1
|
Mukonka VM, Sialubanje C, Matapo BB, Chewe O, Ngomah AM, Ngosa W, Hamoonga R, Sinyange N, Mzyece H, Mazyanga L, Bakyaita N, Kapata N. Euvichol-plus vaccine campaign coverage during the 2017/2018 cholera outbreak in Lusaka district, Zambia: a cross-sectional descriptive study. BMJ Open 2023; 13:e070796. [PMID: 37798024 PMCID: PMC10565249 DOI: 10.1136/bmjopen-2022-070796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To determine the coverage for the oral cholera vaccine (OCV) campaign conducted during the 2017/2018 cholera outbreak in Lusaka, Zambia. STUDY DESIGN A descriptive cross-sectional study employing survey method conducted among 1691 respondents from 369 households following the second round of the 2018 OCV campaign. STUDY SETTING Four primary healthcare facilities and their catchment areas in Lusaka city (Kanyama, Chawama, Chipata and Matero subdistricts). PARTICIPANTS A total of 1691 respondents 12 months and older sampled from 369 households where the campaign was conducted. A satellite map-based sampling technique was used to randomly select households. DATA MANAGEMENT AND ANALYSIS A pretested electronic questionnaire uploaded on an electronic tablet (ODK V.1.12.2) was used for data collection. Descriptive statistics were computed to summarise respondents' characteristics and OCV coverage per dose. Bivariate analysis (χ2 test) was conducted to stratify OCV coverage according to age and sex for each round (p<0.05). RESULTS The overall coverage for the first, second and two doses were 81.3% (95% CI 79.24% to 83.36%), 72.1% (95% CI 69.58% to 74.62%) and 66% (95% CI 63.22% to 68.78%), respectively. The drop-out rate was 18.8% (95% CI 14.51% to 23.09%). Of the 81.3% who received the first dose, 58.8% were female. Among those who received the second dose, the majority (61.0%) were females aged between 5 and 14 years (42.6%) and 15 and 35 years (27.7%). Only 15.5% of the participants aged between 36 and 65 and 2.5% among those aged above 65 years received the second dose. CONCLUSION These findings confirm the 2018 OCV campaign coverage and highlight the need for follow-up surveys to validate administrative coverage estimates using population-based methods. Reliance on health facility data alone may mask low coverage and prevent measures to improve programming. Future public health interventions should consider sociodemographic factors in order to achieve optimal vaccine coverage.
Collapse
Affiliation(s)
- Victor M Mukonka
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
- School of Medicine, The Copperbelt University, Kitwe, Zambia
| | - Cephas Sialubanje
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Orbrie Chewe
- Surveillance and Disease Intelligence, Zambia National Public Health Institute, Lusaka, Zambia
- Public Health, Zambia Ministry of Health, Lusaka, Zambia
| | - Albertina Moraes Ngomah
- Communication Information & Research, Zambia National Public Health Institute, Lusaka, Zambia
| | - Willaim Ngosa
- Communication Information & Research, Zambia National Public Health Institute, Lusaka, Zambia
| | - Raymond Hamoonga
- Surveillance and Disease Intelligence, Zambia National Public Health Institute, Lusaka, Zambia
| | - Nyambe Sinyange
- Surveillance and Disease Intelligence, Zambia National Public Health Institute, Lusaka, Zambia
| | - Hannah Mzyece
- Surveillance and Disease Intelligence, Zambia National Public Health Institute, Lusaka, Zambia
| | - Lucy Mazyanga
- Communication Information & Research, Zambia National Public Health Institute, Lusaka, Zambia
| | | | - Nathan Kapata
- Epidemic Preparedness and Response, Zambia National Public Health Institute, Lusaka, Zambia
| |
Collapse
|
2
|
Park SE, Jeon Y, Kang S, Gedefaw A, Hailu D, Yeshitela B, Edosa M, Getaneh MW, Teferi M. Infectious Disease Control and Management in Ethiopia: A Case Study of Cholera. Front Public Health 2022; 10:870276. [PMID: 35712321 PMCID: PMC9197421 DOI: 10.3389/fpubh.2022.870276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Cholera remains a significant public health problem among the vulnerable populations living in many resource-limited settings with poor access to safe and clean water and hygiene practice. Around 2.86 million cholera cases and 95,000 deaths are estimated to occur in endemic countries. In Ethiopia, cholera has been one of the major epidemic diseases since 1634 when the first cholera outbreak was recorded in-country. Several cholera epidemics occurred with recent outbreaks in 2019–2021. Cholera has been often reported as acute watery diarrhea due to limited diagnostic capacity in remote areas in Ethiopia and sensitivities around cholera outbreaks. The government of Ethiopia has been executing several phases of multi-year health sector development plan in the past decades and has recently developed a national cholera control plan. Here, we aim to present the existing cholera control guidelines and health system in Ethiopia, including case detection and reporting, outbreak declaration, case management, and transmission control. Challenges and way forward on further research and public health interventions are also discussed to address the knowledge and health service gaps related to cholera control in Ethiopia.
