Development of a Cholera Vaccination Policy on the Island of Hispaniola, 2010–2013

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Abstract

Deployment of oral cholera vaccine (OCV) on the Island of Hispaniola has been considered since the emergence of the disease in October of 2010. At that time, emergency response focused on the time-tested measures of treatment to prevent deaths and sanitation to diminish transmission. Use of the limited amount of vaccine available in the global market was recommended for demonstration activities, which were carried out in 2012. As transmission continues, vaccination was recommended in Haiti as one component of a comprehensive initiative supported by an international coalition to eliminate cholera on the Island of Hispaniola. Leveraging its delivery to strengthen other cholera prevention measures and immunization services, a phased OCV introduction is pursued in accordance with global vaccine supply. Not mutually exclusive or sequential deployment options include routine immunization for children over the age of 1 year and campaigns in vulnerable metropolitan areas or rural areas with limited access to health services.

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Most cited references 35

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Refractory periods and climate forcing in cholera dynamics.

Katia Koelle, Md Mostafa, Mercedes Pascual … (2005)

Outbreaks of many infectious diseases, including cholera, malaria and dengue, vary over characteristic periods longer than 1 year. Evidence that climate variability drives these interannual cycles has been highly controversial, chiefly because it is difficult to isolate the contribution of environmental forcing while taking into account nonlinear epidemiological dynamics generated by mechanisms such as host immunity. Here we show that a critical interplay of environmental forcing, specifically climate variability, and temporary immunity explains the interannual disease cycles present in a four-decade cholera time series from Matlab, Bangladesh. We reconstruct the transmission rate, the key epidemiological parameter affected by extrinsic forcing, over time for the predominant strain (El Tor) with a nonlinear population model that permits a contributing effect of intrinsic immunity. Transmission shows clear interannual variability with a strong correspondence to climate patterns at long periods (over 7 years, for monsoon rains and Brahmaputra river discharge) and at shorter periods (under 7 years, for flood extent in Bangladesh, sea surface temperatures in the Bay of Bengal and the El Niño-Southern Oscillation). The importance of the interplay between extrinsic and intrinsic factors in determining disease dynamics is illustrated during refractory periods, when population susceptibility levels are low as the result of immunity and the size of cholera outbreaks only weakly reflects climate forcing.

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Herd immunity conferred by killed oral cholera vaccines in Bangladesh: a reanalysis.

Mohammad Ali, Michael Emch, Lorenz von Seidlein … (2015)

Decisions about the use of killed oral cholera vaccines, which confer moderate levels of direct protection to vaccinees, can depend on whether the vaccines also provide indirect (herd) protection when high levels of vaccine coverage are attained. We reanalysed data from a field trial in Bangladesh to ascertain whether there is evidence of indirect protection from killed oral cholera vaccines. We analysed the first year of surveillance data from a placebo-controlled trial of B subunit-killed whole-cell and killed whole-cell-only oral cholera vaccines in children and adult women in Bangladesh. We calculated whether there was an inverse, monotonic trend for the relation between the level of vaccine coverage in a residential cluster and the incidence of cholera in individual vaccine recipients or placebo recipients residing in the cluster after controlling for potential confounding variables. Vaccine coverage of the targeted population ranged from 4% to 65%. Incidence rates of cholera among placebo recipients were inversely related to levels of vaccine coverage (7.01 cases per 1000 in the lowest quintile of coverage vs 1.47 cases per 1000 in the highest quintile; p<0.0001 for trend). Receipt of vaccine by an individual and the level of vaccine coverage of the individual's cluster were independently related to a reduced risk of cholera. Moreover, after adjustment for the level of vaccine coverage of the cluster, vaccine protective efficacy remained significant (55% [95% CI 41-66], p<0.0001). In addition to providing direct protection to vaccine recipients, killed oral cholera vaccines confer significant herd protection to neighbouring non-vaccinated individuals. Use of these vaccines could have a major effect on the burden of cholera in endemic settings.

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Cholera vaccines: WHO position paper.

of the World Health Organization World Health Organization Constitution (2010)

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Author and article information

Journal

Journal ID (nlm-ta): Am J Trop Med Hyg

Journal ID (iso-abbrev): Am. J. Trop. Med. Hyg

Journal ID (publisher-id): tpmd

Title: The American Journal of Tropical Medicine and Hygiene

Publisher: The American Society of Tropical Medicine and Hygiene

ISSN (Print): 0002-9637

ISSN (Electronic): 1476-1645

Publication date (Print): 09 October 2013

Publication date PMC-release: 09 October 2013

Volume: 89

Issue: 4

Pages: 682-687

Affiliations

Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, District of Columbia; Sabin Vaccine Institute, Washington, District of Columbia; Deputy Director Office, Pan American Health Organization, Washington, District of Columbia

Author notes

*Address correspondence to Andrea S. Vicari, Comprehensive Family Immunization Unit, Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037. E-mail: vicarian@ 123456paho.org

Article

DOI: 10.4269/ajtmh.13-0200

PMC ID: 3795098

PubMed ID: 24106195

SO-VID: 1fc242df-d892-4829-9dc0-1505ef071599

License:

This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Development of a Cholera Vaccination Policy on the Island of Hispaniola, 2010–2013

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Most cited references 35

Refractory periods and climate forcing in cholera dynamics.

Herd immunity conferred by killed oral cholera vaccines in Bangladesh: a reanalysis.

Cholera vaccines: WHO position paper.

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