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Elias Chitio JJ, Baltazar CS, Langa JP, Baloi LD, Mboane RBJ, Manuel JA, Assane S, Omar A, Manso M, Capitine I, Van Rensburg C, Luiz N, Mogasale V, Marks F, Park SE, Beck NS. Pre-emptive oral cholera vaccine (OCV) mass vaccination campaign in Cuamba District, Niassa Province, Mozambique: feasibility, vaccination coverage and delivery costs using CholTool. BMJ Open 2022; 12:e053585. [PMID: 36547726 PMCID: PMC9454037 DOI: 10.1136/bmjopen-2021-053585] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Mozambique suffers from regular floods along its principal river basins and periodic cyclones that resulted in several cholera epidemics during the last decades. Cholera outbreaks in the recent 5 years affected particularly the northern provinces of the country including Nampula and Niassa provinces. A pre-emptive oral cholera vaccine (OCV) mass vaccination campaign was conducted in Cuamba District, Niassa Province, and the feasibility, costs, and vaccination coverage assessed. METHODS WHO prequalified OCV (Euvichol-Plus), a killed whole-cell bivalent vaccine containing Vibrio cholerae O1 (classical and El Tor) and O139, was administered in two doses with a 15-day interval during 7-31 August 2018, targeting around 180 000 people aged above 1 year in Cuamba District. Microplanning, community sensitisation, and training of local public health professionals and field enumerators were conducted. Feasibility and costs of vaccination were assessed using CholTool. Vaccination coverage and barriers were assessed through community surveys. RESULTS The administrative coverage of the first and second rounds of the campaign were 98.9% (194 581) and 98.8% (194 325), respectively, based on the available population data that estimated total 196 652 inhabitants in the target area. The vaccination coverage survey exhibited 75.9% (±2.2%) and 68.5% (±3.3%) coverage for the first and second rounds, respectively. Overall, 60.4% (±3.4%) of the target population received full two doses of OCV. Barriers to vaccination included incompatibility between working hours and campaign time. No severe adverse events were notified. The total financial cost per dose delivered was US$0.60 without vaccine cost and US$1.98 including vaccine costs. CONCLUSION The pre-emptive OCV mass vaccination campaign in remote setting in Mozambique was feasible with reasonable full-dose vaccination coverage to confer sufficient herd immunity for at least the next 3 to 5 years. The delivery cost estimate indicates that the OCV campaign is affordable as it is comparable with Gavi's operational support for vaccination campaigns.
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Affiliation(s)
- Jucunú J Elias Chitio
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - Cynthia S Baltazar
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - José Paulo Langa
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - Liliana Dengo Baloi
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | | | | | - Sadate Assane
- Provincial Directorate of Health, Lichinga City, Mozambique
| | - Alide Omar
- District Health Directorate, Cuamba District, Mozambique
| | - Mariana Manso
- District Health Directorate, Cuamba District, Mozambique
| | - Igor Capitine
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - Craig Van Rensburg
- Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Naira Luiz
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Vittal Mogasale
- Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemology, Public Health, Impact (EPIC) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
| | - Namseon S Beck
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Medair Headquarters, Ecublens, VD, Switzerland
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Gudo ES, Cook K, Kasper AM, Vergara A, Salomão C, Oliveira F, Ismael H, Saeze C, Mosse C, Fernandes Q, Viegas SO, Baltazar CS, Doyle TJ, Yard E, Steck A, Serret M, Falconer TM, Kern SE, Brzezinski JL, Turner JA, Boyd BL, Jani IV. Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa. Clin Infect Dis 2019; 66:1400-1406. [PMID: 29155976 DOI: 10.1093/cid/cix1005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/15/2017] [Indexed: 11/13/2022] Open
Abstract