Collapse
Affiliation(s)
- Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea.,Yonsei University Graduate School of Public Health, Seoul, South Korea
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea
| | - Sunjoo Kang
- Yonsei University Graduate School of Public Health, Seoul, South Korea
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea.,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea.,School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Moti Edosa
- Diseases Surveillance and Response Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Wossen Getaneh
- Diseases Surveillance and Response Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| |
Collapse
|
3
|
Hsiao A, Ramani E, Seo HJ, Pak G, Vuntade D, M'bang'ombe M, Ngwira B, Quentin W, Marks F, Mogasale V. Economic impact of cholera in households in rural southern Malawi: a prospective study. BMJ Open 2022; 12:e052337. [PMID: 35649608 PMCID: PMC9161053 DOI: 10.1136/bmjopen-2021-052337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cholera remains a significant contributor to diarrhoeal illness, especially in sub-Saharan Africa. Few studies have estimated the cost of illness (COI) of cholera in Malawi, a cholera-endemic country. The present study estimated the COI of cholera in Nsanje, southern Malawi, as part of the Cholera Surveillance in Malawi (CSIMA) programme following a mass cholera vaccination campaign in 2015. METHODS Patients ≥12 months of age who were recruited as part of CSIMA were invited to participate in the COI survey. The COI tool captured household components of economic burden, including direct medical and non-medical costs, and indirect lost productivity costs. RESULTS Between April 2016 and March 2020, 40 cholera cases were enrolled in the study, all of whom participated in the COI survey. Only two patients had any direct medical costs and five patients reported lost wages due to illness. The COI per patient was US$14.34 (in 2020), more than half of which was from direct non-medical costs from food, water, and transportation to the health centre. CONCLUSION For the majority of Malawians who struggle to subsist on less than US$2 a day, the COI of cholera represents a significant cost burden to families. While cholera treatment is provided for free in government-run health centres, additional investments in cholera control and prevention at the community level and financial support beyond direct medical costs may be necessary to alleviate the economic burden of cholera on households in southern Malawi.
Collapse
Affiliation(s)
- Amber Hsiao
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Enusa Ramani
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Policy and Economic Research, International Vaccine Institute, Seoul, The Republic of Korea
| | - Hye-Jin Seo
- Epidemiology, Public Health, Impact, International Vaccine Institute, Seoul, The Republic of Korea
| | - GiDeok Pak
- Biostatistics & Data Management, International Vaccine Institute, Seoul, The Republic of Korea
| | - Dan Vuntade
- Department of Environmental Health, University of Malawi the Polytechnic, Blantyre, Malawi
| | | | - Bagrey Ngwira
- Department of Environmental Health, University of Malawi the Polytechnic, Blantyre, Malawi
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Florian Marks
- Epidemiology, Public Health, Impact, International Vaccine Institute, Gwanak-gu, The Republic of Korea
- Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge Institute of Therapeutic Immunology and Infectious Disease, Cambridge, UK
| | - Vittal Mogasale
- Policy and Economic Research, International Vaccine Institute, Seoul, The Republic of Korea
| |
Collapse
|
4
|
Debes AK, Shaffer AM, Ndikumana T, Liesse I, Ribaira E, Djumo C, Ali M, Sack DA. Cholera Hot-Spots and Contextual Factors in Burundi, Planning for Elimination. Trop Med Infect Dis 2021; 6:76. [PMID: 34064986 PMCID: PMC8163194 DOI: 10.3390/tropicalmed6020076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
The Republic of Burundi first reported cholera cases in 1978 and outbreaks have been occurring nearly every year since then. From 2008-2020, 6949 cases and 43 deaths were officially reported. To evaluate Burundi's potential to eliminate cholera, we identified hotspots using cholera incidence and disease persistence as suggested by the Global Task Force for Cholera Control. The mean annual incidence for each district that reported cholera ranged from 0.29 to 563.14 cases per 100,000 population per year from 2014-2020. Ten of 12 Health Districts which recorded cholera cases reported a mean annual incidence ≥5 per 100,000 for this time period. Cholera cases occur during the second half of the year in the areas near Lake Tanganyika and along the Ruzizi River, with the highest risk district being Bujumbura Centre. Additional research is needed to understand the role of Lake Tanganyika; risks associated with fishing; migration patterns; and other factors that may explain cholera's seasonality. Due to the consistent epidemiological pattern and the relatively small area affected by cholera, control and elimination are feasible with an integrated program of campaigns using oral cholera vaccine over the short term and community-based interventions including WASH activities for sustained control.
