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Berhe TM, Fikadu Y, Sahle T, Hailegebireal AH, Eanga S, Ketema T, Wolde SG. Existence of cholera outbreak, challenges, and way forward on public health interventions to control cholera outbreak in Guraghe Zones, southern Ethiopia, 2023. Front Public Health 2024; 12:1355613. [PMID: 38859897 PMCID: PMC11163086 DOI: 10.3389/fpubh.2024.1355613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction In Ethiopia, despite major improvements seen in health service delivery system, the country continues to be significantly affected by cholera outbreaks. Cholera remains a significant public health problem among the vulnerable populations living in many resource-limited settings with poor access to safe and clean water and hygiene practices. Recurring cholera outbreaks are an indication of deprived water and sanitation conditions as well as weak health systems, contributing to the transmission and spread of the cholera infection. Objective To assess the cholera outbreak, its challenges, and the way forward on public health interventions to solve the knowledge and health service delivery gaps related to cholera control in Guraghe Zone, Ethiopia, 2023. Methods Active surveillance of the cholera outbreak was conducted in all kebeles and town administrative of Guraghe zone from 7/8/2023 to 30/10/2023. A total of 224 cholera cases were detected during the active surveillance method. Data obtained from Guraghe zone offices were exported to SPSS version 25 for additional analysis. The case fatality rate, incidence of the cases, and other descriptive variables were presented and described using figures and tables. Result A total of 224 cholera cases were detected through an active surveillance system. In this study, the case fatality rate of cholera outbreak was 2.6%. To tackle the cholera outbreak, the Guraghe zone health office collaborated with other stakeholders to prepare four cholera treatment centers. The absence of OCV, inaccessible safe water, low latrine coverage, inappropriate utilization of latrines, and absence of cholera laboratory rapid diagnostics test in Guraghe Zone are barriers to tackling the outbreak. Conclusion Ethiopia National Cholera Plan targeted eradicating cholera by 2030, 222 cholera outbreak occurred in Guraghe Zone, Ethiopia. To minimize and control cholera mortality rate oral cholera vaccinations should be employed in all areas of the region. Sustainable WASH measures should be guaranteed for the use of safe water and good hygiene practices. Early diagnosis and treatment should be initiated appropriately for those who are infected.
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Affiliation(s)
- Tamirat Melis Berhe
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Yohannes Fikadu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tadesse Sahle
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | | | - Shamil Eanga
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Ketema
- Guraghe Zone Health Office, Disease Prevention and Control, Wolkite, Ethiopia
| | - Shimelis Getu Wolde
- Department of Internal Medicine, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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OKeeffe J, Salem-Bango L, Desjardins MR, Lantagne D, Altare C, Kaur G, Heath T, Rangaiya K, Obroh POO, Audu A, Lecuyot B, Zoungrana T, Ihemezue EE, Aye S, Sikder M, Doocy S, Wang Q, Xiao M, Spiegel PB. Case-area targeted interventions during a large-scale cholera epidemic: A prospective cohort study in Northeast Nigeria. PLoS Med 2024; 21:e1004404. [PMID: 38728366 PMCID: PMC11149837 DOI: 10.1371/journal.pmed.1004404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/04/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Cholera outbreaks are on the rise globally, with conflict-affected settings particularly at risk. Case-area targeted interventions (CATIs), a strategy whereby teams provide a package of interventions to case and neighboring households within a predefined "ring," are increasingly employed in cholera responses. However, evidence on their ability to attenuate incidence is limited. METHODS AND FINDINGS We conducted a prospective observational cohort study in 3 conflict-affected states in Nigeria in 2021. Enumerators within rapid response teams observed CATI implementation during a cholera outbreak and collected data on household demographics; existing water, sanitation, and hygiene (WASH) infrastructure; and CATI interventions. Descriptive statistics showed that CATIs were delivered to 46,864 case and neighbor households, with 80.0% of cases and 33.5% of neighbors receiving all intended supplies and activities, in a context with operational challenges of population density, supply stock outs, and security constraints. We then applied prospective Poisson space-time scan statistics (STSS) across 3 models for each state: (1) an unadjusted model with case and population data; (2) an environmentally adjusted model adjusting for distance to cholera treatment centers and existing WASH infrastructure (improved water source, improved latrine, and handwashing station); and (3) a fully adjusted model adjusting for environmental and CATI variables (supply of Aquatabs and soap, hygiene promotion, bedding and latrine disinfection activities, ring coverage, and response timeliness). We ran the STSS each day of our study period to evaluate the space-time dynamics of the cholera outbreaks. Compared to the unadjusted model, significant cholera clustering was attenuated in the environmentally adjusted model (from 572 to 18 clusters) but there was still risk of cholera transmission. Two states still yielded significant clusters (range 8-10 total clusters, relative risk of 2.2-5.5, 16.6-19.9 day duration, including 11.1-56.8 cholera cases). Cholera clustering was completely attenuated in the fully adjusted model, with no significant anomalous clusters across time and space. Associated measures including quantity, relative risk, significance, likelihood of recurrence, size, and duration of clusters reinforced the results. Key limitations include selection bias, remote data monitoring, and the lack of a control group. CONCLUSIONS CATIs were associated with significant reductions in cholera clustering in Northeast Nigeria despite operational challenges. Our results provide a strong justification for rapid implementation and scale-up CATIs in cholera-response, particularly in conflict settings where WASH access is often limited.
