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Oral Cholera Vaccine Efficacy and Effectiveness. Vaccines (Basel) 2021; 9:vaccines9121482. [PMID: 34960228 PMCID: PMC8708586 DOI: 10.3390/vaccines9121482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Although measuring vaccine efficacy through the conventional phase III study design, randomized, double-blinded controlled trial serves as the "gold standard", effectiveness studies, conducted in the context of a public health program, seek to broaden the understanding of the impact of a vaccine in a real world setting including both individual and population level impacts. Cholera is an acute diarrheal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae. Since the 1980s, either killed or live oral cholera vaccines (OCVs) have been developed and efficacy and effectiveness studies have been conducted on OCV. Although the results of OCV effectiveness studies sometimes showed outliers, the tendency seen is for effectiveness of the vaccine used in public health settings to be somewhat higher than estimated in randomized controlled trials due to the influence of indirect herd protection. Efficacy and Effectiveness studies both generate important information about the vaccine performance characteristics and its impact when used in real world populations at risk for the disease.
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2
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Saha GK, Ganguly NK. Spread and Endemicity of Cholera in India: Factors Beyond the Numbers. J Infect Dis 2021; 224:S710-S716. [PMID: 34550374 PMCID: PMC8687089 DOI: 10.1093/infdis/jiab436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cholera outbreaks currently account for 1.3 to 4.0 million cases and cause between 21 000 and 143 000 deaths worldwide. Cholera is preventable by proper sanitization and immunization; however, in many developing nations such as India, cholera disease is endemic. The surveillance system in India does not adequately capture the actual number of cases. As a result, it is important to utilize limited public health resources correctly in India and other developing counties more effectively to reach vulnerable communities. In this study, we analyze how studies make sense of cholera transmission and spread in India from 1996 to 2015. Furthermore, we analyze how a more sensitive surveillance system can contribute to cholera eradication by giving rise to outbreak preparedness.
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Affiliation(s)
- Gautam K Saha
- Apollo Hospitals Educational and Research Foundation
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3
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Deen J, Clemens JD. Licensed and Recommended Inactivated Oral CholeraVaccines: From Development to Innovative Deployment. Trop Med Infect Dis 2021; 6:32. [PMID: 33803390 PMCID: PMC8005943 DOI: 10.3390/tropicalmed6010032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Cholera is a disease of poverty and occurs where there is a lack of access to clean water and adequate sanitation. Since improved water supply and sanitation infrastructure cannot be implemented immediately in many high-risk areas, vaccination against cholera is an important additional tool for prevention and control. We describe the development of licensed and recommended inactivated oral cholera vaccines (OCVs), including the results of safety, efficacy and effectiveness studies and the creation of the global OCV stockpile. Over the years, the public health strategy for oral cholera vaccination has broadened-from purely pre-emptive use to reactive deployment to help control outbreaks. Limited supplies of OCV doses continues to be an important problem. We discuss various innovative dosing and delivery approaches that have been assessed and implemented and evidence of herd protection conferred by OCVs. We expect that the demand for OCVs will continue to increase in the coming years across many countries.
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Affiliation(s)
- Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Pedro Gil Street, Ermita, Manila 1000, Philippines;
| | - John D. Clemens
- International Centre for Diarrhoeal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh
- UCLA Fielding School of Public Health, 650 Charles E Young Drive South, Los Angeles, CA 90095-1772, USA
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4
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Diep TT, Jensen O, Van Thuong N, Nhi NTN, Thu NNA, Quang VN, Hieu TC, Thang HA, Thuy ND, Thang HV, Tuyen HT, Ngan LD, Ha NTT, Dung TD, Anderson CP, Azman AS, Leung DT. Sero-evaluation of Immune Responses to Vibrio cholerae in a Postelimination Setting. Open Forum Infect Dis 2020; 7:ofaa136. [PMID: 32462045 PMCID: PMC7240342 DOI: 10.1093/ofid/ofaa136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/17/2020] [Indexed: 11/14/2022] Open
Abstract
Cholera remains a significant public health problem worldwide. In settings of declining incidence, serosurveillance may be used to augment clinical surveillance. We utilized dried blood spot sampling and cholera-specific antibody testing to examine the serologic profiles of vaccinated and unvaccinated children in southern Vietnam, where cholera was recently eliminated.