Collapse
Affiliation(s)
- Amanda K. Debes
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA; (A.M.S.); (M.A.); (D.A.S.)
| | - Allison M. Shaffer
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA; (A.M.S.); (M.A.); (D.A.S.)
| | - Thaddee Ndikumana
- Ministry of Public Health, Rue Pierre Ngendandumwe, Bujumbura B.P. 1650, Burundi; (T.N.); (I.L.)
| | - Iteka Liesse
- Ministry of Public Health, Rue Pierre Ngendandumwe, Bujumbura B.P. 1650, Burundi; (T.N.); (I.L.)
| | - Eric Ribaira
- UNICEF Burundi Country Office, Bujumbura B.P. 1650, Burundi; (E.R.); (C.D.)
| | - Clement Djumo
- UNICEF Burundi Country Office, Bujumbura B.P. 1650, Burundi; (E.R.); (C.D.)
| | - Mohammad Ali
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA; (A.M.S.); (M.A.); (D.A.S.)
| | - David A. Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA; (A.M.S.); (M.A.); (D.A.S.)
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
6
|
Bwire G, Roskosky M, Ballard A, Brooks WA, Okello A, Rafael F, Ampeire I, Orach CG, Sack DA. Use of surveys to evaluate an integrated oral cholera vaccine campaign in response to a cholera outbreak in Hoima district, Uganda. BMJ Open 2020; 10:e038464. [PMID: 33303438 PMCID: PMC7733212 DOI: 10.1136/bmjopen-2020-038464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the quality and coverage of the campaign to distribute oral cholera vaccine (OCV) during a cholera outbreak in Hoima, Uganda to guide future campaigns of cholera vaccine. DESIGN Survey of communities targeted for vaccination to determine vaccine coverage rates and perceptions of the vaccination campaign, and a separate survey of vaccine staff who carried out the campaign. SETTING Hoima district, Uganda. PARTICIPANTS Representative clusters of households residing in the communities targeted for vaccination and staff members who conducted the vaccine campaign. RESULTS Among 209 households (1274 individuals) included in the coverage survey, 1193 (94%; 95% CI 92% to 95%) reported receiving at least one OCV dose and 998 (78%; 95% CI 76% to 81%) reported receiving two doses. Among vaccinated individuals, minor complaints were reported by 71 persons (5.6%). Individuals with 'some' education (primary school or above) were more knowledgeable regarding the required OCV doses compared with non-educated (p=0.03). Factors negatively associated with campaign implementation included community sensitisation time, staff payment and problems with field transport. Although the campaign was carried out quickly, the outbreak was over before the campaign started. Most staff involved in the campaign (93%) were knowledgeable about cholera control; however, 29% did not clearly understand how to detect and manage adverse events following immunisation. CONCLUSION The campaign achieved high OCV coverage, but the surveys provided insights for improvement. To achieve high vaccine coverage, more effort is needed for community sensitisation, and additional resources for staff transportation and timely payment for campaign staff is required. Pretest and post-test assessment of staff training can identify and address knowledge and skill gaps.