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Affiliation(s)
- Jennifer OKeeffe
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lindsay Salem-Bango
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael R. Desjardins
- Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Daniele Lantagne
- Lancon Environmental, LLC, Somerville, Massachusetts, United States of America
| | - Chiara Altare
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gurpreet Kaur
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | | | | | | | | | - Solomon Aye
- Solidarités International, Maiduguri, Nigeria
| | - Mustafa Sikder
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon Doocy
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Qiulin Wang
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Melody Xiao
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Paul B. Spiegel
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Endres K, Mwishingo A, Thomas E, Boroto R, Ntumba Nyarukanyi W, Bisimwa JC, Sanvura P, Perin J, Bengehya J, Maheshe G, Cikomola C, George CM. A Quantitative and Qualitative Program Evaluation of a Case-Area Targeted Intervention to Reduce Cholera in Eastern Democratic Republic of the Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:27. [PMID: 38248491 PMCID: PMC10815631 DOI: 10.3390/ijerph21010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
Individuals living near cholera patients have an increased risk of cholera infections. Case-area targeted interventions (CATIs) promoting improved water, sanitation, and hygiene (WASH) present a promising approach to reducing cholera for those residing near cholera cases. However, there is limited evidence on the effectiveness and implementation of this approach in increasing WASH behaviors. We conducted a mixed-methods program evaluation in rural and urban eastern Democratic Republic of the Congo. The quantitative component included household structured observations and spot checks in CATI and control areas to assess WASH conditions and behaviors. The qualitative component included semi-structured interviews with CATI recipients, non-recipients, and implementers to assess CATI implementation. A total of 399 participants were enrolled in the quantitative evaluation conducted within 1 month of CATI delivery. For the qualitative evaluation, 41 semi-structured interviews were conducted, 30 with individuals in CATI areas (recipients and non-recipients) and 11 with CATI implementers. Handwashing with soap was low among both CATI and control area participants (1% vs. 2%, p = 0.89). Significantly more CATI area households (75%) had chlorine tablets present compared to control area households (0%) (p < 0.0001); however, the percentage of households with stored water free chlorine concentrations > 0.2 mg/L was low for both CATI and control area households (11% vs. 6%, p = 0.45). Implementers reported an insufficient supply of soap for distribution to recipients and mistrust in the community of their activities. CATI recipients demonstrated low knowledge of the correct preparation and use of chlorine for water treatment. Recipients also indicated a need for CATI implementers to engage community leaders. As CATIs are part of cholera control plans in many cholera-endemic countries, it is important to evaluate existing programs and develop evidence-based approaches to deliver CATIs that are both tailored to the local context and engage affected communities to increase WASH behaviors to reduce the spread of cholera.
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Affiliation(s)
- Kelly Endres
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (K.E.); (E.T.); (J.P.)
| | - Alain Mwishingo
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (R.B.); (W.N.N.); (J.-C.B.); (P.S.); (C.C.)
| | - Elizabeth Thomas
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (K.E.); (E.T.); (J.P.)
| | - Raissa Boroto
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (R.B.); (W.N.N.); (J.-C.B.); (P.S.); (C.C.)
| | - Wivine Ntumba Nyarukanyi
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (R.B.); (W.N.N.); (J.-C.B.); (P.S.); (C.C.)
| | - Jean-Claude Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (R.B.); (W.N.N.); (J.-C.B.); (P.S.); (C.C.)
| | - Presence Sanvura
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (R.B.); (W.N.N.); (J.-C.B.); (P.S.); (C.C.)
| | - Jamie Perin
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (K.E.); (E.T.); (J.P.)
| | - Justin Bengehya
- Bureau de l’Information Sanitaire, Surveillance Epidémiologique et Recherche Scientifique Division Provinciale de la Santé/Sud Kivu, Ministère de la Santé Publique, Hygiène et Prévention, Bukavu B.P 1899, Democratic Republic of the Congo;
| | - Ghislain Maheshe
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Cirhuza Cikomola
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (R.B.); (W.N.N.); (J.-C.B.); (P.S.); (C.C.)
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Christine Marie George
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (K.E.); (E.T.); (J.P.)
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Ouamba JP, Mbarga NF, Ciglenecki I, Ratnayake R, Tchiasso D, Finger F, Peyraud N, Mounchili I, Boyom T, Yonta C, Nwatchok L, Mouhamadou M, Ekedi C, Marcel J, Luquero F, Ekah F, Amani A, Tamakloe M, Boum Y, Esso L. Implementation of targeted cholera response activities, Cameroon. Bull World Health Organ 2023; 101:170-178. [PMID: 36865607 PMCID: PMC9948504 DOI: 10.2471/blt.22.288885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 03/04/2023] Open
Abstract
Objective To describe the implementation of case-area targeted interventions to reduce cholera transmission using a rapid, localized response in Kribi district, Cameroon. Methods We used a cross-sectional design to study the implementation of case-area targeted interventions. We initiated interventions after rapid diagnostic test confirmation of a case of cholera. We targeted households within a 100-250 metre perimeter around the index case (spatial targeting). The interventions package included: health promotion, oral cholera vaccination, antibiotic chemoprophylaxis for nonimmunized direct contacts, point-of-use water treatment and active case-finding. Findings We implemented eight targeted intervention packages in four health areas of Kribi between 17 September 2020 and 16 October 2020. We visited 1533 households (range: 7-544 per case-area) hosting 5877 individuals (range: 7-1687 per case-area). The average time from detection of the index case to implementation of interventions was 3.4 days (range: 1-7). Oral cholera vaccination increased overall immunization coverage in Kribi from 49.2% (2771/5621 people) to 79.3% (4456/5621 people). Interventions also led to the detection and prompt management of eight suspected cases of cholera, five of whom had severe dehydration. Stool culture was positive for Vibrio cholerae O1 in four cases. The average time from onset of symptoms to admission of a person with cholera to a health facility was 1.2 days. Conclusion Despite challenges, we successfully implemented targeted interventions at the tail-end of a cholera epidemic, after which no further cases were reported in Kribi up until week 49 of 2021. The effectiveness of case-area targeted interventions in stopping or reducing cholera transmission needs further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Christine Ekedi
- Kribi District Hospital, Regional Delegation of the South, Kribi, Cameroon
| | - Johne Marcel
- Kribi District Hospital, Regional Delegation of the South, Kribi, Cameroon
| | | | - Faustin Ekah
- United Nations International Children's Emergency Fund, Yaounde, Cameroon
| | - Adidja Amani
- Sub-direction of Vaccination, Ministry of Public Health, Yaounde, Cameroon
| | | | | | - Linda Esso
- Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaounde, Cameroon
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Zohura F, Thomas ED, Masud J, Bhuyian MSI, Parvin T, Monira S, Faruque ASG, Alam M, George CM. Formative Research for the Development of the CHoBI7 Cholera Rapid Response Program for Cholera Hotspots in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13352. [PMID: 36293930 PMCID: PMC9603179 DOI: 10.3390/ijerph192013352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Cholera is a severe form of acute watery diarrhea that if left untreated can result in death. Globally, there are 2.9 million cholera cases annually. Individuals living in close proximity to cholera cases are at a higher risk for developing cholera compared to the general population. Targeted water, sanitation, and hygiene (WASH) interventions have the potential to reduce cholera transmission in cholera hotspots around cholera cases. The objective of this study was to expand the scope of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) program, focused on cholera patient households, for delivery in cholera hotspots in urban slums in Dhaka, Bangladesh. Thirty-one semi-structured interviews were conducted in cholera hotspots around cholera patients, and three intervention planning workshops were conducted to inform modifications needed to the CHoBI7 program. After exploratory interviews, a two-phase, iterative pilot study was conducted for 9 months to test the developed CHoBI7 Cholera Rapid Response program among 180 participants to further inform modifications to intervention content and delivery. Findings from pilot participant interviews highlighted the need to adapt intervention content for delivery at the compound-rather than household-level, given an environment with multiple households sharing a water source, toilets, and kitchen facilities. This was addressed by conducting a "ring session" for intervention delivery in cholera hotspots for households to discuss how to improve their shared facilities together and encourage a compound-level commitment to promoted WASH behaviors and placement of soapy water bottles in shared spaces. Based on the low number of soapy water bottles observed in communal spaces during the first iteration of the pilot, we also added context-specific examples using the narratives of families in mobile messages to encourage WASH behavioral recommendations. Formative research identified important considerations for the modifications needed to tailor the CHoBI7 program for delivery in cholera hotspots in urban Bangladesh.