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Affiliation(s)
| | - Owen Jensen
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | | | | | | | | | | | | | - Le Dang Ngan
- Provincial Preventive Medical Centres, Tien Giang, Vietnam
| | | | | | - Cole P Anderson
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.,Division of Microbiology & Immunology, University of Utah, Salt Lake City, Utah, USA
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5
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Mogasale V, Kanungo S, Pati S, Lynch J, Dutta S. The history of OCV in India and barriers remaining to programmatic introduction. Vaccine 2020; 38 Suppl 1:A41-A45. [PMID: 31982258 DOI: 10.1016/j.vaccine.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/29/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Cholera-endemic Eastern India has played an important role in the development of oral cholera vaccines (OCV) through conduct of pivotal trials in Kolkata which led to the registration of the first low-cost bivalent killed whole cell OCV in India in 2009, and subsequent prequalification by the World Health Organization prequalification in 2011. Odisha hosted an influential early demonstration project for use of the vaccine in a high-risk population and provided data and lessons that were crucial input in the Vaccine Investment Strategy developed by Gavi, the Vaccine Alliance in 2013. With Gavi's decision to finance an OCV stockpile, the demand for OCV surged and vaccine has been deployed with great success worldwide in areas of need in response to outbreaks and disasters, most notably in Africa. However, although India is considered one of the highest burden countries, no further use of OCV has occurred since the demonstration project in Odisha in 2011. In this paper we will summarize the important contributions of India to the development and use of OCV and discuss the possible barriers to OCV introduction as a public health tool to control cholera.
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Affiliation(s)
- Vittal Mogasale
- International Vaccine Institute, Policy and Economic Research Department; Public Health, Access and Vaccine Epidemiology (PAVE) Unit, Seoul, South Korea
| | - Suman Kanungo
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sanghamitra Pati
- Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Julia Lynch
- International Vaccine Institute, Development & Delivery Unit, Seoul, South Korea
| | - Shanta Dutta
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India.
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6
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Lopez AL, Dutta S, Qadri F, Sovann L, Pandey BD, Bin Hamzah WM, Memon I, Iamsirithaworn S, Dang DA, Chowdhury F, Heng S, Kanungo S, Mogasale V, Sultan A, Ylade M. Cholera in selected countries in Asia. Vaccine 2019; 38 Suppl 1:A18-A24. [PMID: 31326255 DOI: 10.1016/j.vaccine.2019.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/20/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam. METHODS Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available. RESULTS From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases. DISCUSSION AND CONCLUSION We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.
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Affiliation(s)
- Anna Lena Lopez
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Philippines.
| | - Shanta Dutta
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, India
| | - Firdausi Qadri
- International Center for Diarrheal Disease Research, Bangladesh
| | | | | | | | - Iqbal Memon
- Sir Syed College of Medical Science, Pakistan
| | - Sopon Iamsirithaworn
- Department of Disease Control, Thailand Ministry of Public Health-U.S. CDC Collaboration, Thailand
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Viet Nam
| | | | | | - Suman Kanungo
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, India
| | | | | | - Michelle Ylade
- Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Philippines
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7
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Tembo T, Simuyandi M, Chiyenu K, Sharma A, Chilyabanyama ON, Mbwili-Muleya C, Mazaba ML, Chilengi R. Evaluating the costs of cholera illness and cost-effectiveness of a single dose oral vaccination campaign in Lusaka, Zambia. PLoS One 2019; 14:e0215972. [PMID: 31150406 PMCID: PMC6544210 DOI: 10.1371/journal.pone.0215972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 04/11/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION In 2016, for the very first time, the Ministry of Health in Zambia implemented a reactive outbreak response to control the spread of cholera and vaccinated at-risk populations with a single dose of Shancol-an oral cholera vaccine (OCV). This study aimed to assess the costs of cholera illness and determine the cost-effectiveness of the 2016 vaccination campaign. METHODOLOGY From April to June 2017, we conducted a retrospective cost and cost-effectiveness analysis in three peri-urban areas of Lusaka. To estimate costs of illness from a household perspective, a systematic random sample of 189 in-patients confirmed with V. cholera were identified from Cholera Treatment Centre registers and interviewed for out-of-pocket costs. Vaccine delivery and health systems costs were extracted from financial records at the District Health Office and health facilities. The cost of cholera treatment was derived by multiplying the subsidized cost of drugs by the quantity administered to patients during hospitalisation. The cost-effectiveness analysis measured incremental cost-effectiveness ratio-cost per case averted, cost per life saved and cost per DALY averted-for a single dose OCV. RESULTS The mean cost per administered vaccine was US$1.72. Treatment costs per hospitalized episode were US$14.49-US$18.03 for patients ≤15 years old and US$17.66-US$35.16 for older patients. Whereas households incurred costs on non-medical items such as communication, beverages, food and transport during illness, a large proportion of medical costs were borne by the health system. Assuming vaccine effectiveness of 88.9% and 63%, a life expectancy of 62 years and Gross Domestic Product (GDP) per capita of US$1,500, the costs per case averted were estimated US$369-US$532. Costs per life year saved ranged from US$18,515-US$27,976. The total cost per DALY averted was estimated between US$698-US$1,006 for patients ≤15 years old and US$666-US$1,000 for older patients. CONCLUSION Our study determined that reactive vaccination campaign with a single dose of Shancol for cholera control in densely populated areas of Lusaka was cost-effective.
