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Edosa M, Jeon Y, Gedefaw A, Hailu D, Mesfin Getachew E, Mogeni OD, Jang GH, Mukasa D, Yeshitela B, Getahun T, Lynch J, Bouhenia M, Worku Demlie Y, Hussen M, Wossen M, Teferi M, Park SE. Comprehensive Review on the Use of Oral Cholera Vaccine (OCV) in Ethiopia: 2019 to 2023. Clin Infect Dis 2024; 79:S20-S32. [PMID: 38996040 PMCID: PMC11244176 DOI: 10.1093/cid/ciae194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Cholera outbreaks in Ethiopia necessitate frequent mass oral cholera vaccine (OCV) campaigns. Despite this, there is a notable absence of a comprehensive summary of these campaigns. Understanding national OCV vaccination history is essential to design appropriate and effective cholera control strategies. Here, we aimed to retrospectively review all OCV vaccination campaigns conducted across Ethiopia between 2019 and 2023. METHODS The OCV request records from 2019 to October 2023 and vaccination campaign reports for the period from 2019 to December 2023 were retrospectively accessed from the Ethiopia Public Health Institute (EPHI) database. Descriptive analysis was conducted using the retrospective data collected. RESULTS From 2019 to October 2023, Ethiopian government requested 32 044 576 OCV doses (31 899 576 doses to global stockpile; 145 000 doses to outside of stockpile). Around 66.3% of requested doses were approved; of which 90.4% were received. Fifteen OCV campaigns (12 reactive and 3 pre-emptive) were conducted, including five two-dose campaigns with varying dose intervals and single-dose campaigns partially in 2019 and entirely in 2021, 2022 and 2023. Overall vaccine administrative coverage was high; except for Tigray region (41.8% in the 1st round; 2nd round didn't occur). The vaccine administrative coverage records were documented, but no OCV coverage survey data was available. CONCLUSIONS This study represents the first comprehensive review of OCV campaigns in Ethiopia spanning the last five years. Its findings offer valuable insights into informing future cholera control strategies, underscoring the importance of monitoring and evaluation despite resource constraints. Addressing the limitations in coverage survey data availability is crucial for enhancing the efficacy of future campaigns.
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Affiliation(s)
- Moti Edosa
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | | | - Ondari D Mogeni
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - David Mukasa
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tomas Getahun
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Julia Lynch
- Cholera Program Director, International Vaccine Institute, Seoul, Republic of Korea
| | - Malika Bouhenia
- Global Task Force on Cholera Control (GTFCC), World Health Organization (WHO), Geneva, Switzerland
| | - Yeshambel Worku Demlie
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mukemil Hussen
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Global Health and Disease Control, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
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2
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Wheeler J, Rosengart A, Jiang Z, Tan K, Treutle N, Ionides EL. Informing policy via dynamic models: Cholera in Haiti. PLoS Comput Biol 2024; 20:e1012032. [PMID: 38683863 PMCID: PMC11081515 DOI: 10.1371/journal.pcbi.1012032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/09/2024] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Public health decisions must be made about when and how to implement interventions to control an infectious disease epidemic. These decisions should be informed by data on the epidemic as well as current understanding about the transmission dynamics. Such decisions can be posed as statistical questions about scientifically motivated dynamic models. Thus, we encounter the methodological task of building credible, data-informed decisions based on stochastic, partially observed, nonlinear dynamic models. This necessitates addressing the tradeoff between biological fidelity and model simplicity, and the reality of misspecification for models at all levels of complexity. We assess current methodological approaches to these issues via a case study of the 2010-2019 cholera epidemic in Haiti. We consider three dynamic models developed by expert teams to advise on vaccination policies. We evaluate previous methods used for fitting these models, and we demonstrate modified data analysis strategies leading to improved statistical fit. Specifically, we present approaches for diagnosing model misspecification and the consequent development of improved models. Additionally, we demonstrate the utility of recent advances in likelihood maximization for high-dimensional nonlinear dynamic models, enabling likelihood-based inference for spatiotemporal incidence data using this class of models. Our workflow is reproducible and extendable, facilitating future investigations of this disease system.
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Affiliation(s)
- Jesse Wheeler
- Statistics Department, University of Michigan, Ann Arbor, Michigan, United States of America
| | - AnnaElaine Rosengart
- Statistics and Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Zhuoxun Jiang
- Statistics Department, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kevin Tan
- Wharton Statistics and Data Science, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Noah Treutle
- Statistics Department, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Edward L. Ionides
- Statistics Department, University of Michigan, Ann Arbor, Michigan, United States of America
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3
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Kanchanarat S, Nudee K, Chinviriyasit S, Chinviriyasit W. Mathematical analysis of pulse vaccination in controlling the dynamics of measles transmission. Infect Dis Model 2023; 8:964-979. [PMID: 37654518 PMCID: PMC10465959 DOI: 10.1016/j.idm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Although the incidence of measles has been significantly reduced through vaccination, it remains an important public health problem. In this paper, a measles model with pulse vaccination is formulated to investigate the influential pulse vaccination on the period of time for the extinction of the disease. The threshold value of the formulated model, called the control reproduction number and denoted by R ∗ , is derived. It is found that the disease-free periodic solution of the model exists and is globally attractivity whenever R ∗ < 1 in the sense that measles is eliminated. If R ∗ > 1 , the positive solution of the model exists and is permanent which indicates the disease persists in the community. Theoretical conditions for disease eradication under various constraints are given. The effect of pulse vaccination is explored using data from Thailand. The results obtained can guide policymakers in deciding on the optimal scheduling in order to achieve the strategic plan of measles elimination by vaccination.
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Affiliation(s)
- Siwaphorn Kanchanarat
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Kadkanok Nudee
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
- Faculty of Science and Technology Suratthani Rajabhat University, Surat Thani, Thailand
| | - Settapat Chinviriyasit
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Wirawan Chinviriyasit
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
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4
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Boonstra PS, Tabarrok A, Strohbehn GW. Targeted randomization dose optimization trials enable fractional dosing of scarce drugs. PLoS One 2023; 18:e0287511. [PMID: 37903093 PMCID: PMC10615276 DOI: 10.1371/journal.pone.0287511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/07/2023] [Indexed: 11/01/2023] Open
Abstract
Administering drug at a dose lower than that used in pivotal clinical trials, known as fractional dosing, can stretch scarce resources. Implementing fractional dosing with confidence requires understanding a drug's dose-response relationship. Clinical trials aimed at describing dose-response in scarce, efficacious drugs risk underdosing, leading dose-finding trials to not be pursued despite their obvious potential benefit. We developed a new set of response-adaptive randomized dose-finding trials and demonstrate, in a series of simulated trials across diverse dose-response curves, these designs' efficiency in identifying the minimum dose that achieves satisfactory efficacy. Compared to conventional designs, these trials have higher probabilities of identifying lower doses while reducing the risks of both population- and subject-level underdosing. We strongly recommend that, upon demonstration of a drug's efficacy, pandemic drug development swiftly proceeds with response-adaptive dose-finding trials. This unified strategy ensures that scarce effective drugs produce maximum social benefits.
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Affiliation(s)
- Philip S. Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alex Tabarrok
- Department of Economics, George Mason University, Fairfax, Virginia, United States of America
| | - Garth W. Strohbehn
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, United States of America
- Veterans Affairs Center for Clinical Management and Research, Ann Arbor, Michigan, United States of America
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Division of Medical Oncology, LTC Charles S Kettles VA Medical Center, Ann Arbor, Michigan, United States of America
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
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5
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Kwong KWY, Xin Y, Lai NCY, Sung JCC, Wu KC, Hamied YK, Sze ETP, Lam DMK. Oral Vaccines: A Better Future of Immunization. Vaccines (Basel) 2023; 11:1232. [PMID: 37515047 PMCID: PMC10383709 DOI: 10.3390/vaccines11071232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Oral vaccines are gaining more attention due to their ease of administration, lower invasiveness, generally greater safety, and lower cost than injectable vaccines. This review introduces certified oral vaccines for adenovirus, recombinant protein-based, and transgenic plant-based oral vaccines, and their mechanisms for inducing an immune response. Procedures for regulatory approval and clinical trials of injectable and oral vaccines are also covered. Challenges such as instability and reduced efficacy in low-income countries associated with oral vaccines are discussed, as well as recent developments, such as Bacillus-subtilis-based and nanoparticle-based delivery systems that have the potential to improve the effectiveness of oral vaccines.
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Affiliation(s)
- Keith Wai-Yeung Kwong
- Research Department, DreamTec Cytokines Limited, Hong Kong, China
- Oristry BioTech (HK) Limited, Hong Kong, China
- Theratide BioTech (HK) Limited, Hong Kong, China
| | - Ying Xin
- Research Department, DreamTec Cytokines Limited, Hong Kong, China
| | - Nelson Cheuk-Yin Lai
- Research Department, DreamTec Cytokines Limited, Hong Kong, China
- Oristry BioTech (HK) Limited, Hong Kong, China
- Theratide BioTech (HK) Limited, Hong Kong, China
| | - Johnny Chun-Chau Sung
- Research Department, DreamTec Cytokines Limited, Hong Kong, China
- Oristry BioTech (HK) Limited, Hong Kong, China
- Theratide BioTech (HK) Limited, Hong Kong, China
| | - Kam-Chau Wu
- Research Department, DreamTec Cytokines Limited, Hong Kong, China
| | | | - Eric Tung-Po Sze
- School of Science and Technology, Hong Kong Metropolitan University, Hong Kong, China
| | - Dominic Man-Kit Lam
- DrD Novel Vaccines Limited, Hong Kong, China
- Torsten Wiesel International Research Institute, Sichuan University, Chengdu 610064, China
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6
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Dimitrov D, Adamson B, Matrajt L. Evaluation of mpox vaccine dose-sparing strategies. PNAS NEXUS 2023; 2:pgad095. [PMID: 37152676 PMCID: PMC10154907 DOI: 10.1093/pnasnexus/pgad095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/08/2023] [Indexed: 05/09/2023]
Abstract
The spring-summer 2022 mpox outbreak had over 50,000 cases globally, most of them in gay, bisexual, and other men who have sex with men (MSM). In response to vaccine shortages, several countries implemented dose-sparing vaccination strategies, stretching a full-dose vaccine vial into up to five fractional-dose vaccines. Recent studies have found mixed results regarding the effectiveness of the mpox vaccine, raising the question of the utility of dose-sparing strategies. We used an age- and risk-stratified mathematical model of an urban MSM population in the United States with ∼12% high-risk MSM to evaluate potential benefits from implementing dose-sparing vaccination strategies in which a full dose is divided into 3.5 fractional doses. We found that results strongly depend on the fractional-dose vaccine effectiveness (VE) and vaccine supply. With very limited vaccines available, enough to protect with a full dose approximately one-third of the high-risk population, dose-sparing strategies are more beneficial provided that fractional doses preserved at least 40% of full-dose effectiveness (34% absolute VE), projecting 13% (34% VE) to 70% (68% absolute VE) fewer infections than full-dose strategies. In contrast, if vaccine supply is enough to cover the majority of the high-risk population, dose-sparing strategies can be outperformed by full-dose strategies. Scenarios in which fractional dosing was 34% efficacious resulted in almost three times more infections than full dosing. Our analysis suggests that when mpox vaccine supply is limited and fractional-dose vaccination retains moderate effectiveness, there are meaningful health benefits from providing a smaller dose to a larger number of people in the high-risk population. These findings should inform the public-health response to future mpox outbreaks.