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Affiliation(s)
- Fatema Zohura
- Research, Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jahed Masud
- Research, Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Md Sazzadul Islam Bhuyian
- Research, Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Tahmina Parvin
- Research, Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, icddr,b, Dhaka 1212, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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George CM, Parvin T, Bhuyian MSI, Uddin IM, Zohura F, Masud J, Monira S, Sack DA, Perin J, Alam M, Faruque ASG. Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) Cholera Rapid Response Program to Reduce Diarrheal Diseases in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12905. [PMID: 36232205 PMCID: PMC9566036 DOI: 10.3390/ijerph191912905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
(a) Objective: To build an evidence base on effective water, sanitation, and hygiene interventions to reduce diarrheal diseases in cholera hotspots, we developed the CHoBI7 Cholera Rapid Response Program. (b) Methods: Once a cholera patient (confirmed by bacterial culture) is identified at a health facility, a health promoter delivers a targeted WASH intervention to the cholera hotspot (households within 20 m of a cholera patient) through both in-person visits during the first week and bi-weekly WASH mobile messages for the 3-month program period. A randomized controlled trial of the CHoBI7 Cholera Rapid Response Program was conducted with 284 participants in 15 cholera hotspots around cholera patients in urban Dhaka, Bangladesh. This program was compared to the standard message in Bangladesh on the use of oral rehydration solution for dehydration. Five-hour structured observation of handwashing with soap and diarrhea surveillance was conducted monthly. (c) Findings: Handwashing with soap at food- and stool-related events was significantly higher in the CHoBI7 Cholera Rapid Response Program arm compared to the standard message arm at all timepoints (overall 54% in the CHoBI7 arm vs. 23% in the standard arm, p < 0.05). Furthermore, there was a significant reduction in diarrheal prevalence for all participants (adults and children) (Prevalence Ratio (PR) 0.35, 95% CI: 0.14-0.85) and for children under 5 years of age (PR: 0.27, 95% CI: 0.085-0.87) during the 3-month program. (d) Conclusions: These findings demonstrate that the CHoBI7 Cholera Rapid Response Program is effective in lowering diarrhea prevalence and increasing handwashing with soap for a population at high risk of cholera.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Tahmina Parvin
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Md. Sazzadul Islam Bhuyian
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Ismat Minhaj Uddin
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Fatema Zohura
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Jahed Masud
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - A. S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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Bereznicka A, Mikolajczyk K, Czerwinski M, Kaczmarek R. Microbial lectome versus host glycolipidome: How pathogens exploit glycosphingolipids to invade, dupe or kill. Front Microbiol 2022; 13:958653. [PMID: 36060781 PMCID: PMC9437549 DOI: 10.3389/fmicb.2022.958653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Glycosphingolipids (GSLs) are ubiquitous components of the cell membranes, found across several kingdoms of life, from bacteria to mammals, including humans. GSLs are a subclass of major glycolipids occurring in animal lipid membranes in clusters named “lipid rafts.” The most crucial functions of GSLs include signal transduction and regulation as well as participation in cell proliferation. Despite the mainstream view that pathogens rely on protein–protein interactions to survive and thrive in their hosts, many also target the host lipids. In particular, multiple pathogens produce adhesion molecules or toxins that bind GSLs. Attachment of pathogens to cell surface receptors is the initial step in infections. Many mammalian pathogens have evolved to recognize GSL-derived receptors. Animal glycosphingolipidomes consist of multiple types of GSLs differing in terminal glycan and ceramide structures in a cell or tissue-specific manner. Interspecies differences in GSLs dictate host specificity as well as cell and tissue tropisms. Evolutionary pressure exerted by pathogens on their hosts drives changes in cell surface glycoconjugates, including GSLs, and has produced a vast number of molecules and interaction mechanisms. Despite that abundance, the role of GSLs as pathogen receptors has been largely overlooked or only cursorily discussed. In this review, we take a closer look at GSLs and their role in the recognition, cellular entry, and toxicity of multiple bacterial, viral and fungal pathogens.
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Ratnayake R, Peyraud N, Ciglenecki I, Gignoux E, Lightowler M, Azman AS, Gakima P, Ouamba JP, Sagara JA, Ndombe R, Mimbu N, Ascorra A, Welo PO, Mukamba Musenga E, Miwanda B, Boum Y, Checchi F, Edmunds WJ, Luquero F, Porten K, Finger F. Effectiveness of case-area targeted interventions including vaccination on the control of epidemic cholera: protocol for a prospective observational study. BMJ Open 2022; 12:e061206. [PMID: 35793924 PMCID: PMC9260795 DOI: 10.1136/bmjopen-2022-061206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cholera outbreaks in fragile settings are prone to rapid expansion. Case-area targeted interventions (CATIs) have been proposed as a rapid and efficient response strategy to halt or substantially reduce the size of small outbreaks. CATI aims to deliver synergistic interventions (eg, water, sanitation, and hygiene interventions, vaccination, and antibiotic chemoprophylaxis) to households in a 100-250 m 'ring' around primary outbreak cases. METHODS AND ANALYSIS We report on a protocol for a prospective observational study of the effectiveness of CATI. Médecins Sans Frontières (MSF) plans to implement CATI in the Democratic Republic of the Congo (DRC), Cameroon, Niger and Zimbabwe. This study will run in parallel to each implementation. The primary outcome is the cumulative incidence of cholera in each CATI ring. CATI will be triggered immediately on notification of a case in a new area. As with most real-world interventions, there will be delays to response as the strategy is rolled out. We will compare the cumulative incidence among rings as a function of response delay, as a proxy for performance. Cross-sectional household surveys will measure population-based coverage. Cohort studies will measure effects on reducing incidence among household contacts and changes in antimicrobial resistance. ETHICS AND DISSEMINATION The ethics review boards of MSF and the London School of Hygiene and Tropical Medicine have approved a generic protocol. The DRC and Niger-specific versions have been approved by the respective national ethics review boards. Approvals are in process for Cameroon and Zimbabwe. The study findings will be disseminated to the networks of national cholera control actors and the Global Task Force for Cholera Control using meetings and policy briefs, to the scientific community using journal articles, and to communities via community meetings.