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Affiliation(s)
- Tannia Tembo
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Kanema Chiyenu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | | | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Odevall L, Hong D, Digilio L, Sahastrabuddhe S, Mogasale V, Baik Y, Choi S, Kim JH, Lynch J. The Euvichol story - Development and licensure of a safe, effective and affordable oral cholera vaccine through global public private partnerships. Vaccine 2018; 36:6606-6614. [PMID: 30314912 PMCID: PMC6203809 DOI: 10.1016/j.vaccine.2018.09.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 01/04/2023]
Abstract
Cholera, a diarrheal disease primarily affecting vulnerable populations in developing countries, is estimated to cause disease in more than 2.5 million people and kill almost 100,000 annually. An oral cholera vaccine (OCV) has been available globally since 2001; the demand for this vaccine from affected countries has however been very low, due to various factors including vaccine price and mode of administration. The low demand for the vaccine and limited commercial incentives to invest in research and development of vaccines for developing country markets has kept the global supply of OCVs down. Since 1999, the International Vaccine Institute has been committed to make safe, effective and affordable OCVs accessible. Through a variety of partnerships with collaborators in Sweden, Vietnam, India and South Korea, and with public and private funding, IVI facilitated development and production of two affordable and WHO-prequalified OCVs and together with other stakeholders accelerated the introduction of these vaccines for the global public-sector market.
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Affiliation(s)
- Lina Odevall
- Life Science Consultant, Gothenburg, Sweden; International Vaccine Institute, Seoul, Republic of Korea.
| | - Deborah Hong
- International Vaccine Institute, Seoul, Republic of Korea; Médecins Sans Frontières, Seoul, Republic of Korea
| | - Laura Digilio
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Julia Lynch
- International Vaccine Institute, Seoul, Republic of Korea
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9
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Fong Y, Halloran ME, Park JK, Marks F, Clemens JD, Chao DL. Efficacy of a bivalent killed whole-cell cholera vaccine over five years: a re-analysis of a cluster-randomized trial. BMC Infect Dis 2018; 18:84. [PMID: 29463233 PMCID: PMC5819652 DOI: 10.1186/s12879-018-2981-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Oral cholera vaccine (OCV) is a feasible tool to prevent or mitigate cholera outbreaks. A better understanding of the vaccine’s efficacy among different age groups and how rapidly its protection wanes could help guide vaccination policy. Methods To estimate the level and duration of OCV efficacy, we re-analyzed data from a previously published cluster-randomized, double-blind, placebo controlled trial with five years of follow-up. We used a Cox proportional hazards model and modeled the potentially time-dependent effect of age categories on both vaccine efficacy and risk of infection in the placebo group. In addition, we investigated the impact of an outbreak period on model estimation. Results Vaccine efficacy was 38% (95% CI: -2%,62%) for those vaccinated from ages 1 to under 5 years old, 85% (95% CI: 67%,93%) for those 5 to under 15 years, and 69% (95% CI: 49%,81%) for those vaccinated at ages 15 years and older. Among adult vaccinees, efficacy did not appear to wane during the trial, but there was insufficient data to assess the waning of efficacy among child vaccinees. Conclusions Through this re-analysis we were able to detect a statistically significant difference in OCV efficacy when the vaccine was administered to children under 5 years old vs. children 5 years and older. The estimated efficacies are more similar to the previously published analysis based on the first two years of follow-up than the analysis based on all five years. Trial registration ClinicalTrials.gov identifier NCT00289224 Electronic supplementary material The online version of this article (10.1186/s12879-018-2981-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youyi Fong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, 98109, WA, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, 98195, WA, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, 98109, WA, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, 98195, WA, USA
| | - Jin Kyung Park
- Epidemiology Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology Unit, International Vaccine Institute, Seoul, Republic of Korea.,The Department of Medicine, The University of Cambridge, Cambridge, United Kingdom
| | | | - Dennis L Chao
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, 98109, WA, USA. .,Institute for Disease Modeling, Intellectual Ventures, Bellevue, 98005, WA, USA.