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Affiliation(s)
- Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA 98195, USA
| | - Blythe Adamson
- Infectious Economics, New York, NY 10025, USA
- Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA 98195, USA
| | - Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA 98195, USA
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7
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Gelormini M, Gripenberg M, Marke D, Murray M, Yambasu S, Koblo Kamara M, Michael Thomas C, Donald Sonne K, Sang S, Kayita J, Pezzoli L, Caleo G. Coverage survey and lessons learned from a pre-emptive cholera vaccination campaign in urban and rural communities affected by landslides and floods in Freetown Sierra Leone. Vaccine 2023; 41:2397-2403. [PMID: 36872143 PMCID: PMC10102719 DOI: 10.1016/j.vaccine.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND On 14 August 2017, massive landslides and floods hit Freetown (Sierra Leone). More than 1,000 people lost their lives while approximately 6,000 people were displaced. The areas most affected included parts of the town with challenged access to basic water and sanitation facilities, with communal water sources likely contaminated by the disaster. To avert a possible cholera outbreak following this emergency, the Ministry of Health and Sanitation (MoHS), supported by the World Health Organization (WHO) and international partners, including Médecins Sans Frontières (MSF) and UNICEF, launched a two-dose pre-emptive vaccination campaign using Euvichol™, an oral cholera vaccine (OCV). METHODS We conducted a stratified cluster survey to estimate vaccination coverage during the OCV campaign and also monitor adverse events. The study population - subsequently stratified by age group and residence area type (urban/rural) - included all individuals aged 1 year or older, living in one of the 25 communities targeted for vaccination. RESULTS In total 3,115 households were visited, 7,189 individuals interviewed; 2,822 (39%) people in rural and 4,367 (61%) in urban areas. The two-dose vaccination coverage was 56% (95% confidence interval (CI): 51.0-61.5), 44% (95%CI: 35.2-53.0) in rural and 57% (95%CI: 51.6-62.8) in urban areas. Vaccination coverage with at least one dose was 82% (95%CI: 77.3-85.5), 61% (95%CI: 52.0-70.2) in rural and 83% (95%CI: 78.5-87.1) in urban areas. CONCLUSIONS The Freetown OCV campaign exemplified a timely public health intervention to prevent a cholera outbreak, even if coverage was lower than expected. We hypothesised that vaccination coverage in Freetown was sufficient in providing at least short-term immunity to the population. However, long-term interventions to ensure access to safe water and sanitation are needed.
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Affiliation(s)
| | | | - Dennis Marke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mariama Murray
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | | | - Sibylle Sang
- Médecins Sans Frontières, OCA, Amsterdam, the Netherlands
| | - Janet Kayita
- World Health Organization, Freetown, Sierra Leone
| | | | - Grazia Caleo
- Médecins Sans Frontières, OCA, Amsterdam, the Netherlands
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8
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Islam MT, Date K, Khan AI, Bhuiyan TR, Khan ZH, Ahmed S, Hossain M, Khaton F, Zaman K, McMillan NAJ, Anand A, An Q, Zhang C, Weldon WC, Yu A, Luby S, Qadri F. Co-administration of Oral Cholera Vaccine With Oral Polio Vaccine Among Bangladeshi Young Children: A Randomized Controlled Open Label Trial to Assess Interference. Clin Infect Dis 2023; 76:263-270. [PMID: 36136760 PMCID: PMC9839191 DOI: 10.1093/cid/ciac782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/19/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cholera remains a public health threat for low- and middle-income countries, particularly in Asia and Africa. Shanchol™, an inactivated oral cholera vaccine (OCV) is currently in use globally. OCV and oral poliovirus vaccines (OPV) could be administered concomitantly, but the immunogenicity and safety of coadministration among children aged 1-3 years is unknown. METHODS We undertook an open-label, randomized, controlled, inequality trial in Dhaka city, Bangladesh. Healthy children aged 1-3 years were randomly assigned to 1 of 3 groups: bivalent OPV (bOPV)-alone, OCV-alone, or combined bOPV + OCV and received vaccines on the day of enrollment and 28 days later. Blood samples were collected on the day of enrollment, day 28, and day 56. Serum poliovirus neutralizing antibodies and vibriocidal antibodies against Vibrio cholerae O1 were assessed using microneutralization assays. RESULTS A total of 579 children aged 1‒3 years were recruited, 193 children per group. More than 90% of the children completed visits at day 56. Few adverse events following immunization were recorded and were equivalent among study arms. On day 28, 60% (90% confidence interval: 53%-67%) and 54% (46%-61%) of participants with co-administration of bOPV + OCV responded to polioviruses type 1 and 3, respectively, compared to 55% (47%-62%) and 46% (38%-53%) in the bOPV-only group. Additionally, >50% of participants showed a ≥4-fold increase in vibriocidal antibody titer responses on day 28, comparable to the responses observed in OCV-only arm. CONCLUSIONS Co-administration of bOPV and OCV is safe and effective in children aged 1-3 years and can be cost-beneficial. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03581734).
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Affiliation(s)
- Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Infectious Diseases and Immunology, Menzies Health Institute Queensland and School of Pharmacy and Medical Science, Griffith University, Gold Coast, Australia
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zahid Hasan Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shamim Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Motaher Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Khaton
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - K Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nigel A J McMillan
- Infectious Diseases and Immunology, Menzies Health Institute Queensland and School of Pharmacy and Medical Science, Griffith University, Gold Coast, Australia
| | - Abhijeet Anand
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Qian An
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chenhua Zhang
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexander Yu
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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9
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Zhu J, Wang Q, Huang M. Optimizing two-dose vaccine resource allocation to combat a pandemic in the context of limited supply: The case of COVID-19. Front Public Health 2023; 11:1129183. [PMID: 37168073 PMCID: PMC10166111 DOI: 10.3389/fpubh.2023.1129183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 05/13/2023] Open
Abstract
The adequate vaccination is a promising solution to mitigate the enormous socio-economic costs of the ongoing COVID-19 pandemic and allow us to return to normal pre-pandemic activity patterns. However, the vaccine supply shortage will be inevitable during the early stage of the vaccine rollout. Public health authorities face a crucial challenge in allocating scarce vaccines to maximize the benefits of vaccination. In this paper, we study a multi-period two-dose vaccine allocation problem when the vaccine supply is highly limited. To address this problem, we constructed a novel age-structured compartmental model to capture COVID-19 transmission and formulated as a nonlinear programming (NLP) model to minimize the total number of deaths in the population. In the NLP model, we explicitly take into account the two-dose vaccination procedure and several important epidemiologic features of COVID-19, such as pre-symptomatic and asymptomatic transmission, as well as group heterogeneity in susceptibility, symptom rates, severity, etc. We validated the applicability of the proposed model using a real case of the 2021 COVID-19 vaccination campaign in the Midlands of England. We conducted comparative studies to demonstrate the superiority of our method. Our numerical results show that prioritizing the allocation of vaccine resources to older age groups is a robust strategy to prevent more subsequent deaths. In addition, we show that releasing more vaccine doses for first-dose recipients could lead to a greater vaccination benefit than holding back second doses. We also find that it is necessary to maintain appropriate non-pharmaceutical interventions (NPIs) during the vaccination rollout, especially in low-resource settings. Furthermore, our analysis indicates that starting vaccination as soon as possible is able to markedly alleviate the epidemic impact when the vaccine resources are limited but are currently available. Our model provides an effective tool to assist policymakers in developing adaptive COVID-19 likewise vaccination strategies for better preparedness against future pandemic threats.
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10
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Ateudjieu J, Sack DA, Nafack SS, Xiao S, Tchio-Nighie KH, Tchokomeni H, Bita’a LB, Nyibio PN, Guenou E, Mondung KM, Dieumo FFK, Ngome RM, Murt KN, Ram M, Ali M, Debes AK. An Age-stratified, Randomized Immunogenicity Trial of Killed Oral Cholera Vaccine with Delayed Second Dose in Cameroon. Am J Trop Med Hyg 2022; 107:974-983. [PMID: 36395746 PMCID: PMC9709001 DOI: 10.4269/ajtmh.22-0462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/01/2023] Open
Abstract
The recommended schedule for killed oral cholera vaccine (OCV) is two doses, 2 weeks apart. However, during vaccine campaigns, the second round is often delayed by several months. Because more information is needed to document antibody responses when the second dose is delayed, we conducted an open-label, phase 2, noninferiority clinical trial of OCV. One hundred eighty-six participants were randomized into three dose-interval groups (DIGs) to receive the second dose 2 weeks, 6 months, or 11.5 months after the first dose. The DIGs were stratified into three age strata: 1 to 4, 5 to 14, and > 14 years. Inaba and Ogawa vibriocidal titers were assessed before and after vaccination. The primary analysis was geometric mean titer (GMT) 2 weeks after the second dose. Data for primary analysis was available from 147 participants (54, 44, and 49 participants from the three DIGs respectively). Relative to the 2-week interval, groups receiving a delayed second dose had significantly higher GMTs after the second dose. Two weeks after the second dose, Inaba GMTs were 55.1 190.3, and 289.8 and Ogawa GMTs were 70.4, 134.5, and 302.4 for the three DIGs respectively. The elevated titers were brief, returning to lower levels within 3 months. We conclude that when the second dose of killed oral cholera vaccine was given after 6 or 11.5 months, vibriocidal titers were higher than when given after the standard period of 2 weeks. This provides reassurance that a delayed second dose does not compromise, but rather enhances, the serological response to the vaccine.
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Affiliation(s)
- Jérôme Ateudjieu
- MA Sante, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon
- Clinical Research Unit, Division of Health Operations Research, Ministry of Public Health, Cameroon
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Shaoming Xiao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Rosanne Minone Ngome
- Department of Bacteriology-Parasitology-Mycology Laboratory, Centre Pasteur of Cameroon (CPC), Yaoundé, Cameroon
| | - Kelsey N. Murt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amanda K. Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Abstract
OBJECTIVE A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. SUMMARY OF KEY DATA The vast majority of drug development and repurposing during the COVID-19 pandemic - an event that has made clear the ever-present scarcity in healthcare systems -has been ignorant of scarcity and dose optimisation's ability to help address it. CONCLUSIONS Future pandemic clinical trials systems should obtain dose optimisation data, as these appear necessary to enable appropriate scarce resource allocation according to societal values.