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Affiliation(s)
- Ruwan Ratnayake
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Epicentre, Paris, France
| | | | | | | | | | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | | | - Placide Okitayemba Welo
- Programme National d'Elimination du Choléra et de lutte contre les autres Maladies Diarrhéiques, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Berthe Miwanda
- Institut National de Recherche Biologique, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Francesco Checchi
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - W John Edmunds
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Francisco Luquero
- Epicentre, Paris, France
- GAVI the Vaccine Alliance, Geneva, Switzerland
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9
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Park SE, Jeon Y, Kang S, Gedefaw A, Hailu D, Yeshitela B, Edosa M, Getaneh MW, Teferi M. Infectious Disease Control and Management in Ethiopia: A Case Study of Cholera. Front Public Health 2022; 10:870276. [PMID: 35712321 PMCID: PMC9197421 DOI: 10.3389/fpubh.2022.870276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Cholera remains a significant public health problem among the vulnerable populations living in many resource-limited settings with poor access to safe and clean water and hygiene practice. Around 2.86 million cholera cases and 95,000 deaths are estimated to occur in endemic countries. In Ethiopia, cholera has been one of the major epidemic diseases since 1634 when the first cholera outbreak was recorded in-country. Several cholera epidemics occurred with recent outbreaks in 2019–2021. Cholera has been often reported as acute watery diarrhea due to limited diagnostic capacity in remote areas in Ethiopia and sensitivities around cholera outbreaks. The government of Ethiopia has been executing several phases of multi-year health sector development plan in the past decades and has recently developed a national cholera control plan. Here, we aim to present the existing cholera control guidelines and health system in Ethiopia, including case detection and reporting, outbreak declaration, case management, and transmission control. Challenges and way forward on further research and public health interventions are also discussed to address the knowledge and health service gaps related to cholera control in Ethiopia.
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Affiliation(s)
- Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea.,Yonsei University Graduate School of Public Health, Seoul, South Korea
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea
| | - Sunjoo Kang
- Yonsei University Graduate School of Public Health, Seoul, South Korea
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea.,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, South Korea.,School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Moti Edosa
- Diseases Surveillance and Response Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Wossen Getaneh
- Diseases Surveillance and Response Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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10
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Lerch A, Ten Bosch QA, L'Azou Jackson M, Bettis AA, Bernuzzi M, Murphy GAV, Tran QM, Huber JH, Siraj AS, Bron GM, Elliott M, Hartlage CS, Koh S, Strimbu K, Walters M, Perkins TA, Moore SM. Projecting vaccine demand and impact for emerging zoonotic pathogens. BMC Med 2022; 20:202. [PMID: 35705986 PMCID: PMC9200440 DOI: 10.1186/s12916-022-02405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite large outbreaks in humans seeming improbable for a number of zoonotic pathogens, several pose a concern due to their epidemiological characteristics and evolutionary potential. To enable effective responses to these pathogens in the event that they undergo future emergence, the Coalition for Epidemic Preparedness Innovations is advancing the development of vaccines for several pathogens prioritized by the World Health Organization. A major challenge in this pursuit is anticipating demand for a vaccine stockpile to support outbreak response. METHODS We developed a modeling framework for outbreak response for emerging zoonoses under three reactive vaccination strategies to assess sustainable vaccine manufacturing needs, vaccine stockpile requirements, and the potential impact of the outbreak response. This framework incorporates geographically variable zoonotic spillover rates, human-to-human transmission, and the implementation of reactive vaccination campaigns in response to disease outbreaks. As proof of concept, we applied the framework to four priority pathogens: Lassa virus, Nipah virus, MERS coronavirus, and Rift Valley virus. RESULTS Annual vaccine regimen requirements for a population-wide strategy ranged from > 670,000 (95% prediction interval 0-3,630,000) regimens for Lassa virus to 1,190,000 (95% PrI 0-8,480,000) regimens for Rift Valley fever virus, while the regimens required for ring vaccination or targeting healthcare workers (HCWs) were several orders of magnitude lower (between 1/25 and 1/700) than those required by a population-wide strategy. For each pathogen and vaccination strategy, reactive vaccination typically prevented fewer than 10% of cases, because of their presently low R0 values. Targeting HCWs had a higher per-regimen impact than population-wide vaccination. CONCLUSIONS Our framework provides a flexible methodology for estimating vaccine stockpile needs and the geographic distribution of demand under a range of outbreak response scenarios. Uncertainties in our model estimates highlight several knowledge gaps that need to be addressed to target vulnerable populations more accurately. These include surveillance gaps that mask the true geographic distribution of each pathogen, details of key routes of spillover from animal reservoirs to humans, and the role of human-to-human transmission outside of healthcare settings. In addition, our estimates are based on the current epidemiology of each pathogen, but pathogen evolution could alter vaccine stockpile requirements.
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Affiliation(s)
- Anita Lerch
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Quirine A Ten Bosch
- Quantitative Veterinary Epidemiology, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Alison A Bettis
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Mauro Bernuzzi
- Coalition for Epidemic Preparedness Innovations (CEPI), London, UK
| | | | - Quan M Tran
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - John H Huber
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Amir S Siraj
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Gebbiena M Bron
- Quantitative Veterinary Epidemiology, Wageningen University and Research, Wageningen, The Netherlands
| | - Margaret Elliott
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Carson S Hartlage
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Sojung Koh
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Kathyrn Strimbu
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Magdalene Walters
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - T Alex Perkins
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA.
| | - Sean M Moore
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA.