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Nguyen TH, Pham TD, Higa N, Iwashita H, Takemura T, Ohnishi M, Morita K, Yamashiro T. Analysis of Vibrio seventh pandemic island II and novel genomic islands in relation to attachment sequences among a wide variety of Vibrio cholerae strains. Microbiol Immunol 2018; 62:150-157. [PMID: 29315809 PMCID: PMC5900727 DOI: 10.1111/1348-0421.12570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/09/2017] [Accepted: 12/26/2017] [Indexed: 12/14/2022]
Abstract
Vibrio cholerae O1 El Tor, the pathogen responsible for the current cholera pandemic, became pathogenic by acquiring virulent factors including Vibrio seventh pandemic islands (VSP)‐I and −II. Diversity of VSP‐II is well recognized; however, studies addressing attachment sequence left (attL) sequences of VSP‐II are few. In this report, a wide variety of V. cholerae strains were analyzed for the structure and distribution of VSP‐II in relation to their attachment sequences. Of 188 V. cholerae strains analyzed, 81% (153/188) strains carried VSP‐II; of these, typical VSP‐II, and a short variant was found in 36% (55/153), and 63% (96/153), respectively. A novel VSP‐II was found in two V. cholerae non‐O1/non‐O139 strains. In addition to the typical 14‐bp attL, six new attL‐like sequences were identified. The 14‐bp attL was associated with VSP‐II in 91% (139/153), whereas the remaining six types were found in 9.2% (14/153) of V. cholerae strains. Of note, six distinct types of the attL‐like sequence were found in the seventh pandemic wave 1 strains; however, only one or two types were found in the wave 2 or 3 strains. Interestingly, 86% (24/28) of V. cholerae seventh pandemic strains harboring a 13‐bp attL‐like sequence were devoid of VSP‐II. Six novel genomic islands using two unique insertion sites to those of VSP‐II were identified in 11 V. cholerae strains in this study. Four of those shared similar gene clusters with VSP‐II, except integrase gene.
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Affiliation(s)
- Tuan Hai Nguyen
- Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto Nagasaki city, Nagasaki 852-8523, Japan
| | - Tho Duc Pham
- Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto Nagasaki city, Nagasaki 852-8523, Japan
| | - Naomi Higa
- Department of Bacteriology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hanako Iwashita
- Department of Bacteriology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Taichiro Takemura
- Department of Tropical Microbiology, Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kouichi Morita
- Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto Nagasaki city, Nagasaki 852-8523, Japan.,Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Tetsu Yamashiro
- Department of Bacteriology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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11
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Abstract
In a Perspective, Lorenz von Seidlein and Jacqueline L. Deen discuss the implications of Andrew Azman and colleagues' accompanying study for management of cholera outbreaks.
