American Journal of Tropical Medicine and Hygiene
December 2014; 91 (6)
http://www.ajtmh.org/content/current

Modular Laboratories—Cost-Effective and Sustainable Infrastructure for Resource-Limited Settings
Daniel J. Bridges*, James Colborn, Adeline S. T. Chan, Anna M. Winters, Dereje Dengala,
Christen M. Fornadel and Barry Kosloff
Author Affiliations
Akros, Cresta Golfview Grounds, Lusaka, Zambia; President’s Malaria Initiative, U.S. Centers for Disease Control and Prevention, Mozambique; Entomology Branch, Centers for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Abt Associates Inc., Bethesda, Maryland; President’s Malaria Initiative, U.S. Agency for International Development, Washington, DC; London School of Hygiene and Tropical Medicine, Faculty of Tropical Infectious Diseases, Department of Clinical Research, London, United Kingdom; ZAMBART Project, University of Zambia School of Medicine, Lusaka, Zambia
Abstract.
High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world.

Evaluation of Targeted Mass Cholera Vaccination Strategies in Bangladesh: A Demonstration of a New Cost-Effectiveness Calculator
Christopher Troeger, David A. Sack and Dennis L. Chao*
Author Affiliations
Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Abstract
Growing interest in mass vaccination with oral cholera vaccine in endemic and epidemic settings will require policymakers to evaluate how to allocate these vaccines in the most efficient manner. Because cholera, when treated properly, has a low case fatality rate, it may not be economically feasible to vaccinate an entire population. Using a new publicly available calculator for estimating the cost-effectiveness of mass vaccination, we show how targeting high-risk subpopulations for vaccination could be cost-effective in Bangladesh. The approach described here is general enough to adapt to different settings or to other vaccine-preventable diseases.

Economic and Disease Burden of Dengue Illness in India
Donald S. Shepard, Yara A. Halasa, Brij Kishore Tyagi, S. Vivek Adhish, Deoki Nandan, K. S. Karthiga, Vidya Chellaswamy, Mukul Gaba, Narendra K. Arora*, the INCLEN Study Group
Author Affiliations
Brandeis University, Waltham, Massachusetts; Centre for Research in Medical Entomology, Madurai, India; National Institute of Health and Family Welfare, New Delhi, India; INCLEN Trust International, New Delhi, India
Abstract
Between 2006 and 2012 India reported an annual average of 20,474 dengue cases. Although dengue has been notifiable since 1996, regional comparisons suggest that reported numbers substantially underrepresent the full impact of the disease. Adjustment for underreporting from a case study in Madurai district and an expert Delphi panel yielded an annual average of 5,778,406 clinically diagnosed dengue cases between 2006 and 2012, or 282 times the reported number per year. The total direct annual medical cost was US$548 million. Ambulatory settings treated 67% of cases representing 18% of costs, whereas 33% of cases were hospitalized, comprising 82% of costs. Eighty percent of expenditures went to private facilities. Including non-medical and indirect costs based on other dengue-endemic countries raises the economic cost to $1.11 billion, or $0.88 per capita. The economic and disease burden of dengue in India is substantially more than captured by officially reported cases, and increased control measures merit serious consideration.