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11
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Roskosky M, Ali M, Upreti SR, Sack D. Spatial clustering of cholera cases in the Kathmandu Valley: implications for a ring vaccination strategy. Int Health 2021; 13:170-177. [PMID: 32761173 PMCID: PMC7902685 DOI: 10.1093/inthealth/ihaa042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background In mid-2016, a cholera outbreak occurred in Kathmandu Valley, Nepal. This retrospective study aims to determine if a reactive, ring vaccination strategy would have been useful in preventing cholera transmission during that outbreak. Methods Data on cholera cases were collected as part of hospital-based surveillance in the Kathmandu Valley in 2016. Global Positioning System (GPS) coordinates were obtained during household visits. Geographic clusters of cases were visually determined and tested statistically for clustering. Cluster size was determined based on the distribution of cases around the index case. Results GPS coordinates for 69 cases were analysed. Six geographic clusters were identified, all of which showed significant clustering of cases. Approximately 85% of cases within a cluster occurred more than 7 d after the index case. The median ring size was 1 km, with a population of 14 000 people. Conclusions Cholera cases were clustered in space and the majority of cases occurred over 1 week after the initial cases in the cluster, allowing for an opportunity to prevent transmission through the use of the vaccine soon after the initial case was identified. A ring vaccination strategy may be especially useful for large urban areas with recurrent seasonal outbreaks but where the specific locations for such outbreaks are not predictable.
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Affiliation(s)
- Mellisa Roskosky
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe Street, MD-21205, USA
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe Street, MD-21205, USA
| | | | - David Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe Street, MD-21205, USA
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12
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Holmgren J. An Update on Cholera Immunity and Current and Future Cholera Vaccines. Trop Med Infect Dis 2021; 6:tropicalmed6020064. [PMID: 33925118 PMCID: PMC8167659 DOI: 10.3390/tropicalmed6020064] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/12/2022] Open
Abstract
Individual resistance to cholera infection and disease depends on both innate host factors and adaptive immunity acquired by a previous infection or vaccination. Locally produced, intestinal-mucosal secretory IgA (SIgA) antibodies against bacterial surface lipopolysaccharide (LPS) O antigens and/or secreted cholera toxins are responsible for the protective adaptive immunity, in conjunction with an effective mucosal immunologic memory that can elicit a rapid anamnestic SIgA antibody response upon re-exposure to the antigen/pathogen even many years later. Oral cholera vaccines (OCVs), based on inactivated Vibrio cholerae whole-cell components, either together with the cholera toxin B subunit (Dukoral™) or administered alone (Shanchol™/Euvichol-Plus™) were shown to be consistently safe and effective in large field trials in all settings. These OCVs are recommended by the World Health Organisation (WHO) for the control of both endemic cholera and epidemic cholera outbreaks. OCVs are now a cornerstone in WHO’s global strategy found in “Ending Cholera: A Global Roadmap to 2030.” However, the forecasted global demands for OCV, estimated by the Global Alliance for Vaccines and Immunization (GAVI) to 1.5 billion doses for the period 2020–2029, markedly exceed the existing manufacturing capacity. This calls for an increased production capacity of existing OCVs, as well as the rapid introduction of additional and improved vaccines under development.
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Affiliation(s)
- Jan Holmgren
- University of Gothenburg Vaccine Research Institute, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- University of Gothenburg Vaccine Research Institute, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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13
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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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14
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Ratnayake R, Finger F, Azman AS, Lantagne D, Funk S, Edmunds WJ, Checchi F. Highly targeted spatiotemporal interventions against cholera epidemics, 2000-19: a scoping review. THE LANCET. INFECTIOUS DISEASES 2020; 21:e37-e48. [PMID: 33096017 DOI: 10.1016/s1473-3099(20)30479-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023]
Abstract
Globally, cholera epidemics continue to challenge disease control. Although mass campaigns covering large populations are commonly used to control cholera, spatial targeting of case households and their radius is emerging as a potentially efficient strategy. We did a Scoping Review to investigate the effectiveness of interventions delivered through case-area targeted intervention, its optimal spatiotemporal scale, and its effectiveness in reducing transmission. 53 articles were retrieved. We found that antibiotic chemoprophylaxis, point-of-use water treatment, and hygiene promotion can rapidly reduce household transmission, and single-dose vaccination can extend the duration of protection within the radius of households. Evidence supports a high-risk spatiotemporal zone of 100 m around case households, for 7 days. Two evaluations separately showed reductions in household transmission when targeting case households, and in size and duration of case clusters when targeting radii. Although case-area targeted intervention shows promise for outbreak control, it is critically dependent on early detection capacity and requires prospective evaluation of intervention packages.
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Affiliation(s)
- Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Andrew S Azman
- Department of Epidemiology and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Médecins Sans Frontières, Geneva, Switzerland
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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15
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Forecasting evaluation via parametric bootstrap for threshold-INARCH models. COMMUNICATIONS FOR STATISTICAL APPLICATIONS AND METHODS 2020. [DOI: 10.29220/csam.2020.27.2.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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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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17
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Roskosky M, Acharya B, Shakya G, Karki K, Sekine K, Bajracharya D, von Seidlein L, Devaux I, Lopez AL, Deen J, Sack DA. Feasibility of a Comprehensive Targeted Cholera Intervention in The Kathmandu Valley, Nepal. Am J Trop Med Hyg 2020; 100:1088-1097. [PMID: 30887946 PMCID: PMC6493959 DOI: 10.4269/ajtmh.18-0863] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A comprehensive targeted intervention (CTI) was designed and deployed in the neighborhoods of cholera cases in the Kathmandu Valley with the intent of reducing rates among the neighbors of the case. This was a feasibility study to determine whether clinical centers, laboratories, and field teams were able to mount a rapid, community-based response to a case within 2 days of hospital admission. Daily line listings were requested from 15 participating hospitals during the monsoon season, and a single case initiated the CTI. A standard case definition was used: acute watery diarrhea, with or without vomiting, in a patient aged 1 year or older. Rapid diagnostic tests and bacterial culture were used for confirmation. The strategy included household investigation of cases; water testing; water, sanitation, and hygiene (WASH) intervention; and health education. A CTI coverage survey was conducted 8 months postintervention. From June to December of 2016, 169 cases of Vibrio cholerae O1 were confirmed by bacterial culture. Average time to culture result was 3 days. On average, the CTI Rapid Response Team (RRT) was able to visit households 1.7 days after the culture result was received from the hospital (3.9 days from hospital admission). Coverage of WASH and health behavior messaging campaigns were 30.2% in the target areas. Recipients of the intervention were more likely to have knowledge of cholera symptoms, treatment, and prevention than non-recipients. Although the RRT were able to investigate cases at the household within 2 days of a positive culture result, the study identified several constraints that limited a truly rapid response.