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Affiliation(s)
- Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jacqueline L. Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
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12
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Saha A, Hayen A, Ali M, Rosewell A, Clemens JD, Raina MacIntyre C, Qadri F. Socioeconomic risk factors for cholera in different transmission settings: An analysis of the data of a cluster randomized trial in Bangladesh. Vaccine 2017; 35:5043-5049. [PMID: 28765003 DOI: 10.1016/j.vaccine.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cholera remains a threat globally, and socioeconomic factors play an important role in transmission of the disease. We assessed socioeconomic risk factors for cholera in vaccinated and non-vaccinated communities to understand whether the socioeconomic risk factors differ by transmission patterns for cholera. METHODS We used data from a cluster randomized control trial conducted in Dhaka, Bangladesh. There were 90 geographic clusters; 30 in each of the three arms of the study: vaccine (VAC), vaccine plus behavioural change (VBC), and non-intervention. The data were analysed for the three populations: (1) vaccinees in the vaccinated communities (VAC and VBC arms), (2) non-vaccinated individuals in the vaccinated communities and (3) all individuals in the non-vaccinated communities (non-intervention arm). A generalized estimating equation with logit link function was used to evaluate the risk factors for cholera among these different populations adjusting for household level correlation in the data. RESULTS A total of 528 cholera and 226 cholera with severe dehydration (CSD) in 268,896 persons were observed during the two-year follow-up. For population 1, the cholera risk was not associated with any socioeconomic factors; however CSD was less likely to occur among individuals living in a household having ≤4 members (aOR=0.55, 95% CI=0.32-0.96). Among population 2, younger participants and individuals reporting diarrhoea during registration were more likely to have cholera. Females and individuals reporting diarrhoea during registration were at increased risk of CSD. Among population 3, individuals living in a household without a concrete floor, in an area with high population density, closer to the study hospital, or not treating drinking water were at significantly higher risk for both cholera and CSD. CONCLUSION The profile of socioeconomic factors associated with cholera varies by individuals' vaccination status as well as the transmission setting. In a vaccinated community where transmission would be expected to be lower, socioeconomic factors may not increase the risk of the disease.
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Affiliation(s)
- Amit Saha
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Australia
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia
| | - John D Clemens
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; UCLA Fielding School of Public Health, Los Angeles, USA; Korea University School of Medicine, Seoul, South Korea
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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Nguyen TV, Pham QD, Do QK, Diep TT, Phan HC, Ho TV, Do HT, Phan LT, Tran HN. Cholera returns to southern Vietnam in an outbreak associated with consuming unsafe water through iced tea: A matched case-control study. PLoS Negl Trop Dis 2017; 11:e0005490. [PMID: 28406946 PMCID: PMC5390973 DOI: 10.1371/journal.pntd.0005490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/14/2017] [Indexed: 11/18/2022] Open
Abstract
Background After more than a decade of steadily declining notifications, the number of reported cholera cases has recently increased in Vietnam. We conducted a matched case-control study to investigate transmission of cholera during an outbreak in Ben Tre, southern Vietnam, and to explore the associated risk factors. Methodology/Principal findings Sixty of 71 diarrheal patients confirmed to be infected with cholera by culture and diagnosed between May 9 and August 3, 2010 in Ben Tre were consecutively recruited as case-patients. Case-patients were matched 1:4 to controls by commune, sex, and 5-year age group. Risk factors for cholera were examined by multivariable conditional logistic regression. In addition, environmental samples from villages containing case-patients were taken to identify contamination of food and water sources. The regression indicated that drinking iced tea (adjusted odds ratio (aOR) = 8.40, 95% confidence interval (CI): 1.84–39.25), not always boiling drinking water (aOR = 2.62, 95% CI: 1.03–6.67), having the main source of water for use being close to a toilet (aOR = 4.36, 95% CI: 1.37–13.88), living with people who had acute diarrhea (aOR = 13.72, 95% CI: 2.77–67.97), and little or no education (aOR = 4.89, 95% CI: 1.18–20.19) were significantly associated with increased risk of cholera. In contrast, drinking stored rainwater (aOR = 0.17, 95% CI: 0.04–0.63), eating cooked seafood (aOR = 0.27, 95% CI: 0.10–0.73), and eating steamed vegetables (aOR = 0.22, 95% CI: 0.07–0.70) were protective against cholera. Vibrio cholerae O1 Ogawa carrying ctxA was found in two of twenty-five river water samples and one of six wastewater samples. Conclusions/Significance The magnitude of the cholera outbreak in Ben Tre was lower than in other similar settings. This investigation identified several risk factors and underscored the importance of continued responses targeting cholera prevention in southern Vietnam. The association between drinking iced tea and cholera and the spread of V. cholerae O1, altered El Tor strains warrant further research. These findings might be affected by a number of limitations due to the inability to capture asymptomatic or mildly symptomatic infections, the possible underreporting of personal unhygienic behaviors, and the purposive selection of environmental samples. Cholera is a highly contagious, acute diarrheal illness, which poses a profound health threat in many parts of the less developed world. The majority of cases are reported from Sub-Saharan Africa, South-East Asia, and the Americas (i.e., Haiti) where infections are primarily transmitted through ingestion of contaminated water. Today in the era of widely available rehydration therapies and antibiotics, deaths due to cholera are quite rare. Despite this, early detection of contaminated water sources is crucial for directing early interventions for curbing community-wide transmission. The authors found evidence linking an outbreak of cholera in southern Vietnam to consumption of unsafe water, especially drinking iced tea. This finding suggests the need for a water-monitoring system at ice-making plants. Further research is needed to confirm the biological link between iced tea consumption and cholera infection. Larger studies should also be conducted to understand the clinical consequences of infection with the new cholera agent (V. cholerae O1, altered El Tor strains).
