (OPV) was not available in Samarkand, Uzbekistan, from November 1992 to August 1993. The ensuing outbreak of poliomyelitis was investigated: Patients with poliomyelitis were evaluated, the extent of poliovirus circulation was estimated, and the effectiveness of control measures was assessed. Between March 1993 and April 1994, 74 cases of paralytic disease attributable to poliovirus type 3 were reported. Cases originated from 63% of districts; 88% of cases were children < or = 2 years old, and the highest attack rates were for infants 9-11 months (65/100,000) and 12-14 months (60/100,000). Most patients were either unvaccinated (45%) or inadequately vaccinated (23%). Limited quantities of OPV became available in September 1993 and were provided to infants (3 doses) and 1-year-olds (2 doses), controlling rapidly the outbreak in these age groups, but cases continued, primarily among older children, until April 1994. These findings suggest that control efforts should be guided by the age distribution of the children with poliomyelitis.

BACKGROUND: Hib vaccine has gradually been introduced into more and more countries during the past two decades, partly due to GAVI Alliance support to low-income countries. However, since Hib disease burden is difficult to establish in settings with limited diagnostic capacities and since the vaccine continues to be relatively expensive, some Governments remain doubtful about its value leading to concerns about financial sustainability. Similarly, several middle-income countries have not introduced the vaccine. The aim of this study is to estimate and compare the cost-effectiveness of Hib vaccination in a country relying on self-financing (Belarus) and a country eligible for GAVI Alliance support (Uzbekistan). METHODS AND FINDINGS: A decision analytic model was used to estimate morbidity and mortality from Hib meningitis, Hib pneumonia and other types of Hib disease with and without the vaccine. Treatment costs were attached to each disease event. Data on disease incidence, case fatality ratios and costs were primarily determined from national sources. For the Belarus 2009 birth cohort, Hib vaccine is estimated to prevent 467 invasive disease cases, 4 cases of meningitis sequelae, and 3 deaths, while in Uzbekistan 3,069 invasive cases, 34 sequelae cases and 341 deaths are prevented. Estimated costs per discounted DALY averted are US$ 9,323 in Belarus and US$ 267 in Uzbekistan. CONCLUSION: The primary reason why the cost-effectiveness values are more favourable in Uzbekistan than in Belarus is that relatively more deaths are averted in Uzbekistan due to higher baseline mortality burden. Two other explanations are that the vaccine price is lower in Uzbekistan and that Uzbekistan uses a three dose schedule compared to four doses in Belarus. However, when seen in the context of the relative ability to pay for public health, the vaccine can be considered cost-effective in both countries.