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Affiliation(s)
- Mellisa Roskosky
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bhim Acharya
- Epidemiology Disease Control Division, Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Geeta Shakya
- National Public Health Laboratory, Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | | | - Kazutaka Sekine
- United Nations International Children's Emergency Fund (UNICEF) Sierra Leone, Freetown, Sierra Leone
| | | | - Lorenz von Seidlein
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Isabelle Devaux
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Mogasale V, Kanungo S, Pati S, Lynch J, Dutta S. The history of OCV in India and barriers remaining to programmatic introduction. Vaccine 2020; 38 Suppl 1:A41-A45. [PMID: 31982258 DOI: 10.1016/j.vaccine.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/29/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Cholera-endemic Eastern India has played an important role in the development of oral cholera vaccines (OCV) through conduct of pivotal trials in Kolkata which led to the registration of the first low-cost bivalent killed whole cell OCV in India in 2009, and subsequent prequalification by the World Health Organization prequalification in 2011. Odisha hosted an influential early demonstration project for use of the vaccine in a high-risk population and provided data and lessons that were crucial input in the Vaccine Investment Strategy developed by Gavi, the Vaccine Alliance in 2013. With Gavi's decision to finance an OCV stockpile, the demand for OCV surged and vaccine has been deployed with great success worldwide in areas of need in response to outbreaks and disasters, most notably in Africa. However, although India is considered one of the highest burden countries, no further use of OCV has occurred since the demonstration project in Odisha in 2011. In this paper we will summarize the important contributions of India to the development and use of OCV and discuss the possible barriers to OCV introduction as a public health tool to control cholera.
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Affiliation(s)
- Vittal Mogasale
- International Vaccine Institute, Policy and Economic Research Department; Public Health, Access and Vaccine Epidemiology (PAVE) Unit, Seoul, South Korea
| | - Suman Kanungo
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sanghamitra Pati
- Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Julia Lynch
- International Vaccine Institute, Development & Delivery Unit, Seoul, South Korea
| | - Shanta Dutta
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India.
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19
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Michel E, Gaudart J, Beaulieu S, Bulit G, Piarroux M, Boncy J, Dely P, Piarroux R, Rebaudet S. Estimating effectiveness of case-area targeted response interventions against cholera in Haiti. eLife 2019; 8:50243. [PMID: 31886768 PMCID: PMC7041943 DOI: 10.7554/elife.50243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/20/2019] [Indexed: 01/24/2023] Open
Abstract
Case-area targeted interventions (CATIs) against cholera are conducted by rapid response teams, and may include various activities like water, sanitation, hygiene measures. However, their real-world effectiveness has never been established. We conducted a retrospective observational study in 2015-2017 in the Centre department of Haiti. Using cholera cases, stool cultures and CATI records, we identified 238 outbreaks that were responded to. After adjusting for potential confounders, we found that a prompt response could reduce the number of accumulated cases by 76% (95% confidence interval, 59 to 86) and the outbreak duration by 61% (41 to 75) when compared to a delayed response. An intense response could reduce the number of accumulated cases by 59% (11 to 81) and the outbreak duration by 73% (49 to 86) when compared to a weaker response. These results suggest that prompt and repeated CATIs were significantly effective at mitigating and shortening cholera outbreaks in Haiti.
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Affiliation(s)
- Edwige Michel
- Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Port-au-Prince, Haiti
| | - Jean Gaudart
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Hop Timone, BiSTIC, Biostatistics and ICT, Marseille, France
| | | | - Gregory Bulit
- United Nations Children's Fund, Port-au-Prince, Haiti
| | - Martine Piarroux
- Centre d'Épidémiologie et de Santé Publique des Armées, Service de Santé des Armées, Marseille, France
| | - Jacques Boncy
- Ministry of Public Health and Population, National Laboratory of Public Health, Delmas, Haiti
| | - Patrick Dely
- Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Port-au-Prince, Haiti
| | - Renaud Piarroux
- Sorbonne Université, Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique (IPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stanislas Rebaudet
- APHM, Hôpital Européen, Aix Marseille Université, INSERM, IRD, SESSTIM, IPLESP, Marseille, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Paris, France
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20
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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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Threshold-asymmetric volatility models for integer-valued time series. COMMUNICATIONS FOR STATISTICAL APPLICATIONS AND METHODS 2019. [DOI: 10.29220/csam.2019.26.3.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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George CM, Sack DA. Integration of water, sanitation and hygiene intervention delivery at health facilities with a reactive ring vaccination programme to reduce cholera. Int J Epidemiol 2018; 46:2093-2094. [PMID: 28338776 DOI: 10.1093/ije/dyx025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christine Marie George
- 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
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Khan AI, Khan IA, Siddique SA, Rahman A, Islam MT, Bhuiya MAI, Saha NC, Biswas PK, Saha A, Chowdhury F, Qadri F. Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh. Hum Vaccin Immunother 2018; 15:1302-1309. [PMID: 30261152 PMCID: PMC6663147 DOI: 10.1080/21645515.2018.1528833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1–9 years) and the lowest was amongst 18–29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.
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Affiliation(s)
- Ashraful Islam Khan
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Iqbal Ansary Khan
- b Medical Social Science , Institute of Epidemiology, Disease Control and Research (IEDCR) , Dhaka , Bangladesh
| | - Shah Alam Siddique
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Anisur Rahman
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Md Taufiqul Islam
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Md Amirul Islam Bhuiya
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Nirod Chandra Saha
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Prasanta Kumar Biswas
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Amit Saha
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Fahima Chowdhury
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Firdausi Qadri
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
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Semá Baltazar C, Rafael F, Langa JPM, Chicumbe S, Cavailler P, Gessner BD, Pezzoli L, Barata A, Zaina D, Inguane DL, Mengel MA, Munier A. Oral cholera vaccine coverage during a preventive door-to-door mass vaccination campaign in Nampula, Mozambique. PLoS One 2018; 13:e0198592. [PMID: 30281604 PMCID: PMC6169854 DOI: 10.1371/journal.pone.0198592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/22/2018] [Indexed: 12/13/2022] Open
Abstract
Background In addition to improving water, sanitation and hygiene (WASH) measures and optimal case management, the introduction of Oral cholera vaccine (OCV) is a complementary strategy for cholera prevention and control for vulnerable population groups. In October 2016, the Mozambique Ministry of Health implemented a mass vaccination campaign using a two-dose regimen of the Shanchol™ OCV in six high-risk neighborhoods of Nampula city, in Northern Mozambique. Overall 193,403 people were targeted by the campaign, which used a door-to-door strategy. During campaign follow-up, a population survey was conducted to assess: (1) OCV coverage; (2) frequency of adverse events following immunization; (3) vaccine acceptability and (4) reasons for non-vaccination. Methodology/Principal findings In the absence of a household listing and clear administrative neighborhood delimitations, we used geospatial technology to select households from satellite images and used the support of community leaders. One person per household was randomly selected for interview. In total, 636 individuals were enrolled in the survey. The overall vaccination coverage with at least one dose (including card and oral reporting) was 69.5% (95%CI: 51.2–88.2) and the two-dose coverage was 51.2% (95%CI: 37.9–64.3). The campaign was well accepted. Among the 185 non-vaccinated individuals, 83 (44.6%) did not take the vaccine because they were absent when the vaccination team visited their houses. Among the 451 vaccinated individuals, 47 (10%) reported minor and non-specific complaints, and 78 (17.3%) mentioned they did not receive any information before the campaign. Conclusions/Significance In spite of overall coverage being slightly lower than expected, the use of a mobile door-to-door strategy remains a viable option even in densely-populated urban settings. Our results suggest that campaigns can be successfully implemented and well accepted in Mozambique in non-emergency contexts in order to prevent cholera outbreaks. These findings are encouraging and complement the previous Mozambican experience related to OCV.