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Affiliation(s)
- Garth Strohbehn
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Health Care, Ann Arbor, Michigan, USA
| | - Govind Persad
- Sturm College of Law, University of Denver, Denver, Colorado, USA
| | - William F Parker
- Maclean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
| | - Srinivas Murthy
- Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Muzembo BA, Kitahara K, Mitra D, Ohno A, Miyoshi SI. Long-Term Kinetics of Serological Antibodies against Vibrio cholerae Following a Clinical Cholera Case: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7141. [PMID: 35742404 PMCID: PMC9223532 DOI: 10.3390/ijerph19127141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Approximately 2.9 million people worldwide suffer from cholera each year, many of whom are destitute. However, understanding of immunity against cholera is still limited. Several studies have reported the duration of antibodies following cholera; however, systematic reviews including a quantitative synthesis are lacking. OBJECTIVE To meta-analyze cohort studies that have evaluated vibriocidal, cholera toxin B subunit (CTB), and lipopolysaccharide (LPS) antibody levels following a clinical cholera case. METHODS Design: Systematic review and meta-analysis. We searched PubMed and Web of science for studies assessing antibodies against Vibrio cholerae in cohorts of patients with clinical cholera. Two authors independently extracted data and assessed the quality of included studies. Random effects models were used to pool antibody titers in adults and older children (aged ≥ 6 years). In sensitivity analysis, studies reporting data on young children (2-5 years) were included. RESULTS Nine studies met our inclusion criteria for systematic review and seven for meta-analysis. The pooled mean of vibriocidal antibody titers in adults and older children (aged ≥ 6 years) was 123 on day 2 post-symptom onset, which sharply increased on day 7 (pooled mean = 6956) and gradually waned to 2247 on day 30, 578 on day 90, and 177 on day 360. Anti-CTB IgA antibodies also peaked on day 7 (pooled mean = 49), followed by a rapid decrease on day 30 (pooled mean = 21), and further declined on day 90 (pooled mean = 10), after which it plateaued from day 180 (pooled mean = 8) to 360 (pooled mean = 6). Similarly, anti-CTB IgG antibodies peaked in early convalescence between days 7 (pooled mean = 65) and 30 (pooled mean = 69), then gradually waned on days 90 (pooled mean = 42) and 180 (pooled mean = 30) and returned to baseline on day 360 (pooled mean = 24). Anti-LPS IgA antibodies peaked on day 7 (pooled mean = 124), gradually declined on day 30 (pooled mean = 44), which persisted until day 360 (pooled mean = 10). Anti LPS IgG antibodies peaked on day 7 (pooled mean = 94). Thereafter, they decreased on day 30 (pooled mean = 85), and dropped further on days 90 (pooled mean = 51) and 180 (pooled mean = 47), and returned to baseline on day 360 (pooled mean = 32). Sensitivity analysis including data from young children (aged 2-5 years) showed very similar findings as in the primary analysis. CONCLUSIONS This study confirms that serological antibody (vibriocidal, CTB, and LPS) titers return to baseline levels within 1 year following clinical cholera, i.e., before the protective immunity against subsequent cholera wanes. However, this decay should not be interpreted as waning immunity because immunity conferred by cholera against subsequent disease lasts 3-10 years. Our study provides evidence for surveillance strategies and future research on vaccines and also demonstrates the need for further studies to improve our understanding of immunity against cholera.
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Affiliation(s)
- Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (S.-I.M.)
| | - Kei Kitahara
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (S.-I.M.)
- Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata 700010, India;
| | - Debmalya Mitra
- Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata 700010, India;
| | - Ayumu Ohno
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (S.-I.M.)
- Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata 700010, India;
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (S.-I.M.)
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13
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Geoffroy F, Traulsen A, Uecker H. Vaccination strategies when vaccines are scarce: on conflicts between reducing the burden and avoiding the evolution of escape mutants. J R Soc Interface 2022; 19:20220045. [PMID: 35765804 PMCID: PMC9240677 DOI: 10.1098/rsif.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
When vaccine supply is limited but population immunization urgent, the allocation of the available doses needs to be carefully considered. One aspect of dose allocation is the time interval between the first and the second injections in two-dose vaccines. By stretching this interval, more individuals can be vaccinated with the first dose more quickly, which can be beneficial in reducing case numbers, provided a single dose is sufficiently effective. On the other hand, there has been concern that intermediate levels of immunity in partially vaccinated individuals may favour the evolution of vaccine escape mutants. In that case, a large fraction of half-vaccinated individuals would pose a risk-but only if they encounter the virus. This raises the question whether there is a conflict between reducing the burden and the risk of vaccine escape evolution or not. We develop an SIR-type model to assess the population-level effects of the timing of the second dose. Trade-offs can occur both if vaccine escape evolution is more likely or if it is less likely in half-vaccinated than in unvaccinated individuals. Their presence or absence depends on the efficacies for susceptibility and transmissibility elicited by a single dose.
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Affiliation(s)
- Félix Geoffroy
- Department of Evolutionary Theory, Max Planck Institute for Evolutionary Biology, August-Thienemann-Strasse 2, 24306 Plön, Germany
| | - Arne Traulsen
- Department of Evolutionary Theory, Max Planck Institute for Evolutionary Biology, August-Thienemann-Strasse 2, 24306 Plön, Germany
| | - Hildegard Uecker
- Department of Evolutionary Theory, Max Planck Institute for Evolutionary Biology, August-Thienemann-Strasse 2, 24306 Plön, Germany
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14
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Ahmad Zamri N, Rusli MEF, Mohamad Yusof L, Rosli R. Immunization with a bicistronic DNA vaccine modulates systemic IFN-γ and IL-10 expression against Vibrio cholerae infection. J Med Microbiol 2022; 71. [PMID: 35635780 DOI: 10.1099/jmm.0.001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Cholera is an acute enteric infection caused by Vibrio cholerae, particularly in areas lacking access to clean water. Despite the global effort to improve water quality in these regions, the burden of cholera in recent years has not yet declined. Interest has therefore extended in the use of bicistronic DNA vaccine encoding ctxB and tcpA genes of V. cholerae as a potential vaccine.Hypothesis/Gap Statement. The potential of a bicistronic DNA vaccine, pVAX-ctxB-tcpA has not been determined in vitro and in vivo.Aim. The goal of present study was to evaluate in vitro expression and in vivo potential of pVAX-ctxB-tcpA vaccine against V. cholerae.Methodology. The pVAX-ctxB-tcpA was transiently transfected into mammalian COS-7 cells, and the in vitro expression was assessed using fluorescence and Western blot analyses. Next, the vaccine was encapsulated into sodium alginate using water-in-oil emulsification and evaluated for its efficiency in different pH conditions. Subsequently, oral vaccination using en(pVAX-ctxB-tcpA) was performed in vivo. The animals were challenged with V. cholerae O1 El Tor after 2 weeks of vaccination using the Removable Intestinal Tie-Adult Rabbit Diarrhoea (RITARD) model. Following the infection challenge, the rabbits were monitored for evidence of symptoms, and analysed for systemic cytokine expression level (TNF-α, IFN-γ, IL-6 and IL-10) using quantitative real-time polymerase chain reaction.Results. The in vitro expression of pVAX-ctxB-tcpA was successfully verified via fluorescence and Western blot analyses. Meanwhile, in vivo analysis demonstrated that the en(pVAX-ctxB-tcpA) was able to protect the RITARD model against V. cholerae infection due to a lack of evidence on the clinical manifestations of cholera following bacterial challenge. Furthermore, the bicistronic group showed an upregulation of systemic IFN-γ and IL-10 following 12 days of vaccination, though not significant, suggesting the possible activation of both T-helper 1 and 2 types of response. However, upon bacterial challenge, the gene expression of all cytokines did not change.Conclusion. Our findings suggest that the bicistronic plasmid DNA vaccine, pVAX-ctxB-tcpA, showed a potential role in inducing immune response against cholera through upregulation of in vitro gene and protein expression as well as in vivo cytokine gene expression, particularly IFN-γ and IL-10.
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Affiliation(s)
- Najwa Ahmad Zamri
- Medical Genetics Laboratory, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Muhammad Ehsan Fitri Rusli
- Medical Genetics Laboratory, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Loqman Mohamad Yusof
- Department of Companion Animal and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rozita Rosli
- Medical Genetics Laboratory, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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15
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Leung T, Eaton J, Matrajt L. Optimizing one-dose and two-dose cholera vaccine allocation in outbreak settings: A modeling study. PLoS Negl Trop Dis 2022; 16:e0010358. [PMID: 35442958 PMCID: PMC9060364 DOI: 10.1371/journal.pntd.0010358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/02/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A global stockpile of oral cholera vaccine (OCV) was established in 2013 for use in outbreak response and are licensed as two-dose regimens. Vaccine availability, however, remains limited. Previous studies have found that a single dose of OCV may provide substantial protection against cholera. METHODS Using a mathematical model with two age groups paired with optimization algorithms, we determine the optimal vaccination strategy with one and two doses of vaccine to minimize cumulative overall infections, symptomatic infections, and deaths. We explore counterfactual vaccination scenarios in three distinct settings: Maela, the largest refugee camp in Thailand, with high in- and out-migration; N'Djamena, Chad, a densely populated region; and Haiti, where departments are connected by rivers and roads. RESULTS Over the short term under limited vaccine supply, the optimal strategies for all objectives prioritize one dose to the older age group (over five years old), irrespective of setting and level of vaccination coverage. As more vaccine becomes available, it is optimal to administer a second dose for long-term protection. With enough vaccine to cover the whole population with one dose, the optimal strategies can avert up to 30% to 90% of deaths and 36% to 92% of symptomatic infections across the three settings over one year. The one-dose optimal strategies can avert 1.2 to 1.8 times as many cases and deaths compared to the standard two-dose strategy. CONCLUSIONS In an outbreak setting, speedy vaccination campaigns with a single dose of OCV is likely to avert more cases and deaths than a two-dose pro-rata campaign under a limited vaccine supply.
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Affiliation(s)
- Tiffany Leung
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Julia Eaton
- School of Interdisciplinary Arts and Sciences, University of Washington, Tacoma, Washington, United States of America
| | - Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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16
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Ateudjieu J, Yakum MN, Goura AP, Tembei Ayok M, Guenou E, Kangmo Sielinou CB, Kiadjieu FF, Tsafack M, Douanla Koutio IM, Tchio-Nighie KH, Tchokomeni H, Ntsekendio PN, Sack DA. An innovative approach in monitoring oral cholera vaccination campaign: integration of a between-round survey. BMC Public Health 2022; 22:238. [PMID: 35123444 PMCID: PMC8817499 DOI: 10.1186/s12889-022-12610-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Monitoring and Evaluation (M&E) is essential in ensuring population's access to immunization. Surveys are part of this M&E approach but its timing limits the use of its results to improve the coverage of the evaluated campaign. An oral cholera vaccination campaign was organized in a health district of the Far North region of Cameroon and involved an innovative M&E approach. The aim of this project was to assess the feasibility and effect of using recommendations of a community-based immunization and communication coverage survey conducted after the first round of an OCV campaign on the coverage of the second-round of the campaign. METHODS Two community-based surveys were included in the M&E plan and conducted at the end of each of the campaign rounds. Data were collected by trained and closely supervised surveyors and reported using smartphones. Key results of the first-round survey were disseminated to campaign implementing team prior to the second round. The two rounds of the pre-emptive campaign were organized by the Cameroon Ministry of Public Health and partners with a two-week interval in the Mogode Health District of the Far North region of Cameroon in May and June 2017. RESULTS Of 120 targeted clusters, 119 (99.1%) and 117 (97.5%) were reached for the first and second rounds respectively. Among the Mogode population eligible for vaccination, the immunization coverage based on evidence (card or finger mark) were estimated at 81.0% in the first round and increased to 88.8% in the second round (X2=69.0 and p <0.00). For the second round, we estimated 80.1% and 4.3% of persons who were administered 2 doses and 1 dose of OCV with evidence respectively, and 3.8% of persons who have not been vaccinated. The distribution of campaign communication coverage per health area was shared with the campaign coordination team for better planning of the second round campaign activities. CONCLUSIONS It is feasible to plan and implement coverage survey after first round OCV campaign and use its results for the better planning of the second round. For the present study, this is associated to the improvement of OCV coverage in the second-round vaccination. If this is persistent in other contexts, it may apply to improve coverage of any health campaign that is organized in more than one round.