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Affiliation(s)
| | - Quang D. Pham
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Quoc K. Do
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Tai T. Diep
- Department of Microbiology and Immunology, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Hung C. Phan
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Thang V. Ho
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Hong T. Do
- Ben Tre Preventive Health Centre, Ben Tre, Vietnam
| | - Lan T. Phan
- Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Huu N. Tran
- Pasteur Institute, Ho Chi Minh City, Vietnam
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Desai SN, Pezzoli L, Alberti KP, Martin S, Costa A, Perea W, Legros D. Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era. Hum Vaccin Immunother 2017; 13:579-587. [PMID: 27813703 PMCID: PMC5360144 DOI: 10.1080/21645515.2016.1245250] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 12/13/2022] Open
Abstract
Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.
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Mogasale V, Ramani E, Wee H, Kim JH. Oral Cholera Vaccination Delivery Cost in Low- and Middle-Income Countries: An Analysis Based on Systematic Review. PLoS Negl Trop Dis 2016; 10:e0005124. [PMID: 27930668 PMCID: PMC5145138 DOI: 10.1371/journal.pntd.0005124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/23/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Use of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers. OBJECTIVES To review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization that can help in collation, analysis, and comparison of delivery costs across countries. DATA SOURCES Peer reviewed publications listed in PubMed database, Google Scholar and World Health Organization (WHO) websites and unpublished data from organizations involved in oral cholera vaccination. STUDY ELIGIBILITY CRITERIA The publications and reports containing oral cholera vaccination delivery costs, conducted in low- and middle-income countries based on World Bank Classification. Limits are humans and publication date before December 31st, 2014. PARTICIPANTS No participants are involved, only costs are collected. INTERVENTION Oral cholera vaccination and cost estimation. STUDY APPRAISAL AND SYNTHESIS METHOD A systematic review was conducted using pre-defined inclusion and exclusion criteria. Cost items were categorized into four main cost groups: vaccination program preparation, vaccine administration, adverse events following immunization and vaccine procurement; the first three groups constituting the vaccine delivery costs. The costs were re-estimated in 2014 US dollars (US$) and in international dollar (I$). RESULTS Ten studies were identified and included in the analysis. The vaccine delivery costs ranged from US$0.36 to US$ 6.32 (in US$2014) which was equivalent to I$ 0.99 to I$ 16.81 (in I$2014). The vaccine procurement costs ranged from US$ 0.29 to US$ 29.70 (in US$2014), which was equivalent to I$ 0.72 to I$ 78.96 (in I$2014). The delivery costs in routine immunization systems were lowest from US$ 0.36 (in US$2014) equivalent to I$ 0.99 (in I$2014). LIMITATIONS The reported cost categories are not standardized at collection point and may lead to misclassification. Costs for some OCV campaigns are not available and analysis does not include direct and indirect costs to vaccine recipients. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Vaccine delivery cost estimation is needed for budgeting and economic analysis of vaccination programs. The cost categorization methodology presented in this study is helpful in collecting OCV delivery costs in a standardized manner, comparing delivery costs, planning vaccination campaigns and informing decision-making.