Collapse
Affiliation(s)
- Godfrey Bwire
- Department of Community Health, Ministry of Health, Kampala, Uganda
| | - Mellisa Roskosky
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Ballard
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alfred Okello
- Makerere University, College of Health Sciences, Kampala, Uganda
| | - Florentina Rafael
- Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Immaculate Ampeire
- Ministry of Health, Uganda National Expanded Program on Immunization, Kampala, Uganda
| | | | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Ngwa MC, Alemu W, Okudo I, Owili C, Ugochukwu U, Clement P, Devaux I, Pezzoli L, Oche JA, Ihekweazu C, Sack DA. The reactive vaccination campaign against cholera emergency in camps for internally displaced persons, Borno, Nigeria, 2017: a two-stage cluster survey. BMJ Glob Health 2020; 5:e002431. [PMID: 32601092 PMCID: PMC7326259 DOI: 10.1136/bmjgh-2020-002431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In 2017, amidst insecurity and displacements posed by Boko Haram armed insurgency, cholera outbreak started in the Muna Garage camp for Internally Displaced Persons (IDPs) in Borno State, Nigeria. In response, the Borno Ministry of Health and partners determined to provide oral cholera vaccine (OCV) to about 1 million people in IDP camps and surrounding communities in six Local Government Areas (LGAs) including Maiduguri, Jere, Konduga, Mafa, Dikwa, and Monguno. As part of Monitoring and Evaluation, we described the coverage achieved, adverse events following immunisation (AEFI), non-vaccination reasons, vaccination decisions as well as campaign information sources. METHODS We conducted two-stage probability cluster surveys with clusters selected without replacement according to probability-proportionate-to-population-size in the six LGAs targeted by the campaign. Individuals aged ≥1 years were the eligible study population. Data sources were household interviews with vaccine card verification and memory recall, if no card, as well as multiple choice questions with an open-ended option. RESULTS Overall, 12 931 respondents participated in the survey. Overall, 90% (95% CI: 88 to 92) of the target population received at least one dose of OCV, range 87% (95% CI: 75 to 94) in Maiduguri to 94% (95% CI: 88 to 97) in Monguno. The weighted two-dose coverage was 73% (95% CI: 68 to 77) with a low of 68% (95% CI: 46 to 86) in Maiduguri to a high of 87% (95% CI: 74 to 95) in Dikwa. The coverage was lower during first round (76%, 95% CI: 71 to 80) than second round (87%, 95% CI: 84 to 89) and ranged from 72% (95% CI: 42 to 89) and 82% (95% CI: 82 to 91) in Maiduguri to 87% (95% CI: 75 to 95) and 94% (95% CI: 88 to 97) in Dikwa for the respective first and second rounds. Also, coverage was higher among females of age 5 to 14 and ≥15 years than males of same age groups. There were mild AEFI with the most common symptoms being fever, headache and diarrhoea occurring up to 48 hours after ingesting the vaccine. The most common actions taken after AEFI symptoms included 'did nothing' and 'self-medicated at home'. The top reason for taking vaccine was to protect from cholera while top reason for non-vaccination was travel/work. The main source of campaign information was a neighbour. An overwhelming majority (96%, 95% CI: 95% to 98%) felt the campaign team treated them with respect. While 43% (95% CI: 36% to 50%) asked no questions, 37% (95% CI: 31% to 44%) felt the team addressed all their concerns. CONCLUSION The campaign achieved high coverage using door-to-door and fixed sites strategies amidst insecurity posed by Boko Haram. Additional studies are needed to improve how to reduce non-vaccination, especially for the first round. While OCV provides protection for a few years, additional actions will be needed to make investments in water, sanitation and hygiene infrastructure.