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Affiliation(s)
- Jerôme Ateudjieu
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Martin Ndinakie Yakum
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - André Pascal Goura
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Maureen Tembei Ayok
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Etienne Guenou
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Faculty of Sciences, University of Buea, Buea, Cameroon
| | | | - Frank Forex Kiadjieu
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Marcellin Tsafack
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | | | - Ketina Hirma Tchio-Nighie
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Hervé Tchokomeni
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Paul Nyibio Ntsekendio
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - David A. Sack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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17
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McCarty J, Bedell L, De Lame PA, Cassie D, Lock M, Bennett S, Haney D. Update on CVD 103-HgR single-dose, live oral cholera vaccine. Expert Rev Vaccines 2021; 21:9-23. [PMID: 34775892 DOI: 10.1080/14760584.2022.2003709] [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] [Indexed: 01/09/2023]
Abstract
Cholera remains endemic in >50 countries, putting millions at risk, especially young children for whom killed vaccines offer limited protection. An oral, live attenuated vaccine - CVD 103-HgR (Vaxchora vaccine) - was licensed by the US FDA in 2016 for adults aged 18-64 years traveling to endemic regions, based on clinical trials in human volunteers showing the vaccine was well tolerated and conferred 90% efficacy within 10 days. The evidence base for Vaxchora vaccine has expanded with additional clinical trial data, in older adults (aged 46-64 years) and children (aged 2-17 years), demonstrating that the vaccine produces a strong vibriocidal antibody response. Over 68,000 doses have been administered in the United States, with no new safety signals. The dose volume has been reduced in children to improve acceptability, and cold chain requirements are less st ringent, at +2°C─+8°C. The vaccine has recently been licensed in the Untied States for children aged 2-17 years, in Europe for individuals aged ≥2 years, and for home administration in Europe. Next steps include a Phase 4 study in infants (6-23 months). Additional information is needed regarding duration of immunity, the need for and timing of revaccination, and efficacy data from lower-middle-income countries.
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Affiliation(s)
- James McCarty
- Stanford University School of Medicine, 291 Campus Drive, Stanford, California, USA
| | - Lisa Bedell
- Emergent Travel Health, Redwood City, California, USA
| | | | - David Cassie
- Emergent Travel Health, Redwood City, California, USA
| | - Michael Lock
- Emergent Travel Health, Redwood City, California, USA
| | - Sean Bennett
- Adjuvance Technologies, Inc., Lincoln, Nebraska, USA
| | - Douglas Haney
- Emergent Travel Health, Redwood City, California, USA
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18
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Muzembo BA, Kitahara K, Ohno A, Debnath A, Okamoto K, Miyoshi SI. Cholera Rapid Diagnostic Tests for the Detection of Vibrio cholerae O1: An Updated Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11112095. [PMID: 34829444 PMCID: PMC8622830 DOI: 10.3390/diagnostics11112095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 02/01/2023] Open
Abstract
The rapid diagnosis of cholera contributes to adequate outbreak management. This meta-analysis assesses the diagnostic accuracy of cholera rapid tests (RDTs) to detect Vibrio cholerae O1. Methods: Systematic review and meta-analysis. We searched four databases (Medline, EMBASE, Google Scholar, and Web of Science up to 8 September 2021) for studies that evaluated cholera RDTs for the detection of V. cholerae O1 compared with either stool culture or polymerase chain reaction (PCR). We assessed the studies’ quality using the QUADAS-2 criteria. In addition, in this update, GRADE approach was used to rate the overall certainty of the evidence. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity of cholera RDTs. Results: Overall, 20 studies were included in this meta-analysis. Studies were from Africa (n = 11), Asia (n = 7), and America (Haiti; n = 2). They evaluated eight RDTs (Crystal VC-O1, Crystal VC, Cholkit, Institut Pasteur cholera dipstick, SD Bioline, Artron, Cholera Smart O1, and Smart II Cholera O1). Using direct specimen testing, sensitivity and specificity of RDTs were 90% (95% CI, 86 to 93) and 86% (95% CI, 81 to 90), respectively. Cholera Sensitivity was higher in studies conducted in Africa [92% (95% CI, 89 to 94)] compared with Asia [82% (95% CI, 77 to 87)]. However, specificity [83% (95% CI, 71 to 91)] was lower in Africa compared with Asia [90% (95% CI, 84 to 94)]. GRADE quality of evidence was estimated as moderate. Conclusions: Against culture or PCR, current cholera RDTs have moderate sensitivity and specificity for detecting Vibrio cholerae O1.
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Affiliation(s)
- Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (A.D.); (K.O.); (S.-I.M.)
- Correspondence: or
| | - Kei Kitahara
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (A.D.); (K.O.); (S.-I.M.)
- Collaborative Research Center, Okayama University for Infectious Diseases in India, Kolkata 700010, India
| | - Ayumu Ohno
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (A.D.); (K.O.); (S.-I.M.)
| | - Anusuya Debnath
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (A.D.); (K.O.); (S.-I.M.)
| | - Keinosuke Okamoto
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (A.D.); (K.O.); (S.-I.M.)
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (K.K.); (A.O.); (A.D.); (K.O.); (S.-I.M.)
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19
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Alzain MA, Haruwn MH, Abdelaziz MO, Elsheikh M, Asweto CO, Algahtani FD, Adeboye AA, Elhassan NEE, Itumalla R. Association between Cholera Outbreak and Traditional Gold Mining in Northern State, Sudan 2017. J Glob Infect Dis 2021; 13:115-119. [PMID: 34703150 PMCID: PMC8491817 DOI: 10.4103/jgid.jgid_47_20] [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: 03/18/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Cholera is one of the health problems causing considerable morbidity and mortality. The Northern State of Sudan experienced a recent cholera outbreak, however, there are limited data on the outbreak. Methods The objective of this study was to assess the magnitude and risk factors associated with the cholera outbreak in the Northern State of Sudan. A retrospective case series study was conducted in the Northern State of Sudan, which involved tracing cases of cholera outbreak of 2017. Data were collected through reports and interviews. A geographical information system was used to map all cases during the outbreak. Chi-square test and logistic regression were used to identify associated factors. Results There were 957 cholera cases reported in the state with an attack rate of 14.2/10,000 persons. Dalgo locality had the highest number (415) of cases reported with an attack rate of 167.2/10,000 persons. About 78% of cases were adult males, while 56.2% of cases were immigrants from other states. Immigrants in Halfa and Dalgo localities were four times (odds ratio [OR] = 4.031, 95% confidence interval [CI]: 2.482-6.547) and eight times (OR = 8.318, 95% CI: 5.674-12.193), respectively, at risk of cholera infection compared to immigrants in Dongola locality. The overall case-fatality rate was 1.9%. This was significantly higher in younger (5.8%) and older (22.7%) age groups (P < 0.05). Conclusions The study revealed that the cholera outbreak spread highly along with traditional gold mining areas due to poor sanitation. Therefore, improving sanitation services and establishing an effective surveillance system in these areas are essential to prevent future occurrence of outbreaks.
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Affiliation(s)
- Mohamed Ali Alzain
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, PO BOX 47, Dongola 41111, Sudan
| | | | - Mohamed Osman Abdelaziz
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, PO BOX 47, Dongola 41111, Sudan
| | - Mohamed Elsheikh
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, PO BOX 47, Dongola 41111, Sudan
| | - Collins Otieno Asweto
- Department of Community Health, School of Nursing, University of Embu, PO Box 6-60100 Embu, Kenya
| | - Fahad D Algahtani
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Molecular Diagnostic and Personalized Therapeutic Unit, Hail, PO BOX 2440, Hail 81451, Kingdom of Saudi Arabia
| | - Adeniyi Abolaji Adeboye
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Department of Public Health, University of Texas Health Sciences at Houston, Houston, TX 77030, USA
| | - Najm Eldinn Elsser Elhassan
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Department of Environmental Health, College of Public and Environmental Health, University of Bahri, Khartoum, PO BOX 166011111, Sudan
| | - Ramaiah Itumalla
- Department of Health Management, College of Public Health and Health Informatics, University of Hail, Hail, PO BOX 2440, Hail 81451, Kingdom of Saudi Arabia
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20
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Böttcher L, Nagler J. Decisive conditions for strategic vaccination against SARS-CoV-2. CHAOS (WOODBURY, N.Y.) 2021; 31:101105. [PMID: 34717322 DOI: 10.1063/5.0066992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
While vaccines against severe acute respiratory syndrome coronavirus (SARS-CoV-2) are being administered, in many countries it may still take months until their supply can meet demand. The majority of available vaccines elicit strong immune responses when administered as prime-boost regimens. Since the immunological response to the first ("prime") dose may provide already a substantial reduction in infectiousness and protection against severe disease, it may be more effective-under certain immunological and epidemiological conditions-to vaccinate as many people as possible with only one dose instead of administering a person a second ("booster") dose. Such a vaccination campaign may help to more effectively slow down the spread of SARS-CoV-2 and reduce hospitalizations and fatalities. The conditions that make prime-first vaccination favorable over prime-boost campaigns, however, are not well understood. By combining epidemiological modeling, random-sampling techniques, and decision tree learning, we find that prime-first vaccination is robustly favored over prime-boost vaccination campaigns even for low single-dose efficacies. For epidemiological parameters that describe the spread of coronavirus disease 2019 (COVID-19), recent data on new variants included, we show that the difference between prime-boost and single-shot waning rates is the only discriminative threshold, falling in the narrow range of 0.01-0.02 day-1 below which prime-first vaccination should be considered.
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Affiliation(s)
- Lucas Böttcher
- Computational Social Science, Centre for Human and Machine Intelligence, Frankfurt School of Finance & Management, 60322 Frankfurt am Main, Germany
| | - Jan Nagler
- Deep Dynamics Group, Centre for Human and Machine Intelligence, Frankfurt School of Finance & Management, 60322 Frankfurt am Main, Germany
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21
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Mwaba J, Chisenga CC, Xiao S, Ng'ombe H, Banda E, Shea P, Mabula-Bwalya C, Mwila-Kazimbaya K, Laban NM, Alabi P, Chirwa-Chobe M, Simuyandi M, Harris J, Iyer AS, Bosomprah S, Scalzo P, Murt KN, Ram M, Kwenda G, Ali M, Sack DA, Chilengi R, Debes AK. Serum vibriocidal responses when second doses of oral cholera vaccine are delayed 6 months in Zambia. Vaccine 2021; 39:4516-4523. [PMID: 34217572 DOI: 10.1016/j.vaccine.2021.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
Two-dose killed oral cholera vaccines (OCV) are currently being used widely to control cholera. The standard dose-interval for OCV is 2 weeks; however, during emergency use of the vaccine, it may be more appropriate to use the available doses to quickly give a single dose to more people and give a delayed second dose when more vaccine becomes available. This study is an open label, randomized, phase 2 clinical trial of the vibriocidal response induced by OCV, comparing the responses when the second dose was given either 2 weeks (standard dose interval) or 6 months (extended dose interval) after the first dose. Vaccine was administered to healthy participants > 1 year of age living in the Lukanga Swamps area of Zambia. Three age cohorts (<5 years, 5-14 years, and ≥ 15 years) were randomized to the either dose-interval. The primary outcome was the vibriocidal GMT 14 days after the second dose. 156 of 172 subjects enrolled in the study were included in this analysis. The Inaba vibriocidal titers were not significantly different 14 days post dose two for a standard dose-interval GMT: 45.6 (32-64.9), as compared to the GMT 47.6 (32.6-69.3), for the extended dose-interval, (p = 0.87). However, the Ogawa vibriocidal GMTs were significantly higher 14 days post dose two for the extended-dose interval at 87.6 (58.9-130.4) compared to the standard dose-interval group at 49.7 (34.1-72.3), p = 0.04. Vibriocidal seroconversion rates (a > 4-fold rise in vibriocidal titer) were not significantly different between dose-interval groups. This study demonstrated that vibriocidal titers 14 days after a second dose when given at an extended\ dose interval were similar to the standard dose-interval. The findings suggest that a flexible dosing schedule may be considered when epidemiologically appropriate. The trial was registered at Clinical Trials.gov (NCT03373669).