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Affiliation(s)
- Vittal Mogasale
- International Vaccine Institute, Policy and Economic Research Department, SNU Research Park, Seoul, South Korea
| | - Enusa Ramani
- International Vaccine Institute, Policy and Economic Research Department, SNU Research Park, Seoul, South Korea
| | - Hyeseung Wee
- International Vaccine Institute, Policy and Economic Research Department, SNU Research Park, Seoul, South Korea
- Korea Development Institute, Sejong-si, South Korea
| | - Jerome H. Kim
- International Vaccine Institute, Policy and Economic Research Department, SNU Research Park, Seoul, South Korea
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Saha A, Rosewell A, Hayen A, MacIntyre CR, Qadri F. Improving immunization approaches to cholera. Expert Rev Vaccines 2016; 16:235-248. [PMID: 27805467 DOI: 10.1080/14760584.2017.1249470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cholera's impact is greatest in resource-limited countries. In the last decade several large epidemics have led to a global push to improve and implement the tools for cholera prevention and control. Areas covered: PubMed, Google Scholar and the WHO website were searched to review the literature and summarize the current status of cholera vaccines to make recommendations on improving immunization approaches to cholera. Oral cholera vaccines (OCVs) have demonstrated their effectiveness in endemic, outbreak response and emergency settings, highlighting their potential for wider adoption. While two doses of the currently available OCVs are recommended by manufacturers, a single dose would be easier to implement. Encouragingly, recent studies have shown that cold chain requirements may no longer be essential. The establishment of the global OCV stockpile in 2013 has been a major advance in cholera preparedness. New killed and live-attenuated vaccines are being actively explored as candidate vaccines for endemic settings and/or as a traveller's vaccine. The recent advances in cholera vaccination approaches should be considered in the global cholera control strategy. Expert commentary: The development of affordable cholera vaccines is a major success to improve cholera control. New vaccines and country specific interventions will further reduce the burden of this disease globally.
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Affiliation(s)
- Amit Saha
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia.,b Infectious Diseases Division , International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b) , Dhaka , Bangladesh
| | - Alexander Rosewell
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia
| | - Andrew Hayen
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia.,c Faculty of Health , University of Technology Sydney , Sydney , NSW , Australia
| | - C Raina MacIntyre
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia
| | - Firdausi Qadri
- b Infectious Diseases Division , International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b) , Dhaka , Bangladesh
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Kim JH, Mogasale V, Burgess C, Wierzba TF. Impact of oral cholera vaccines in cholera-endemic countries: A mathematical modeling study. Vaccine 2016; 34:2113-20. [DOI: 10.1016/j.vaccine.2016.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/11/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
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Hall RH, Sack DA. Introducing cholera vaccination in Asia, Africa and Haiti: A meeting report. Vaccine 2015; 33:487-92. [DOI: 10.1016/j.vaccine.2014.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/24/2014] [Accepted: 11/18/2014] [Indexed: 11/16/2022]
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Martin S, Lopez AL, Bellos A, Deen J, Ali M, Alberti K, Anh DD, Costa A, Grais RF, Legros D, Luquero FJ, Ghai MB, Perea W, Sack DA. Post-licensure deployment of oral cholera vaccines: a systematic review. Bull World Health Organ 2014; 92:881-93. [PMID: 25552772 PMCID: PMC4264394 DOI: 10.2471/blt.14.139949] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 09/14/2014] [Accepted: 09/17/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe and analyse the characteristics of oral cholera vaccination campaigns; including location, target population, logistics, vaccine coverage and delivery costs. METHODS We searched PubMed, the World Health Organization (WHO) website and the Cochrane database with no date or language restrictions. We contacted public health personnel, experts in the field and in ministries of health and did targeted web searches. FINDINGS A total of 33 documents were included in the analysis. One country, Viet Nam, incorporates oral cholera vaccination into its public health programme and has administered approximately 10.9 million vaccine doses between 1997 and 2012. In addition, over 3 million doses of the two WHO pre-qualified oral cholera vaccines have been administered in more than 16 campaigns around the world between 1997 and 2014. These campaigns have either been pre-emptive or reactive and have taken place under diverse conditions, such as in refugee camps or natural disasters. Estimated two-dose coverage ranged from 46 to 88% of the target population. Approximate delivery cost per fully immunized person ranged from 0.11-3.99 United States dollars. CONCLUSION Experience with oral cholera vaccination campaigns continues to increase. Public health officials may draw on this experience and conduct oral cholera vaccination campaigns more frequently.
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Affiliation(s)
- Stephen Martin
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland
| | - Anna Lena Lopez
- University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | - Anna Bellos
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland
| | - Jacqueline Deen
- Delivering Oral Vaccine Effectively (DOVE), Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America (USA)
| | - Mohammad Ali
- Delivering Oral Vaccine Effectively (DOVE), Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America (USA)
| | - Kathryn Alberti
- United Nations Children's Fund, United Nations Plaza, New York, USA
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Alejandro Costa
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland
| | | | - Dominique Legros
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland
| | | | - Megan B Ghai
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland
| | - William Perea
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland
| | - David A Sack
- Delivering Oral Vaccine Effectively (DOVE), Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America (USA)
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