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Affiliation(s)
| | | | | | - Sergio Chicumbe
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Américo Barata
- Direcção Provincial de Saúde, Ministry of Health, Nampula, Mozambique
| | - Dores Zaina
- Direcção de Saúde de Cidade, Ministry of Health, Nampula, Mozambique
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Protection from killed oral cholera vaccine continues for 4 years. THE LANCET GLOBAL HEALTH 2018; 6:e946-e947. [DOI: 10.1016/s2214-109x(18)30311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
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Lopez AL, Deen J, Azman AS, Luquero FJ, Kanungo S, Dutta S, von Seidlein L, Sack DA. Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis. Clin Infect Dis 2018; 66:1960-1971. [PMID: 29177437 PMCID: PMC5982790 DOI: 10.1093/cid/cix1039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/19/2017] [Indexed: 12/16/2022] Open
Abstract
In addition to improved water supply and sanitation, the 2-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The metaanalysis showed that an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggest otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.
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Affiliation(s)
- Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, West Bengal, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, West Bengal, India
| | - Lorenz von Seidlein
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David A Sack
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
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Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M, Mengel M, Dunoyer J, M'bangombe M, Lee EC, Djingarey MH, Sudre B, Bompangue D, Fraser RSM, Abubakar A, Perea W, Legros D, Azman AS. Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet 2018; 391:1908-1915. [PMID: 29502905 PMCID: PMC5946088 DOI: 10.1016/s0140-6736(17)33050-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions. METHODS We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence. FINDINGS We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538-146 505) were reported per year. 4·0% (95% CrI 1·7-16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population. INTERPRETATION Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sean M Moore
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA; Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Epicentre, Paris, France
| | - Heather S McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Myriam Henkens
- Médecins Sans Frontières International Office, Brussels, Belgium
| | | | - Jessica Dunoyer
- UNICEF West and Central Africa Regional Office, Dakar, Senegal
| | | | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Infectious Diseases, Georgetown University, Washington, DC, USA
| | | | - Bertrand Sudre
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Didier Bompangue
- Ministry of Health, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Robert S M Fraser
- International Federation for the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | | | | | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Médecins sans Frontières, Geneva, Switzerland
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Deen J, von Seidlein L. The case for ring vaccinations with special consideration of oral cholera vaccines. Hum Vaccin Immunother 2018; 14:2069-2074. [PMID: 29630444 PMCID: PMC6149944 DOI: 10.1080/21645515.2018.1462068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 01/09/2023] Open
Abstract
Ring vaccinations create a zone of immune contacts around a case to prevent further disease transmission and have been successfully employed in the eradication of smallpox and the control of other infections. Millions of oral cholera vaccine (OCV) doses have been effectively deployed through mass vaccination campaigns. But there are situations when the OCV supply, resources, and time are limited and alternative strategies need to be considered. People living in close proximity of cholera cases often share risk factors such as contaminated water supply and poor sanitation. Targeting people within a given radius around a cholera case for intervention including vaccination, improved water supply and sanitation may be a practical and effective approach. A ring oral cholera vaccination strategy could be considered before, after or as an alternative to a mass vaccination approach. We review here the use of the ring vaccinations in general and specifically during cholera outbreaks.
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Affiliation(s)
- Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Finger F, Bertuzzo E, Luquero FJ, Naibei N, Touré B, Allan M, Porten K, Lessler J, Rinaldo A, Azman AS. The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study. PLoS Med 2018; 15:e1002509. [PMID: 29485987 PMCID: PMC5828347 DOI: 10.1371/journal.pmed.1002509] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cholera prevention and control interventions targeted to neighbors of cholera cases (case-area targeted interventions [CATIs]), including improved water, sanitation, and hygiene, oral cholera vaccine (OCV), and prophylactic antibiotics, may be able to efficiently avert cholera cases and deaths while saving scarce resources during epidemics. Efforts to quickly target interventions to neighbors of cases have been made in recent outbreaks, but little empirical evidence related to the effectiveness, efficiency, or ideal design of this approach exists. Here, we aim to provide practical guidance on how CATIs might be used by exploring key determinants of intervention impact, including the mix of interventions, "ring" size, and timing, in simulated cholera epidemics fit to data from an urban cholera epidemic in Africa. METHODS AND FINDINGS We developed a micro-simulation model and calibrated it to both the epidemic curve and the small-scale spatiotemporal clustering pattern of case households from a large 2011 cholera outbreak in N'Djamena, Chad (4,352 reported cases over 232 days), and explored the potential impact of CATIs in simulated epidemics. CATIs were implemented with realistic logistical delays after cases presented for care using different combinations of prophylactic antibiotics, OCV, and/or point-of-use water treatment (POUWT) starting at different points during the epidemics and targeting rings of various radii around incident case households. Our findings suggest that CATIs shorten the duration of epidemics and are more resource-efficient than mass campaigns. OCV was predicted to be the most effective single intervention, followed by POUWT and antibiotics. CATIs with OCV started early in an epidemic focusing on a 100-m radius around case households were estimated to shorten epidemics by 68% (IQR 62% to 72%), with an 81% (IQR 69% to 87%) reduction in cases compared to uncontrolled epidemics. These same targeted interventions with OCV led to a 44-fold (IQR 27 to 78) reduction in the number of people needed to target to avert a single case of cholera, compared to mass campaigns in high-cholera-risk neighborhoods. The optimal radius to target around incident case households differed by intervention type, with antibiotics having an optimal radius of 30 m to 45 m compared to 70 m to 100 m for OCV and POUWT. Adding POUWT or antibiotics to OCV provided only marginal impact and efficiency improvements. Starting CATIs early in an epidemic with OCV and POUWT targeting those within 100 m of an incident case household reduced epidemic durations by 70% (IQR 65% to 75%) and the number of cases by 82% (IQR 71% to 88%) compared to uncontrolled epidemics. CATIs used late in epidemics, even after the peak, were estimated to avert relatively few cases but substantially reduced the number of epidemic days (e.g., by 28% [IQR 15% to 45%] for OCV in a 100-m radius). While this study is based on a rigorous, data-driven approach, the relatively high uncertainty about the ways in which POUWT and antibiotic interventions reduce cholera risk, as well as the heterogeneity in outbreak dynamics from place to place, limits the precision and generalizability of our quantitative estimates. CONCLUSIONS In this study, we found that CATIs using OCV, antibiotics, and water treatment interventions at an appropriate radius around cases could be an effective and efficient way to fight cholera epidemics. They can provide a complementary and efficient approach to mass intervention campaigns and may prove particularly useful during the initial phase of an outbreak, when there are few cases and few available resources, or in order to shorten the often protracted tails of cholera epidemics.