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Affiliation(s)
- John Mwaba
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Shaoming Xiao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Harriet Ng'ombe
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Elena Banda
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Patrick Shea
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Katayi Mwila-Kazimbaya
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Natasha Makabilo Laban
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; London School of Hygiene and Tropical Medicine, United Kingdom
| | - Peter Alabi
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Masuzyo Chirwa-Chobe
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Michelo Simuyandi
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jason Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Anita S Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel Bosomprah
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Scalzo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelsey N Murt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roma Chilengi
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Amanda K Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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22
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Böttcher L, Nagler J. Decisive Conditions for Strategic Vaccination against SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.05.21252962. [PMID: 33758886 PMCID: PMC7987045 DOI: 10.1101/2021.03.05.21252962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
While vaccines against SARS-CoV-2 are being administered, in most countries it may still take months until their supply can meet demand. The majority of available vaccines elicits strong immune responses when administered as prime-boost regimens. Since the immunological response to the first ("prime") injection may provide already a substantial reduction in infectiousness and protection against severe disease, it may be more effective-under certain immunological and epidemiological conditions-to vaccinate as many people as possible with only one shot, instead of administering a person a second ("boost") shot. Such a vaccination campaign may help to more effectively slow down the spread of SARS-CoV-2, reduce hospitalizations, and reduce fatalities, which is our objective. Yet, the conditions which make single-dose vaccination favorable over prime-boost administrations are not well understood. By combining epidemiological modeling, random sampling techniques, and decision tree learning, we find that single-dose vaccination is robustly favored over prime-boost vaccination campaigns, even for low single-dose efficacies. For realistic scenarios and assumptions for SARS-CoV-2, recent data on new variants included, we show that the difference between prime-boost and single-shot waning rates is the only discriminative threshold, falling in the narrow range of 0.01-0.02 day-1 below which single-dose vaccination should be considered.
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Affiliation(s)
- Lucas Böttcher
- Dept. of Computational Medicine, University of California, Los Angeles, CA 90095-1766, United States of America
- Computational Social Science, Frankfurt School of Finance & Management, Frankfurt am Main, 60322, Germany
| | - Jan Nagler
- Deep Dynamics Group, Centre for Human and Machine Intelligence, Frankfurt School of Finance & Management, Frankfurt am Main, 60322, Germany
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23
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Matrajt L, Eaton J, Leung T, Dimitrov D, Schiffer JT, Swan DA, Janes H. Optimizing vaccine allocation for COVID-19 vaccines shows the potential role of single-dose vaccination. Nat Commun 2021; 12:3449. [PMID: 34103510 PMCID: PMC8187351 DOI: 10.1038/s41467-021-23761-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/13/2021] [Indexed: 01/17/2023] Open
Abstract
Most COVID-19 vaccines require two doses, however with limited vaccine supply, policymakers are considering single-dose vaccination as an alternative strategy. Using a mathematical model combined with optimization algorithms, we determined optimal allocation strategies with one and two doses of vaccine under various degrees of viral transmission. Under low transmission, we show that the optimal allocation of vaccine vitally depends on the single-dose efficacy. With high single-dose efficacy, single-dose vaccination is optimal, preventing up to 22% more deaths than a strategy prioritizing two-dose vaccination for older adults. With low or moderate single-dose efficacy, mixed vaccination campaigns with complete coverage of older adults are optimal. However, with modest or high transmission, vaccinating older adults first with two doses is best, preventing up to 41% more deaths than a single-dose vaccination given across all adult populations. Our work suggests that it is imperative to determine the efficacy and durability of single-dose vaccines, as mixed or single-dose vaccination campaigns may have the potential to contain the pandemic much more quickly.
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Affiliation(s)
- Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Julia Eaton
- School of Interdisciplinary Arts and Sciences, University of Washington, Tacoma, WA, USA
| | - Tiffany Leung
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David A Swan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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24
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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] [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.
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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.)
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25
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Matrajt L, Eaton J, Leung T, Dimitrov D, Schiffer JT, Swan DA, Janes H. Optimizing vaccine allocation for COVID-19 vaccines: potential role of single-dose vaccination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2020.12.31.20249099. [PMID: 33469590 PMCID: PMC7814836 DOI: 10.1101/2020.12.31.20249099] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Most COVID-19 vaccines require two doses, however with limited vaccine supply, policymakers are considering single-dose vaccination as an alternative strategy. Using a mathematical model combined with optimization algorithms, we determined optimal allocation strategies with one and two doses of vaccine under various degrees of viral transmission. Under low transmission, we show that the optimal allocation of vaccine vitally depends on the single-dose efficacy (SDE). With high SDE, single-dose vaccination is optimal, preventing up to 22% more deaths than a strategy prioritizing two-dose vaccination for older adults. With low or moderate SDE, mixed vaccination campaigns with complete coverage of older adults are optimal. However, with modest or high transmission, vaccinating older adults first with two doses is best, preventing up to 41% more deaths than a single-dose vaccination given across all adult populations. Our work suggests that it is imperative to determine the efficacy and durability of single-dose vaccines, as mixed or single-dose vaccination campaigns may have the potential to contain the pandemic much more quickly.
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Affiliation(s)
- Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Julia Eaton
- School of Interdisciplinary Arts and Sciences, University of Washington, Tacoma, USA
| | - Tiffany Leung
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Joshua T. Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - David A. Swan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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26
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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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27
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Duffin RP, Delbuono M, Chew L, Johnstone J, Niedan V, Schwarz P, Shabram P, Patel AA. Home Administration of CVD 103-HgR: A Live Attenuated Oral Cholera Vaccine. Am J Trop Med Hyg 2021; 104:1232-1240. [PMID: 33646977 DOI: 10.4269/ajtmh.20-1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/02/2021] [Indexed: 11/07/2022] Open
Abstract
Vaccination is a well-established means for prevention and spread of disease in people traveling abroad. Although vaccines to diseases such as cholera are recommended by world health agencies, they are seldom required even when traveling to endemic regions. Consequences of noncompliance can affect traveler's health and spread diseases to new regions, as occurred in Haiti in 2010 when United Nations peacekeepers from Nepal, where a cholera outbreak was underway, introduced the disease to the region. Steps to increase vaccine recommendation compliance should therefore be an integral part of vaccine development. PXVX0200 contains Center for Vaccine Development 103-HgR live, attenuated recombinant Vibrio cholerae vaccine strain, and is indicated for single-dose immunization against the bacteria that causes cholera. It is supplied as one buffer and one active component packet to be mixed into water and ingested. Administration instructions are designed to be "user friendly" with flexibility for self-administration, thus promoting compliance. Studies to support self-administration were conducted to cover stability of the vaccine outside of normal storage conditions, potency in case of misadministration, and disposal procedures to minimize environmental impact. The principal findings showed that the stability of vaccine was maintained under conditions allowing for transport times and temperature conditions as well as when misadministration errors were made. Finally, the vaccine was effectively neutralized with hot water and soap to prevent bacterial environmental contamination in the event of an accidental spill. The conclusion is that PXVX0200 oral vaccine is stable, easy to formulate and dispose of, and is amenable to self-administration.
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28
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Lee EC, Chao DL, Lemaitre JC, Matrajt L, Pasetto D, Perez-Saez J, Finger F, Rinaldo A, Sugimoto JD, Halloran ME, Longini IM, Ternier R, Vissieres K, Azman AS, Lessler J, Ivers LC. Achieving coordinated national immunity and cholera elimination in Haiti through vaccination: a modelling study. Lancet Glob Health 2020; 8:e1081-e1089. [PMID: 32710864 PMCID: PMC7738665 DOI: 10.1016/s2214-109x(20)30310-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/17/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cholera was introduced into Haiti in 2010. Since then, more than 820 000 cases and nearly 10 000 deaths have been reported. Oral cholera vaccine (OCV) is safe and effective, but has not been seen as a primary tool for cholera elimination due to a limited period of protection and constrained supplies. Regionally, epidemic cholera is contained to the island of Hispaniola, and the lowest numbers of cases since the epidemic began were reported in 2019. Hence, Haiti may represent a unique opportunity to eliminate cholera with OCV. METHODS In this modelling study, we assessed the probability of elimination, time to elimination, and percentage of cases averted with OCV campaign scenarios in Haiti through simulations from four modelling teams. For a 10-year period from January 19, 2019, to Jan 13, 2029, we compared a no vaccination scenario with five OCV campaign scenarios that differed in geographical scope, coverage, and rollout duration. Teams used weekly department-level reports of suspected cholera cases from the Haiti Ministry of Public Health and Population to calibrate the models and used common vaccine-related assumptions, but other model features were determined independently. FINDINGS Among campaigns with the same vaccination coverage (70% fully vaccinated), the median probability of elimination after 5 years was 0-18% for no vaccination, 0-33% for 2-year campaigns focused in the two departments with the highest historical incidence, 0-72% for three-department campaigns, and 35-100% for nationwide campaigns. Two-department campaigns averted a median of 12-58% of infections, three-department campaigns averted 29-80% of infections, and national campaigns averted 58-95% of infections. Extending the national campaign to a 5-year rollout (compared to a 2-year rollout), reduced the probability of elimination to 0-95% and the proportion of cases averted to 37-86%. INTERPRETATION Models suggest that the probability of achieving zero transmission of Vibrio cholerae in Haiti with current methods of control is low, and that bolder action is needed to promote elimination of cholera from the region. Large-scale cholera vaccination campaigns in Haiti would offer the opportunity to synchronise nationwide immunity, providing near-term population protection while improvements to water and sanitation promote long-term cholera elimination. FUNDING Bill & Melinda Gates Foundation, Global Good Fund, Institute for Disease Modeling, Swiss National Science Foundation, and US National Institutes of Health.
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Affiliation(s)
- Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Joseph C Lemaitre
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Damiano Pasetto
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Venice, Italy
| | - Javier Perez-Saez
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Flavio Finger
- Centre for Mathematical Modelling of Infectious Diseases and Department for Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea Rinaldo
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jonathan D Sugimoto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Ira M Longini
- Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Ralph Ternier
- Partners In Health/Zanmi Lasante, Port-au-Prince, Haiti
| | | | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
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29
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Yan F, Gao F. A systematic strategy for the investigation of vaccines and drugs targeting bacteria. Comput Struct Biotechnol J 2020; 18:1525-1538. [PMID: 32637049 PMCID: PMC7327267 DOI: 10.1016/j.csbj.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023] Open
Abstract
Infectious and epidemic diseases induced by bacteria have historically caused great distress to people, and have even resulted in a large number of deaths worldwide. At present, many researchers are working on the discovery of viable drug and vaccine targets for bacteria through multiple methods, including the analyses of comparative subtractive genome, core genome, replication-related proteins, transcriptomics and riboswitches, which plays a significant part in the treatment of infectious and pandemic diseases. The 3D structures of the desired target proteins, drugs and epitopes can be predicted and modeled through target analysis. Meanwhile, molecular dynamics (MD) analysis of the constructed drug/epitope-protein complexes is an important standard for testing the suitability of these screened drugs and vaccines. Currently, target discovery, target analysis and MD analysis are integrated into a systematic set of drug and vaccine analysis strategy for bacteria. We hope that this comprehensive strategy will help in the design of high-performance vaccines and drugs.