Collapse
Affiliation(s)
- Moise Chi Ngwa
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | - David A Sack
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Abstract
Vaccination is a key intervention to prevent and control cholera in conjunction with water, sanitation and hygiene activities. An oral cholera vaccine (OCV) stockpile was established by the World Health Organization (WHO) in 2013. We reviewed its use from July 2013 to all of 2018 in order to assess its role in cholera control. We computed information related to OCV deployments and campaigns conducted including setting, target population, timelines, delivery strategy, reported adverse events, coverage achieved, and costs. In 2013-2018, a total of 83,509,941 OCV doses have been requested by 24 countries, of which 55,409,160 were approved and 36,066,010 eventually shipped in 83 deployments, resulting in 104 vaccination campaigns in 22 countries. OCVs had in general high uptake (mean administrative coverage 1st dose campaign at 90.3%; 2nd dose campaign at 88.2%; mean survey-estimated two-dose coverage at 69.9%, at least one dose at 84.6%) No serious adverse events were reported. Campaigns were organized quickly (five days median duration). In emergency settings, the longest delay was from the occurrence of the emergency to requesting OCV (median: 26 days). The mean cost of administering one dose of vaccine was 2.98 USD. The OCV stockpile is an important public health resource. OCVs were generally well accepted by the population and their use demonstrated to be safe and feasible in all settings. OCV was an inexpensive intervention, although timing was a limiting factor for emergency use. The dynamic created by the establishment of the OCV stockpile has played a role in the increased use of the vaccine by setting in motion a virtuous cycle by which better monitoring and evaluation leads to better campaign organization, better cholera control, and more requests being generated. Further work is needed to improve timeliness of response and contextualize strategies for OCV delivery in the various settings.
Collapse
Affiliation(s)
- Lorenzo Pezzoli
- Cholera Team/Focal Point for Vaccination, Infectious Hazard Management (IHM), World Health Organization, Switzerland
| |
Collapse
|
9
|
Deen J, Mengel MA, Clemens JD. Epidemiology of cholera. Vaccine 2020; 38 Suppl 1:A31-A40. [DOI: 10.1016/j.vaccine.2019.07.078] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
|
10
|
Burnett EM, Francois J, Sreenivasan N, Wannemuehler K, Faye PC, Tohme RA, Delly P, Deslouches YG, Etheart MD, Dismer AM, Patel R, Date K. Oral cholera vaccination coverage after the first global stockpile deployment in Haiti, 2014. Vaccine 2019; 37:6348-55. [DOI: 10.1016/j.vaccine.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022]
|
11
|
Khan AI, Islam MS, Islam MT, Ahmed A, Chowdhury MI, Chowdhury F, Siddik MAU, Clemens JD, Qadri F. Oral cholera vaccination strategy: Self-administration of the second dose in urban Dhaka, Bangladesh. Vaccine 2019; 37:827-832. [PMID: 30639459 DOI: 10.1016/j.vaccine.2018.12.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/06/2018] [Accepted: 12/21/2018] [Indexed: 01/22/2023]
Abstract
Cholera remains a major public health problem in many developing countries including Bangladesh. The oral cholera vaccine (OCV) is now considered a key component of the public health response to cholera. Although maintaining cold chain and organizing human resource are the major challenges of vaccine delivery to the community. Here we applied an innovative approach to second dose OCV delivery to minimize financial and logistic burdens. The purpose of this study was to assess the feasibility and compliance of second dose self-administration when the second dose was provided in a plastic bag to first dose vaccine recipients as OCV is stable for up to 42 days at ambient temperatures. We aimed to deploy vaccines (N = 112,000) left over from other studies to 56,000 people aged ≥ one year living in Mirpur, Dhaka to see the feasibility of self-administration strategy. During vaccination, the first OCV dose (OCV1) was given from fixed sites and the second dose (OCV2) was provided in a plastic zip-lock bag for the participant to take the vaccine two weeks later at home. Participants were instructed to keep the vaccine away from light and in a dry cool place. Empty vials were collected following the end date of the scheduled second vaccination. Of the targeted population, 41,694 (74%) received the first OCV dose whereas an estimated 38,852 (93% of those receiving the first dose) received the second dose which represents a 7% drop out rate from OCV1 to OCV2. However the average two dose coverage was 69%. A survey of a subsample 2990 (from 8551) randomly selected households revealed that almost all respondents (98.75%) appreciated this new self-administration strategy and considered the strategy to be more practical and convenient than the usual method. This simplified, self-administered delivery strategy provides an ideal alternative for second-dose OCV delivery in hard-to-reach populations and resource-poor settings.