Background On 9 January 2015, in a rural town in Mozambique, >230 persons became sick and 75 died of an illness linked to drinking pombe, a traditional alcoholic beverage. Methods An investigation was conducted to identify case patients and determine the cause of the outbreak. A case patient was defined as any resident of Chitima who developed any new or unexplained neurologic, gastrointestinal, or cardiovascular symptom from 9 January at 6:00 am through 12 January at 11:59 pm. We conducted medical record reviews, healthcare worker and community surveys, anthropologic and toxicologic investigations of local medicinal plants and commercial pesticides, and laboratory testing of the suspect and control pombe. Results We identified 234 case patients; 75 (32%) died and 159 recovered. Overall, 61% of case patients were female (n = 142), and ages ranged from 1 to 87 years (median, 30 years). Signs and symptoms included abdominal pain, diarrhea, vomiting, and generalized malaise. Death was preceded by psychomotor agitation and abnormal posturing. The median interval from pombe consumption to symptom onset was 16 hours. Toxic levels of bongkrekic acid (BA) were detected in the suspect pombe but not the control pombe. Burkholderia gladioli pathovar cocovenenans, the bacteria that produces BA, was detected in the flour used to make the pombe. Conclusions We report for the first time an outbreak of a highly lethal illness linked to BA, a deadly food-borne toxin in Africa. Given that no previous outbreaks have been recognized outside Asia, our investigation suggests that BA might be an unrecognized cause of toxic outbreaks globally.
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Affiliation(s)
| | - Kyla Cook
- Association of Schools and Programs of Public Health, Washington, DC
| | - Amelia M Kasper
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alfredo Vergara
- Center for Global Health, Centers for Disease Control and Prevention, Maputo
| | | | | | - Hamida Ismael
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Cristovão Saeze
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Carla Mosse
- Tete Provincial Health Directorate, Ministry of Health, Maputo
| | | | | | | | - Timothy J Doyle
- Center for Global Health, Centers for Disease Control and Prevention, Maputo
| | - Ellen Yard
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alaina Steck
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Travis M Falconer
- Forensic Chemistry Center, US Food and Drug Administration, Cincinnati, Ohio
| | - Sara E Kern
- Forensic Chemistry Center, US Food and Drug Administration, Cincinnati, Ohio
| | | | - James A Turner
- Forensic Chemistry Center, US Food and Drug Administration, Cincinnati, Ohio
| | - Brian L Boyd
- Forensic Chemistry Center, US Food and Drug Administration, Cincinnati, Ohio
| | - Ilesh V Jani
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
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Nadri J, Sauvageot D, Njanpop-Lafourcade BM, Baltazar CS, Banla Kere A, Bwire G, Coulibaly D, Kacou N’Douba A, Kagirita A, Keita S, Koivogui L, Landoh DE, Langa JP, Miwanda BN, Mutombo Ndongala G, Mwakapeje ER, Mwambeta JL, Mengel MA, Gessner BD. Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa. Am J Trop Med Hyg 2018; 98:1021-1030. [PMID: 29488455 PMCID: PMC5928804 DOI: 10.4269/ajtmh.16-0523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/20/2017] [Indexed: 11/07/2022] Open
Abstract
During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for Vibrio cholerae in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.
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Affiliation(s)
| | | | | | | | - Abiba Banla Kere
- Institut National d’Hygiène, Lomé, Togo
- Ministry of Health, Lomé, Togo
| | - Godfrey Bwire
- Control of Diarrheal Diseases, Community Health Department, Ministry of Health, Kampala, Uganda
| | | | | | - Atek Kagirita
- Central Public Health Laboratory, Ministry of Health, Kampala, Uganda
| | - Sakoba Keita
- Division Prévention et Lutte contre la Maladie, Ministry of Health, Conakry, Guinea
| | | | | | - Jose P. Langa
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Berthe N. Miwanda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Guy Mutombo Ndongala
- Division Provinciale de la Santé du Nord Kivu, Goma, Democratic Republic of Congo
| | - Elibariki R. Mwakapeje
- Epidemiology and Diseases Control Section, Preventive Department, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Jacob L. Mwambeta
- Curative Department, National Health Laboratory Quality Assurance and Training Center, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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