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Affiliation(s)
- Fangfang Yan
- Department of Physics, School of Science, Tianjin University, Tianjin 300072, China
| | - Feng Gao
- Department of Physics, School of Science, Tianjin University, Tianjin 300072, China
- Frontiers Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300072, China
- SynBio Research Platform, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin 300072, China
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30
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Xian TH, Sinniah K, Yean CY, Krishnamoorthy V, Bahari MB, Ravichandran M, Prabhakaran G. Immunogenicity and protective efficacy of a live, oral cholera vaccine formulation stored outside-the-cold-chain for 140 days. BMC Immunol 2020; 21:29. [PMID: 32450807 PMCID: PMC7249306 DOI: 10.1186/s12865-020-00360-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/20/2020] [Indexed: 01/29/2023] Open
Abstract
Background Cholera, an acute watery diarrhoeal disease caused by Vibrio cholerae serogroup O1 and O139 across the continents. Replacing the existing WHO licensed killed multiple-dose oral cholera vaccines that demand ‘cold chain supply’ at 2–8 °C with a live, single-dose and cold chain-free vaccine would relieve the significant bottlenecks and cost determinants in cholera vaccination campaigns. In this direction, a prototype cold chain-free live attenuated cholera vaccine formulation (LACV) was developed against the toxigenic wild-type (WT) V. cholerae O139 serogroup. LACV was found stable and retained its viability (5 × 106 CFU/mL), purity and potency at room temperature (25 °C ± 2 °C, and 60% ± 5% relative humidity) for 140 days in contrast to all the existing WHO licensed cold-chain supply (2–8 °C) dependent killed oral cholera vaccines. Results The LACV was evaluated for its colonization potential, reactogenicity, immunogenicity and protective efficacy in animal models after its storage at room temperature for 140 days. In suckling mice colonization assay, the LACV recorded the highest recovery of (7.2 × 107 CFU/mL) compared to those of unformulated VCUSM14P (5.6 × 107 CFU/mL) and the WT O139 strain (3.5 × 107 CFU/mL). The LACV showed no reactogenicity even at an inoculation dose of 104–106 CFU/mL in a rabbit ileal loop model. The rabbits vaccinated with the LACV or unformulated VCUSM14P survived a challenge with WT O139 and showed no signs of diarrhoea or death in the reversible intestinal tie adult rabbit diarrhoea (RITARD) model. Vaccinated rabbits recorded a 275-fold increase in anti-CT IgG and a 15-fold increase in anti-CT IgA antibodies compared to those of rabbits vaccinated with unformulated VCUSM14P. Vibriocidal antibodies were increased by 31-fold with the LACV and 14-fold with unformulated VCUSM14P. Conclusion The vaccine formulation mimics a natural infection, is non-reactogenic and highly immunogenic in vivo and protects animals from lethal wild-type V. cholerae O139 challenge. The single dose LACV formulation was found to be stable at room temperature (25 ± 2 °C) for 140 days and it would result in significant cost savings during mass cholera vaccination campaigns.
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Affiliation(s)
- Tew Hui Xian
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Kurunathan Sinniah
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Chan Yean Yean
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | | | - Mohd Baidi Bahari
- Faculty of Pharmacy, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Manickam Ravichandran
- Centre of Excellence for Omics-Driven Computational Biodiscovery, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Guruswamy Prabhakaran
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia.
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Kahn R, Peak CM, Fernández-Gracia J, Hill A, Jambai A, Ganda L, Castro MC, Buckee CO. Incubation periods impact the spatial predictability of cholera and Ebola outbreaks in Sierra Leone. Proc Natl Acad Sci U S A 2020; 117:5067-5073. [PMID: 32054785 PMCID: PMC7060667 DOI: 10.1073/pnas.1913052117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Forecasting the spatiotemporal spread of infectious diseases during an outbreak is an important component of epidemic response. However, it remains challenging both methodologically and with respect to data requirements, as disease spread is influenced by numerous factors, including the pathogen's underlying transmission parameters and epidemiological dynamics, social networks and population connectivity, and environmental conditions. Here, using data from Sierra Leone, we analyze the spatiotemporal dynamics of recent cholera and Ebola outbreaks and compare and contrast the spread of these two pathogens in the same population. We develop a simulation model of the spatial spread of an epidemic in order to examine the impact of a pathogen's incubation period on the dynamics of spread and the predictability of outbreaks. We find that differences in the incubation period alone can determine the limits of predictability for diseases with different natural history, both empirically and in our simulations. Our results show that diseases with longer incubation periods, such as Ebola, where infected individuals can travel farther before becoming infectious, result in more long-distance sparking events and less predictable disease trajectories, as compared to the more predictable wave-like spread of diseases with shorter incubation periods, such as cholera.
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Affiliation(s)
- Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Corey M Peak
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Juan Fernández-Gracia
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
- Institute for Cross-Disciplinary Physics and Complex Systems, Universitat de les Illes Balears - Consell Superior d'Investigacions Científiques, E-07122 Palma de Mallorca, Spain
| | - Alexandra Hill
- Disease Control in Humanitarian Emergencies, World Health Organization, CH-1211 Geneva 27, Switzerland
| | - Amara Jambai
- Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone FPGG+89
| | - Louisa Ganda
- Country Office, World Health Organization, Freetown, Sierra Leone FPGG+89
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Caroline O Buckee
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115;
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Pezzoli L. Global oral cholera vaccine use, 2013-2018. Vaccine 2020; 38 Suppl 1:A132-A140. [PMID: 31519444 PMCID: PMC10967685 DOI: 10.1016/j.vaccine.2019.08.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/01/2019] [Accepted: 08/30/2019] [Indexed: 12/17/2022]
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.
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Affiliation(s)
- Lorenzo Pezzoli
- Cholera Team/Focal Point for Vaccination, Infectious Hazard Management (IHM), World Health Organization, Switzerland
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33
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Chowdhury F, Bhuiyan TR, Akter A, Bhuiyan MS, Khan AI, Tauheed I, Ahmed T, Ferdous J, Dash P, Basher SR, Hakim A, Lynch J, Kim JH, Excler JL, Kim DR, Clemens JD, Qadri F. Augmented immune responses to a booster dose of oral cholera vaccine in Bangladeshi children less than 5 years of age: Revaccination after an interval of over three years of primary vaccination with a single dose of vaccine. Vaccine 2020; 38:1753-1761. [PMID: 31879124 PMCID: PMC7014297 DOI: 10.1016/j.vaccine.2019.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/31/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022]
Abstract
We have earlier reported that a single dose of oral cholera vaccine (OCV) is protective in adults and children ≥5 years of age and sustained for 2 years. We enrolled participants (n = 240) from this study, between March-September 2017, over 3 years after receiving a primary single dose. Immune responses were measured in placebo group (Primary Immunization group: PI) and compared with those who received a single dose (Booster Immunization group: BI). The children were 4 to <5 years, 5 to <18 years and adults >18 years. Blood was collected at day 0 (before vaccination) and after receiving 1st and 2nd doses of OCV. Overall, the BI and PI groups showed vibriocidal antibody response after 1st and 2nd dose of vaccination in all age groups to V. cholerae O1 and O139. Young children in the BI group showed significantly higher vibriocidal antibody response two weeks after receiving the first dose as compared to PI group to LPS. Elevated plasma IgA responses to LPS after the first dose were observed among the BI group compared to the PI group among the young children. Mucosal antibody responses measured in fecal extracts showed similar increases as that of vibriocidal and LPS responses in the BI group. These results suggest a single boosting dose of OCV generated immune response in primed population >5 years of age who had earlier received OCV. However, young children who had received OCV earlier, boosting after a single dose, resulted in increased immune responses compared to the PI group. Further studies are needed to assess protection obtained from different strategies, especially for young children and to determine the numbers of primary and booster doses needed. In addition, more information is needed regarding the optimum interval between primary and booster doses to plan future interventions for cholera control. ClinicalTrials.gov Identifier: NCT02027207.
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Affiliation(s)
- Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Saruar Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pinki Dash
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Al Hakim
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julia Lynch
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Deok Ryun Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, CA, USA; Korea University School of Medicine, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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34
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Panda S, Chatterjee P, Deb A, Kanungo S, Dutta S. Preventing cholera in India: Synthesizing evidences through a systematic review for policy discussion on the use of oral cholera vaccine. Vaccine 2020; 38 Suppl 1:A148-A156. [DOI: 10.1016/j.vaccine.2019.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/30/2019] [Accepted: 07/05/2019] [Indexed: 01/28/2023]
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35
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Shaikh H, Lynch J, Kim J, Excler JL. Current and future cholera vaccines. Vaccine 2019; 38 Suppl 1:A118-A126. [PMID: 31879125 DOI: 10.1016/j.vaccine.2019.12.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 11/08/2019] [Accepted: 12/06/2019] [Indexed: 01/21/2023]
Abstract
Cholera remains a major global public health problem that is primarily linked to insufficient access to safe water and proper sanitation. Oral Cholera Vaccine (OCV) has been recommended as an additional public health tool along with WASH in cholera endemic countries and in areas at risk for outbreaks. The new generation OCV is safe and offers good protection in older children and adults while limited protection in younger children less than five years of age has been observed. The combination of direct vaccine protection and vaccine herd immunity effects makes OCV highly cost-effective and, therefore, attractive for use in developing countries. Additionally, in recent studies OCV was safe in pregnant women, supporting its use in pregnant women in cholera endemic countries. However, knowledge need to be developed for current vaccines for their prolonged duration of protection and vaccines need improvements for better immune response in younger children. A single dose vaccination regimen would be more cost-effective and easier to deliver. Recent approaches have focused on designing genetically attenuated cholera strains for use in single-dose cholera vaccines. The global demand for OCV has been boosted by the WHO recommendation to use OCV and is driven largely by epidemics and outbreaks and has been increasing due to the availability of cheaper easy-to-use vaccines, feasibility of mass OCV vaccination campaigns, demonstration of protection to underserved population in precarious situations, and vaccine costs being borne by Gavi (Vaccine Alliance). For rapid access in emergency and equitable distribution of OCV in cholera-endemic low-income countries, a global OCV stockpile was established in 2013 with support from the Global Alliance for Vaccines and Immunization. The three WHO-prequalified vaccines are Dukoral®, Shanchol™, Euvichol® (and Euvichol® Plus presentation), the latter two being included in the stockpile.