Collapse
Affiliation(s)
- Ashraful Islam Khan
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Taufiqul Islam
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Azimuddin Ahmed
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiul Islam Chowdhury
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ashraf Uddin Siddik
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John D Clemens
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
Semá Baltazar C, Rafael F, Langa JPM, Chicumbe S, Cavailler P, Gessner BD, Pezzoli L, Barata A, Zaina D, Inguane DL, Mengel MA, Munier A. Oral cholera vaccine coverage during a preventive door-to-door mass vaccination campaign in Nampula, Mozambique. PLoS One 2018; 13:e0198592. [PMID: 30281604 PMCID: PMC6169854 DOI: 10.1371/journal.pone.0198592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/22/2018] [Indexed: 12/13/2022] Open
Abstract
Background In addition to improving water, sanitation and hygiene (WASH) measures and optimal case management, the introduction of Oral cholera vaccine (OCV) is a complementary strategy for cholera prevention and control for vulnerable population groups. In October 2016, the Mozambique Ministry of Health implemented a mass vaccination campaign using a two-dose regimen of the Shanchol™ OCV in six high-risk neighborhoods of Nampula city, in Northern Mozambique. Overall 193,403 people were targeted by the campaign, which used a door-to-door strategy. During campaign follow-up, a population survey was conducted to assess: (1) OCV coverage; (2) frequency of adverse events following immunization; (3) vaccine acceptability and (4) reasons for non-vaccination. Methodology/Principal findings In the absence of a household listing and clear administrative neighborhood delimitations, we used geospatial technology to select households from satellite images and used the support of community leaders. One person per household was randomly selected for interview. In total, 636 individuals were enrolled in the survey. The overall vaccination coverage with at least one dose (including card and oral reporting) was 69.5% (95%CI: 51.2–88.2) and the two-dose coverage was 51.2% (95%CI: 37.9–64.3). The campaign was well accepted. Among the 185 non-vaccinated individuals, 83 (44.6%) did not take the vaccine because they were absent when the vaccination team visited their houses. Among the 451 vaccinated individuals, 47 (10%) reported minor and non-specific complaints, and 78 (17.3%) mentioned they did not receive any information before the campaign. Conclusions/Significance In spite of overall coverage being slightly lower than expected, the use of a mobile door-to-door strategy remains a viable option even in densely-populated urban settings. Our results suggest that campaigns can be successfully implemented and well accepted in Mozambique in non-emergency contexts in order to prevent cholera outbreaks. These findings are encouraging and complement the previous Mozambican experience related to OCV.
Collapse
Affiliation(s)
| | | | | | - Sergio Chicumbe
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Américo Barata
- Direcção Provincial de Saúde, Ministry of Health, Nampula, Mozambique
| | - Dores Zaina
- Direcção de Saúde de Cidade, Ministry of Health, Nampula, Mozambique
| | | | | | | |
Collapse
|
14
|
Grandesso F, Rafael F, Chipeta S, Alley I, Saussier C, Nogareda F, Burns M, Lechevalier P, Page AL, Salumu L, Pezzoli L, Mwesawina M, Cavailler P, Mengel M, Luquero FJ, Cohuet S. Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi. Bull World Health Organ 2018; 96:817-825. [PMID: 30505029 PMCID: PMC6249704 DOI: 10.2471/blt.17.206417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023] Open
Abstract
Objective To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. Methods We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplified cold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras. Finding Vaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) on zimboweras. Coverage with two doses was 53.0% (769/1451), 91.1% (1010/1106) and 78.8% (186/236), in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies. Conclusion Vaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term.
Collapse
Affiliation(s)
| | | | - Sikhona Chipeta
- Directorate of Preventive Health Services, Ministry of Health, Lilongwe, Malawi
| | - Ian Alley
- Epicentre, 8 rue Saint-Sabin, 75011 Paris, France
| | | | - Francisco Nogareda
- Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Lorenzo Pezzoli
- Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Maurice Mwesawina
- Directorate of Preventive Health Services, Ministry of Health, Lilongwe, Malawi
| | | | | | | | | |
Collapse
|
15
|
Lopez AL, Deen J, Azman AS, Luquero FJ, Kanungo S, Dutta S, von Seidlein L, Sack DA. Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis. Clin Infect Dis 2018; 66:1960-1971. [PMID: 29177437 PMCID: PMC5982790 DOI: 10.1093/cid/cix1039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/19/2017] [Indexed: 12/16/2022] Open
Abstract
In addition to improved water supply and sanitation, the 2-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The metaanalysis showed that an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggest otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.
