We analyzed the cost-effectiveness of hepatitis A vaccination regimens using a mathematical simulation model. Passive immunization and two active vaccination strategies (with and without prior screening) were compared with "doing nothing." Hepatitis A antibodies were determined in 2,325 Dutch marines; other input data were retrieved from published and unpublished sources. The prevalence of hepatitis A antibody was 14%. Screening before vaccination was identified as appropriate at a prevalence > 20%. Passive immunization was the cheapest prevention for a single 6-month deployment per 10 years. The inactivated vaccine containing 1,440 enzyme-linked immunosorbent assay units without prior screening was identified as the best option for more frequent deployments. It was cost-saving with two or more missions per 10 years. A 5.3% hepatitis A attack rate validated the investment for this policy. Overall, immunization with inactivated hepatitis A vaccine without prior screening proved to be the optimum strategy for troops at regular risk.
This prospective descriptive study presents the morbidity among 2,283 Dutch marines in northwest Cambodia from 1992 and 1993. In a field database, we recorded 4,036 consultations from 1,356 persons (59.4%) leading to 3,562 diagnoses and 392 different International Classification of Diseases codes. Most diagnoses were for tropical disorders (24.8%), musculoskeletal disorders and injuries (23.9%), and dermatological disorders (22.7%). Risk factors for morbidity were being in battalion 1 and in lower military ranks. There were 3,468 lost working days (0.91%), predominantly caused by musculoskeletal disorders and injuries (35.1%), tropical disorders (29.7%), and dermatological disorders (18.1%). Risk factors for lost working days were being in battalion 1, of younger age, and in lower ranks. Most lost working days occurred during the second month of each deployment. Despite many consultations, the overall morbidity and consequent lost working days remained low.
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