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Affiliation(s)
- Flavio Finger
- Laboratory of Ecohydrology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Enrico Bertuzzo
- Laboratory of Ecohydrology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca’ Foscari Venezia, Venice, Italy
| | - Francisco J. Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Epicentre, Paris, France
| | - Nathan Naibei
- Communauté des Amis de l’Informatique pour le Développement–Tchad, N’Djamena, Chad
| | | | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrea Rinaldo
- Laboratory of Ecohydrology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Dipartimento di Ingegneria Civile, Edile ed Ambientale, Università di Padova, Padova, Italy
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Ali M, Kim DR, Kanungo S, Sur D, Manna B, Digilio L, Dutta S, Marks F, Bhattacharya SK, Clemens J. Use of oral cholera vaccine as a vaccine probe to define the geographical dimensions of person-to-person transmission of cholera. Int J Infect Dis 2017; 66:90-95. [PMID: 29174695 PMCID: PMC7413038 DOI: 10.1016/j.ijid.2017.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 01/17/2023] Open
Abstract
Background Cholera is known to be transmitted from person to person, and inactivated oral cholera vaccines (OCVs) have been shown to confer herd protection via interruption of this transmission. However, the geographic dimensions of chains of person-to-person transmission of cholera are uncertain. The ability of OCVs to confer herd protection was used to define these dimensions in two cholera-endemic settings, one in rural Bangladesh and the other in urban India. Methods Two large randomized, placebo-controlled trials of inactivated OCVs, one in rural Matlab, Bangladesh and the other in urban Kolkata, India, were reanalyzed. Vaccine herd protection was evaluated by relating the risk of cholera in placebo recipients to vaccine coverage of surrounding residents residing within concentric rings. In Matlab, concentric rings in 100-m increments up to 700 m were evaluated; in Kolkata, 50-m increments up to 350m were evaluated. Results One hundred and eight cholera cases among 24 667 placebo recipients were detected during 1 year of post-vaccination follow-up at Matlab; 128 cholera cases among 34 968 placebo recipients were detected during 3 years of follow-up in Kolkata. Consistent inverse relationships were observed between vaccine coverage of the ring and the risk of cholera in the central placebo recipient for rings with radii up to 500 m in Matlab and up to 150 m in Kolkata. Conclusions These results suggest that the dimensions of chains of person-to-person transmission in endemic settings can be quite large and may differ substantially from setting to setting. Using OCVs as 'probes' to define these dimensions can inform geographical targeting strategies for the deployment of these vaccines in endemic settings.
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Affiliation(s)
- Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Laura Digilio
- International Vaccine Institute, Seoul, Republic of Korea
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - John Clemens
- icddr,b, Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, USA; Korea University School of Medicine, Seoul, Republic of Korea.
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Parker LA, Rumunu J, Jamet C, Kenyi Y, Lino RL, Wamala JF, Mpairwe AM, Muller V, Llosa AE, Uzzeni F, Luquero FJ, Ciglenecki I, Azman AS. Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage. PLoS Negl Trop Dis 2017; 11:e0005652. [PMID: 28594891 PMCID: PMC5478158 DOI: 10.1371/journal.pntd.0005652] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/20/2017] [Accepted: 05/19/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION In June 2015, a cholera outbreak was declared in Juba, South Sudan. In addition to standard outbreak control measures, oral cholera vaccine (OCV) was proposed. As sufficient doses to cover the at-risk population were unavailable, a campaign using half the standard dosing regimen (one-dose) targeted high-risk neighborhoods and groups including neighbors of suspected cases. Here we report the operational details of this first public health use of a single-dose regimen of OCV and illustrate the feasibility of conducting highly targeted vaccination campaigns in an urban area. METHODOLOGY/PRINCIPAL FINDINGS Neighborhoods of the city were prioritized for vaccination based on cumulative attack rates, active transmission and local knowledge of known cholera risk factors. OCV was offered to all persons older than 12 months at 20 fixed sites and to select groups, including neighbors of cholera cases after the main campaign ('case-triggered' interventions), through mobile teams. Vaccination coverage was estimated by multi-stage surveys using spatial sampling techniques. 162,377 individuals received a single-dose of OCV in the targeted neighborhoods. In these neighborhoods vaccine coverage was 68.8% (95% Confidence Interval (CI), 64.0-73.7) and was highest among children ages 5-14 years (90.0%, 95% CI 85.7-94.3), with adult men being less likely to be vaccinated than adult women (Relative Risk 0.81, 95% CI: 0.68-0.96). In the case-triggered interventions, each lasting 1-2 days, coverage varied (range: 30-87%) with an average of 51.0% (95% CI 41.7-60.3). CONCLUSIONS/SIGNIFICANCE Vaccine supply constraints and the complex realities where cholera outbreaks occur may warrant the use of flexible alternative vaccination strategies, including highly-targeted vaccination campaigns and single-dose regimens. We showed that such campaigns are feasible. Additional work is needed to understand how and when to use different strategies to best protect populations against epidemic cholera.
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Affiliation(s)
- Lucy A. Parker
- Médecins Sans Frontières, Geneva, Switzerland
- CIBER Epidemiología y Salud Pública, Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - John Rumunu
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | | | - Yona Kenyi
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Andrew S. Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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