Collapse
Affiliation(s)
- Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, West Bengal, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, West Bengal, India
| | - Lorenz von Seidlein
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David A Sack
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
16
|
Massing LA, Aboubakar S, Blake A, Page AL, Cohuet S, Ngandwe A, Mukomena Sompwe E, Ramazani R, Allheimen M, Levaillant P, Lechevalier P, Kashimi M, de la Motte A, Calmejane A, Bouhenia M, Dabire E, Bompangue D, Kebela B, Porten K, Luquero F. Highly targeted cholera vaccination campaigns in urban setting are feasible: The experience in Kalemie, Democratic Republic of Congo. PLoS Negl Trop Dis 2018; 12:e0006369. [PMID: 29734337 PMCID: PMC5957443 DOI: 10.1371/journal.pntd.0006369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/17/2018] [Accepted: 03/06/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction Oral cholera vaccines are primarily recommended by the World Health Organization for cholera control in endemic countries. However, the number of cholera vaccines currently produced is very limited and examples of OCV use in endemic countries, and especially in urban settings, are scarce. A vaccination campaign was organized by Médecins Sans Frontières and the Ministry of Health in a highly endemic area in the Democratic Republic of Congo. This study aims to describe the vaccine coverage achieved with this highly targeted vaccination campaign and the acceptability among the vaccinated communities. Methods and findings We performed a cross-sectional survey using random spatial sampling. The study population included individuals one year old and above, eligible for vaccination, and residing in the areas targeted for vaccination in the city of Kalemie. Data sources were household interviews with verification by vaccination card. In total 2,488 people were included in the survey. Overall, 81.9% (95%CI: 77.9–85.3) of the target population received at least one dose of vaccine. The vaccine coverage with two doses was 67.2% (95%CI: 61.9–72.0) among the target population. The vaccine coverage was higher during the first round (74.0, 95%CI: 69.3–78.3) than during the second round of vaccination (69.1%, 95%CI: 63.9–74.0). Vaccination coverage was lower in male adults. The main reason for non-vaccination was to be absent during the campaign. No severe adverse events were notified during the interviews. Conclusions Cholera vaccination campaigns using highly targeted strategies are feasible in urban settings. High vaccination coverage can be obtained using door to door vaccination. However, alternative strategies should be considered to reach non-vaccinated populations like male adults and also in order to improve the efficiency of the interventions. The oral cholera vaccine, Shanchol, has already been shown as an effective tool in controlling a cholera outbreak. The limited amount of doses, concurrently with the logistic constraints associated with a targeted vaccination campaign are serious difficulties to tackle in order to organize a vaccination campaign in an urban setting. Although the World Health Organization recommends its use for cholera control in endemic countries, the fact remains that the use of the oral cholera vaccine in endemic setting has scarcely been described, especially in an urban setting, until now. Médecins Sans Frontières and the Ministry of Health from Democratic Republic of Congo organized a vaccination campaign of a limited part of the urbanized and highly endemic city of Kalemie, in the Tanganyika Province using a door to door strategy. The vaccine coverage in the targeted zones was high and demonstrated the feasibility of cholera vaccination campaign in this setting but also the need for creative strategies in order to reach population remaining hard to vaccine.
Collapse
Affiliation(s)
| | | | | | | | | | - Adalbert Ngandwe
- Ministère de la Santé Publique, Katanga, Democratic Republic of Congo
| | | | - Romain Ramazani
- Médecins Sans Frontières, Katanga, Democratic Republic of Congo
| | | | | | | | - Marie Kashimi
- Médecins Sans Frontières, Katanga, Democratic Republic of Congo
| | | | | | | | - Ernest Dabire
- World Health Organization, Kinshasa, Democratic Republic of Congo
| | - Didier Bompangue
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | - Benoit Kebela
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | | | | |
Collapse
|