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Affiliation(s)
- Hanif Shaikh
- International Vaccine Institute, Seoul, Republic of Korea; K.E.M. Hospital Research Centre, Pune, Maharashtra, India.
| | - Julia Lynch
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jerome Kim
- International Vaccine Institute, Seoul, Republic of Korea
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36
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Havumaki J, Meza R, Phares CR, Date K, Eisenberg MC. Comparing alternative cholera vaccination strategies in Maela refugee camp: using a transmission model in public health practice. BMC Infect Dis 2019; 19:1075. [PMID: 31864298 PMCID: PMC6925891 DOI: 10.1186/s12879-019-4688-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022] Open
Abstract
Background Cholera is a major public health concern in displaced-person camps, which often contend with overcrowding and scarcity of resources. Maela, the largest and longest-standing refugee camp in Thailand, located along the Thai-Burmese border, experienced four cholera outbreaks between 2005 and 2010. In 2013, a cholera vaccine campaign was implemented in the camp. To assist in the evaluation of the campaign and planning for subsequent campaigns, we developed a mathematical model of cholera in Maela. Methods We formulated a Susceptible-Infectious-Water-Recovered-based transmission model and estimated parameters using incidence data from 2010. We next evaluated the reduction in cases conferred by several immunization strategies, varying timing, effectiveness, and resources (i.e., vaccine availability). After the vaccine campaign, we generated case forecasts for the next year, to inform on-the-ground decision-making regarding whether a booster campaign was needed. Results We found that preexposure vaccination can substantially reduce the risk of cholera even when <50% of the population is given the full two-dose series. Additionally, the preferred number of doses per person should be considered in the context of one vs. two dose effectiveness and vaccine availability. For reactive vaccination, a trade-off between timing and effectiveness was revealed, indicating that it may be beneficial to give one dose to more people rather than two doses to fewer people, given that a two-dose schedule would incur a delay in administration of the second dose. Forecasting using realistic coverage levels predicted that there was no need for a booster campaign in 2014 (consistent with our predictions, there was not a cholera epidemic in 2014). Conclusions Our analyses suggest that vaccination in conjunction with ongoing water sanitation and hygiene efforts provides an effective strategy for controlling cholera outbreaks in refugee camps. Effective preexposure vaccination depends on timing and effectiveness. If a camp is facing an outbreak, delayed distribution of vaccines can substantially alter the effectiveness of reactive vaccination, suggesting that quick distribution of vaccines may be more important than ensuring every individual receives both vaccine doses. Overall, this analysis illustrates how mathematical models can be applied in public health practice, to assist in evaluating alternative intervention strategies and inform decision-making.
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Affiliation(s)
- Joshua Havumaki
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
| | - Christina R Phares
- US Centers for Disease Control and Prevention; National Center for Emerging and Zoonotic Infectious Diseases; Division of Global Migration and Quarantine and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA
| | - Kashmira Date
- US Centers for Disease Control and Prevention; Global Immunization Division - Center for Global Health, 1600 Clifton Road, Atlanta, 30329, GA, USA
| | - Marisa C Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA.
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37
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Chen WH, Azman AS. Mitigating Cholera in the Aftermath of Cyclone Idai. Am J Trop Med Hyg 2019; 101:960-962. [PMID: 31333158 PMCID: PMC6838597 DOI: 10.4269/ajtmh.19-0285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/21/2019] [Indexed: 01/30/2023] Open
Abstract
Catastrophic damage and floods followed the deadliest cyclone on record for the Southern Hemisphere. In the aftermath of Cyclone Idai, a cholera outbreak was detected. The global stockpile of oral cholera vaccine was rapidly deployed to counter this fast-growing epidemic. We urge the international community to continue to highlight the importance of water, sanitation, and hygiene as the long-term goal for controlling cholera and meeting the 2030 Sustainable Development Goals.
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Affiliation(s)
- Wilbur H. Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrew S. Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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38
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Hubbard TP, Billings G, Dörr T, Sit B, Warr AR, Kuehl CJ, Kim M, Delgado F, Mekalanos JJ, Lewnard JA, Waldor MK. A live vaccine rapidly protects against cholera in an infant rabbit model. Sci Transl Med 2019; 10:10/445/eaap8423. [PMID: 29899024 DOI: 10.1126/scitranslmed.aap8423] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022]
Abstract
Outbreaks of cholera, a rapidly fatal diarrheal disease, often spread explosively. The efficacy of reactive vaccination campaigns-deploying Vibrio cholerae vaccines during epidemics-is partially limited by the time required for vaccine recipients to develop adaptive immunity. We created HaitiV, a live attenuated cholera vaccine candidate, by deleting diarrheagenic factors from a recent clinical isolate of V. cholerae and incorporating safeguards against vaccine reversion. We demonstrate that administration of HaitiV 24 hours before lethal challenge with wild-type V. cholerae reduced intestinal colonization by the wild-type strain, slowed disease progression, and reduced mortality in an infant rabbit model of cholera. HaitiV-mediated protection required viable vaccine, and rapid protection kinetics are not consistent with development of adaptive immunity. These features suggest that HaitiV mediates probiotic-like protection from cholera, a mechanism that is not known to be elicited by traditional vaccines. Mathematical modeling indicates that an intervention that works at the speed of HaitiV-mediated protection could improve the public health impact of reactive vaccination.
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Affiliation(s)
- Troy P Hubbard
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Gabriel Billings
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Tobias Dörr
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Brandon Sit
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Alyson R Warr
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Carole J Kuehl
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Minsik Kim
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Fernanda Delgado
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA.,Howard Hughes Medical Institute, Boston, MA 02115, USA
| | - John J Mekalanos
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Joseph A Lewnard
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Matthew K Waldor
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA. .,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02115, USA.,Howard Hughes Medical Institute, Boston, MA 02115, USA.,Department of Immunology and Infectious Disease, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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39
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Ciglenecki I, Azman AS, Jamet C, Serafini M, Luquero FJ, Cabrol JC. Progress and Challenges in Using Oral Cholera Vaccines to Control Outbreaks: The Médecins Sans Frontières Experience. J Infect Dis 2019; 218:S165-S166. [PMID: 30239901 PMCID: PMC6188544 DOI: 10.1093/infdis/jiy487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The use of oral cholera vaccine (OCV) has increased since 2011, when Shanchol, the first OCV suitable for large-scale use, became available. Médecins Sans Frontières considers OCVs an essential cholera outbreak control tool and has contributed to generating new evidence on OCV use in outbreaks. We showed that large-scale mass campaigns are feasible during outbreaks, documented high short-term effectiveness and showed that vaccines are likely safe in pregnancy. We found that a single-dose regimen has high short-term effectiveness, making rapid delivery of vaccine during outbreaks easier, especially given the on-going global vaccine shortage. Despite progress, OCV has still not been used widely in some of the largest recent outbreaks and thousands of cholera deaths are reported every year. While working towards improving our tools to protect those most at-risk of cholera, we must strive to use all available effective interventions in efficient ways, including OCV, to prevent avoidable deaths today.
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Affiliation(s)
| | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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40
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Ferreras E, Matapo B, Chizema-Kawesha E, Chewe O, Mzyece H, Blake A, Moonde L, Zulu G, Poncin M, Sinyange N, Kasese-Chanda N, Phiri C, Malama K, Mukonka V, Cohuet S, Uzzeni F, Ciglenecki I, Danovaro-Holliday MC, Luquero FJ, Pezzoli L. Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016. PLoS One 2019; 14:e0219040. [PMID: 31469853 PMCID: PMC6716633 DOI: 10.1371/journal.pone.0219040] [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: 02/21/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign. METHODS Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling. RESULTS The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose. CONCLUSIONS The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
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Affiliation(s)
- Eva Ferreras
- World Health Organization, Lusaka, Zambia
- Epicentre, Paris, France
| | | | | | - Orbrie Chewe
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Hannah Mzyece
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Ray A, Sarkar K, Haldar P, Ghosh R. Oral cholera vaccine delivery strategy in India: Routine or campaign?-A scoping review. Vaccine 2019; 38 Suppl 1:A184-A193. [PMID: 31377080 DOI: 10.1016/j.vaccine.2019.07.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/13/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022]
Abstract
Oral Cholera Vaccine (OCV) has been recognized as an adjunct tool for prevention and control of cholera. However, policy directions are currently unavailable in India to guide the vaccine delivery. We conducted a scoping review to inform the policy about the scopes and challenges of different strategic choices of OCV delivery in India in light of current evidences, highlighting the scope of new research. METHODS Adopting the Arksey and O'Malley Framework for review, we searched for literatures on "efficacy", "effectiveness", and "cost" of oral cholera vaccine delivery through different strategies in Pubmed and Scopus. RESULTS We found that the protective efficacy of OCV depends on its coverage. Evidence on effectiveness of OCV are available for both reactive and pre-vaccination campaigns. Reactive high-risk vaccination is more effective than reactive ring and mass vaccination. Pre-vaccination campaigns are more effective than reactive vaccination when vaccine availability is adequate. Pre-vaccination through school campaigns in 1-14 years age group have been cost effective in India. Vaccination campaigns in under-5 children are also cost effective in spite of low efficacy due to the scope of averting a higher number of cases. However, no evidence is available regarding efficacy and effectiveness of OCV in children <1 year as well as the effectiveness of delivering OCV through routine immunization. CONCLUSION Little evidence exist to depict mass-campaign as more economic and effective than routine expanded programme on immunization (EPI) session for delivery of OCV. Considering operational feasibility, it needs to be explored whether OCV delivery strategy is compatible with India's current EPI, if it can be introduced in routine immunization at measles containing vaccine age-schedule, optionally preceded by a campaign in targeted hot-spots in the 1-14 year age-group. Safety and efficacy data of OCV during infancy as well as hot-spot surveillance are pre-requisites for formulation of such EPI policy.
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Kaminsky J, Keegan LT, Metcalf CJE, Lessler J. Perfect counterfactuals for epidemic simulations. Philos Trans R Soc Lond B Biol Sci 2019; 374:20180279. [PMID: 31104612 PMCID: PMC6558563 DOI: 10.1098/rstb.2018.0279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 01/02/2023] Open
Abstract
Simulation studies are often used to predict the expected impact of control measures in infectious disease outbreaks. Typically, two independent sets of simulations are conducted, one with the intervention, and one without, and epidemic sizes (or some related metric) are compared to estimate the effect of the intervention. Since it is possible that controlled epidemics are larger than uncontrolled ones if there is substantial stochastic variation between epidemics, uncertainty intervals from this approach can include a negative effect even for an effective intervention. To more precisely estimate the number of cases an intervention will prevent within a single epidemic, here we develop a 'single-world' approach to matching simulations of controlled epidemics to their exact uncontrolled counterfactual. Our method borrows concepts from percolation approaches, prunes out possible epidemic histories and creates potential epidemic graphs (i.e. a mathematical representation of all consistent epidemics) that can be 'realized' to create perfectly matched controlled and uncontrolled epidemics. We present an implementation of this method for a common class of compartmental models (e.g. SIR models), and its application in a simple SIR model. Results illustrate how, at the cost of some computation time, this method substantially narrows confidence intervals and avoids nonsensical inferences. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.
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Affiliation(s)
- Joshua Kaminsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lindsay T. Keegan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C. Jessica E. Metcalf
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Brouwer AF, Masters NB, Eisenberg JNS. Quantitative Microbial Risk Assessment and Infectious Disease Transmission Modeling of Waterborne Enteric Pathogens. Curr Environ Health Rep 2019; 5:293-304. [PMID: 29679300 DOI: 10.1007/s40572-018-0196-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Waterborne enteric pathogens remain a global health threat. Increasingly, quantitative microbial risk assessment (QMRA) and infectious disease transmission modeling (IDTM) are used to assess waterborne pathogen risks and evaluate mitigation. These modeling efforts, however, have largely been conducted independently for different purposes and in different settings. In this review, we examine the settings where each modeling strategy is employed. RECENT FINDINGS QMRA research has focused on food contamination and recreational water in high-income countries (HICs) and drinking water and wastewater in low- and middle-income countries (LMICs). IDTM research has focused on large outbreaks (predominately LMICs) and vaccine-preventable diseases (LMICs and HICs). Human ecology determines the niches that pathogens exploit, leading researchers to focus on different risk assessment research strategies in different settings. To enhance risk modeling, QMRA and IDTM approaches should be integrated to include dynamics of pathogens in the environment and pathogen transmission through populations.
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Affiliation(s)
- Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Nina B Masters
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, 48109, USA
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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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Heyerdahl LW, Pugliese-Garcia M, Nkwemu S, Tembo T, Mwamba C, Demolis R, Chilengi R, Gessner BD, Guillermet E, Sharma A. "It depends how one understands it:" a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia. BMC Infect Dis 2019; 19:421. [PMID: 31088376 PMCID: PMC6518637 DOI: 10.1186/s12879-019-4072-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December. Understanding uptake of this first-ever two-dose OCV campaign is critical to design effective OCV campaigns and for delivery of oral vaccines in the country and the region. Methods We conducted 12 Focus Group Discussions (FGDs) with men and women who self-reported taking no OCV doses and six with those self-reporting taking both doses. Simple descriptive analysis was conducted on socio-demographic and cholera-related data collected using a short questionnaire. We analyzed transcribed FGDs using the framework of dose, gender and geographic location. Results No differences were found by gender and location. All participants thought cholera to be severe and the reactive OCV campaign as relevant if efficacious. Most reported not receiving information on OCV side-effects and duration of protection. Those who took both doses listed more risk factors (including ‘wind’) and felt personally susceptible to cholera and protected by OCV. Some described OCV side-effects, mostly diarrhoea, vomiting and dizziness, as the expulsion of causative agents. Those who did not take OCV felt protected by their good personal hygiene practices or, thought of themselves and OCV as powerless against the multiple causes of cholera including poor living conditions, water, wind, and curse. Most of those who did not take OCV feared side-effects reported by others. Some interpreted side-effects as ‘western’ malevolence. Though > 80% discussants reported not knowing duration of protection, some who did not vaccinate, suggested that rather than rely on OCV which could lose potency, collective action should be taken to change the physical and economic environment to prevent cholera. Conclusions Due to incomplete information, individual decision-making was complex, rooted in theories of disease causation, perceived susceptibility, circulating narratives, colonial past, and observable outcomes of vaccination. To increase coverage, future OCV campaigns may benefit from better communication on eligibility and susceptibility, expected side effects, mechanism of action, and duration of protection. Governmental improvements in the physical and economic environment may increase confidence in OCV and other public health interventions among residents in Lusaka compounds.
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Affiliation(s)
- Leonard W Heyerdahl
- Agence de Médecine Préventive, J 87, Deux Plateaux, Abidjan, Côte d'Ivoire. .,École normale supérieure de Lyon, UMR 5206 Triangle, Lyon, France.
| | - Miguel Pugliese-Garcia
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Sharon Nkwemu
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Taniya Tembo
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Rachel Demolis
- Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Bradford D Gessner
- Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France
| | - Elise Guillermet
- Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
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Luquero FJ, Azman AA. Protection of young children with cholera vaccine. THE LANCET. INFECTIOUS DISEASES 2019; 18:947-948. [PMID: 30152359 DOI: 10.1016/s1473-3099(18)30465-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Andrew A Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Franke MF, Ternier R, Jerome JG, Matias WR, Harris JB, Ivers LC. Long-term effectiveness of one and two doses of a killed, bivalent, whole-cell oral cholera vaccine in Haiti: an extended case-control study. LANCET GLOBAL HEALTH 2019; 6:e1028-e1035. [PMID: 30103980 PMCID: PMC6190920 DOI: 10.1016/s2214-109x(18)30284-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/22/2018] [Accepted: 05/30/2018] [Indexed: 01/22/2023]
Abstract
Background No study of long-term protection following killed oral cholera vaccination has been done outside of the historically cholera-endemic areas of south Asia, or has examined protection after a single-dose vaccination regimen. To address this, we examined the duration of protection of the standard two-dose regimen and an incomplete regimen of one dose up to 4 years after vaccination in Haiti. Methods In the setting of two-dose vaccination campaigns with a killed, bivalent, whole-cell oral cholera vaccination, we did a case-control study from October, 2012 through November, 2016. Eligible participants were required to be resident in the vaccine catchment area (Artibonite Department or Central Department) where they were recruited at the start of the study; and be eligible for the vaccination campaign (ie, aged ≥12 months, not pregnant, and living in the region at the time of the vaccine campaign). Patients with cholera had a positive stool culture and were recruited from cholera treatment centres. Community controls were matched to people with cholera by age group, time, and neighbourhood. We did adjusted matched regression analyses to calculate vaccine effectiveness and examine heterogeneity in effectiveness over time. The primary outcome was the effectiveness of one and two oral cholera doses as compared with zero doses from 2 months to 48 months after vaccination, measured by self reporting. Findings Among 178 people assigned to the case group and 706 people assigned to the control group, we found no evidence that two-dose effectiveness decreased during follow-up. In adjusted analyses, the average cumulative 4 year effectiveness for two doses was 76% (95% CI 59–86). In contrast, single-dose effectiveness decreased over time in a log-linear fashion, with a predicted vaccine effectiveness of 79% at the end of 12 months (95% CI 43–93), which declined to zero before the end of the second year. Interpretation In a setting of epidemic and newly endemic cholera in Haiti, single-dose vaccination with killed, bivalent, whole-cell oral cholera vaccination provided short-term protection; however, vaccination with two doses was required for long-term protection, which lasted up to 4 years after vaccination. These results add to the evidence in support of the use of killed, bivalent, whole-cell oral cholera vaccination as part of comprehensive cholera control plans. Funding US National Institute of Allergy and Infectious Diseases of the National Institutes of Health and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Molly F Franke
- Department of Global Health and Social Medicine, Boston, MA, USA.
| | - Ralph Ternier
- Harvard Medical School, Boston, MA, USA; Partners In Health, Port au Prince, Haiti, MA, USA
| | - J Gregory Jerome
- Harvard Medical School, Boston, MA, USA; Partners In Health, Port au Prince, Haiti, MA, USA
| | - Wilfredo R Matias
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason B Harris
- Department of Pediatrics, Boston, MA, USA; Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Partners In Health, Port au Prince, Haiti, MA, USA; Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
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Xian TH, Parasuraman S, Sinniah K, Ravichandran M, Prabhakaran G. Repeated dose toxicity evaluation of a cold chain-free, live, attenuated oral cholera vaccine in Sprague Dawley rats. Vaccine 2019; 37:711-720. [PMID: 30630696 DOI: 10.1016/j.vaccine.2018.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022]
Abstract
The repeated dose toxicity of a prototype cold chain-free, live, attenuated oral cholera vaccine containing 5 × 106 CFU/mL of the VCUSM14P strain was evaluated in Sprague Dawley (SD) rats (single dose administered daily for 30 days) to ascertain its safety for clinical use. Repeated dose toxicity studies for cholera vaccines in the literature have administered 2 or 3 fixed doses at 7, 14, 21 or 69 day intervals. The present study reports an evaluation of 30 repeated doses of cholera vaccine administered at three different concentrations (Group II (1.25 × 106 CFU), Group III (2.5 × 106 CFU) and Group IV (5 × 106 CFU)) in SD rats. The liquid vaccine was administered orally to the rats with the respective dose every day, and normal saline was administered to the control group (Group I). No significant difference (P > 0.05) was observed in the body weights and biochemical parameters of the rats after 15 and 30 repeated doses compared to those of the control group. However, compared to those of Group I, a significant increase (P < 0.05) in the organ to body weight ratios of the lungs, ureter, liver, kidney, heart and spleen was found in G-II, G-III and G-IV. In the haematological analysis, a significant increase in the WBC was observed in G-II and G-IV compared to that in G-I. The histopathological findings indicated mild to moderate degeneration in the liver, kidney, heart and spleen in the treated rats. Mild to moderate lymphocytic infiltration in the lungs was observed in the G-II and G-III rats, and severe infiltration was observed in the G-IV rats. These histopathological findings may be attributed to the 30 doses of vaccine given in daily succession without an interval. In the acute toxicity study, a single dose of vaccine up to 10 × 106 CFU did not cause any adverse effects and lethality in SD rats.
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Affiliation(s)
- Tew Hui Xian
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Semeling 08100, Kedah, Malaysia
| | - Subramani Parasuraman
- Unit of Pharmacology, Faculty of Pharmacy, AIMST University, Semeling 08100, Kedah, Malaysia
| | - Kurunathan Sinniah
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Semeling 08100, Kedah, Malaysia
| | - Manickam Ravichandran
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Semeling 08100, Kedah, Malaysia
| | - Guruswamy Prabhakaran
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Semeling 08100, Kedah, Malaysia.
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Ahmed MU, Baquilod M, Deola C, Tu ND, Anh DD, Grasso C, Gautam A, Hamzah WM, Heng S, Iamsirithaworn S, Kadim M, Kar SK, Le Thi Quynh M, Lopez AL, Lynch J, Memon I, Mengel M, Long VN, Pandey BD, Quadri F, Saadatian-Elahi M, Gupta SS, Sultan A, Sur D, Tan DQ, Ha HTT, Hein NT, Lan PT, Upreti SR, Endtz H, Ganguly NK, Legros D, Picot V, Nair GB. Cholera prevention and control in Asian countries. BMC Proc 2018; 12:62. [PMID: 30807619 PMCID: PMC6284268 DOI: 10.1186/s12919-018-0158-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cholera remains a major public health problem in many countries. Poor sanitation and inappropriate clean water supply, insufficient health literacy and community mobilization, absence of national plans and cross-border collaborations are major factors impeding optimal control of cholera in endemic countries. In March 2017, a group of experts from 10 Asian cholera-prone countries that belong to the Initiative against Diarrheal and Enteric Diseases in Africa and Asia (IDEA), together with representatives from the World Health Organization, the US National Institutes of Health, International Vaccine Institute, Agence de médecine préventive, NGOs (Save the Children) and UNICEF, met in Hanoi (Vietnam) to share progress in terms of prevention and control interventions on water, sanitation and hygiene (WASH), surveillance and oral cholera vaccine use. This paper reports on the country situation, gaps identified in terms of cholera prevention and control and strategic interventions to bridge these gaps.
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Affiliation(s)
| | | | | | - Nguyen Dong Tu
- 4National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Dang Duc Anh
- 4National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Cindy Grasso
- 5Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
| | | | | | - Seng Heng
- 8Ministry of Health Cambodia, Phnom Penh, Cambodia
| | | | - Musal Kadim
- Indonesia Pediatric Society, Jakarta, Indonesia
| | - S K Kar
- 11S'O'A University, Bhubaneswar, Odisha India
| | | | | | - Julia Lynch
- 13International Vaccine Institute, Seoul, South Korea
| | - Iqbal Memon
- Pakistan Pediatric Association, Karachi, Pakistan
| | | | | | | | - Firdausi Quadri
- 18International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | | | - Sanjukta Sen Gupta
- 20Translational Health Science and Technology Institute, Pali, Haryana India
| | | | - Dipika Sur
- 22Program for Appropriate Technology in Health (PATH), New Delhi, India
| | | | | | | | | | | | - Hubert Endtz
- 5Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
| | - N K Ganguly
- 20Translational Health Science and Technology Institute, Pali, Haryana India
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Ciglenecki I, Azman AS, Rumunu J, Cabrol JC, Luquero FJ. Vaccination against cholera in Juba - Authors' reply. THE LANCET. INFECTIOUS DISEASES 2018; 17:480-481. [PMID: 28447952 DOI: 10.1016/s1473-3099(17)30184-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew S Azman
- Médecins Sans Frontières, Geneva 1202, Switzerland; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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