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Ferreras E, Matapo B, Chizema-Kawesha E, Chewe O, Mzyece H, Blake A, Moonde L, Zulu G, Poncin M, Sinyange N, Kasese-Chanda N, Phiri C, Malama K, Mukonka V, Cohuet S, Uzzeni F, Ciglenecki I, Danovaro-Holliday MC, Luquero FJ, Pezzoli L. Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016. PLoS One 2019; 14:e0219040. [PMID: 31469853 PMCID: PMC6716633 DOI: 10.1371/journal.pone.0219040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign. METHODS Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling. RESULTS The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose. CONCLUSIONS The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
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Affiliation(s)
- Eva Ferreras
- World Health Organization, Lusaka, Zambia
- Epicentre, Paris, France
| | | | | | - Orbrie Chewe
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Hannah Mzyece
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Keating P, Carrion Martin AI, Blake A, Lechevalier P, Uzzeni F, Gignoux E, Okonta C, Langendorf C, Smit S, Ahuka S, Suchard M, Pukuta E, Degail MA, Hansen L, Kibanza-Kyungu J, Ciglenecki I, Cohuet S. Measles seroprevalence after reactive vaccination campaigns during the 2015 measles outbreak in four health zones of the former Katanga Province, Democratic Republic of Congo. BMC Public Health 2019; 19:1153. [PMID: 31438898 PMCID: PMC6704676 DOI: 10.1186/s12889-019-7500-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles continues to circulate in the Democratic Republic of Congo, and the country suffered from several important outbreaks over the last 5 years. Despite a large outbreak starting in the former province of Katanga in 2010 and the resulting immunization activities, another outbreak occurred in 2015 in this same region. We conducted measles seroprevalence surveys in four health zones (HZ) in the former Katanga Province in order to assess the immunity against measles in children 6 months to 14 years after the 2015 outbreak. METHODS We conducted multi-stage cluster surveys stratified by age group in four HZs, Kayamba, Malemba-Nkulu, Fungurume, and Manono. The age groups were 6-11 months, 12-59 months, and 5-14 years in Kayamba and Malemba-Nkulu, 6-59 months and 5-14 years in Manono and Fungurume. The serological status was measured on dried capillary blood spots collected systematically along with vaccination status (including routine Extended Program of Immunization (EPI), and supplementary immunization activities (SIAs)) and previous self-reported history of suspected measles. RESULTS Overall seroprevalence against measles was 82.7% in Kayamba, 97.6% in Malemba-Nkulu, 83.2% in Manono, and 74.4% in Fungurume, and it increased with age in all HZs. It was 70.7 and 93.8% in children 12-59 months in Kayamba and Malemba-Nkulu, and 49.8 and 64.7% in children 6-59 months in Fungurume and Manono. The EPI coverage was low but varied across HZ. The accumulation of any type of vaccination against measles resulted in an overall vaccine coverage (VC) of at least 85% in children 12-59 months in Kayamba and Malemba-Nkulu, 86.1 and 74.8% in children 6-59 months in Fungurume and Manono. Previous measles infection in 2015-early 2016 was more frequently reported in children aged 12-59 months or 6-59 months (depending on the HZ). CONCLUSION The measured seroprevalence was consistent with the events that occurred in these HZs over the past few years. Measles seroprevalence might prove a valuable source of information to help adjust the timing of future SIAs and prioritizing support to the EPI in this region as long as the VC does not reach a level high enough to efficiently prevent epidemic flare-ups.
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Affiliation(s)
- Patrick Keating
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
- Epicentre, Paris, France
| | | | | | | | - Florent Uzzeni
- Médecins Sans Frontières – Operational Center Geneva, Geneva, Switzerland
| | | | - Chibuzo Okonta
- Médecins Sans Frontières – Operational Center Paris, Paris, France
| | | | - Sheilagh Smit
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Steve Ahuka
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Melinda Suchard
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Elizabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | - Lisa Hansen
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
| | - Jerry Kibanza-Kyungu
- Division Provinciale Sanitaire du Tanganyika, Kalémie, Democratic Republic of Congo
| | - Iza Ciglenecki
- Médecins Sans Frontières – Operational Center Geneva, Geneva, Switzerland
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Rull M, Masson S, Peyraud N, Simonelli M, Ventura A, Dorion C, Luquero FJ, Uzzeni F, Cigleneki I. The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman, South Sudan. Confl Health 2018; 12:11. [PMID: 29599819 PMCID: PMC5868060 DOI: 10.1186/s13031-018-0147-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction The main causes of death during population movements can be prevented by addressing the population's basic needs. In 2013, the World Health Organization (WHO) issued a framework for decision making to help prioritize vaccinations in acute humanitarian emergencies. This article describes MSF's experience of applying this framework in addition to addressing key population needs in a displacement setting in Minkaman, South Sudan. Case description Military clashes broke out in South Sudan in December 2013. By May 2014, Minkaman, a village in the Lakes State, hosted some 85,000 displaced people. MSF arrived in Minkaman on 28 December 2013 and immediately provided interventions to address the key humanitarian needs (health care, access to drinking water, measles vaccination). The WHO framework was used to identify priority vaccines: those preventing outbreaks (measles, polio, oral cholera vaccine, and vaccine against meningococcal meningitis A (MenAfrivac®)) and those reducing childhood morbidity and mortality (pentavalent vaccine that combines diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type B; pneumococcal vaccine; and rotavirus vaccine). By mid-March, access to primary and secondary health care was ensured, including community health activities and the provision of safe water. Mass vaccination campaigns against measles, polio, cholera, and meningitis had been organized. Vaccination campaigns against the main deadly childhood diseases, however, were not in place owing to lack of authorization by the Ministry of Health (MoH). Conclusions The first field use of the new WHO framework for prioritizing vaccines in acute emergencies is described. Although MSF was unable to implement the full package of priority vaccines because authorization could not be obtained from the MoH, a series of mass vaccination campaigns against key epidemic-prone diseases was successfully implemented within a complex emergency context. Together with covering the population's basic needs, this might have contributed to reducing mortality levels below the emergency threshold and to the absence of epidemics. For the WHO framework to be used to its full potential it must not only be adapted for field use but, most importantly, national decision makers should be briefed on the framework and its practical implementation.
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Affiliation(s)
- Monica Rull
- 1Medecins Sans Frontieres Switzerland, Geneva, Switzerland
| | | | | | | | | | - Claire Dorion
- 1Medecins Sans Frontieres Switzerland, Geneva, Switzerland
| | | | | | - Iza Cigleneki
- 1Medecins Sans Frontieres Switzerland, Geneva, Switzerland
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Ferreras E, Chizema-Kawesha E, Blake A, Chewe O, Mwaba J, Zulu G, Poncin M, Rakesh A, Page AL, Stoitsova S, Voute C, Uzzeni F, Robert H, Serafini M, Matapo B, Eiros JM, Quilici ML, Pezzoli L, Azman AS, Cohuet S, Ciglenecki I, Malama K, Luquero FJ. Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia. N Engl J Med 2018; 378:577-579. [PMID: 29414267 DOI: 10.1056/nejmc1711583] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | - John Mwaba
- University Teaching Hospital, Lusaka, Zambia
| | | | - Marc Poncin
- Médecins sans Frontières, Geneva, Switzerland
| | | | | | - Savina Stoitsova
- European Program for Intervention Epidemiology Training, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Andrew S Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Poncin M, Zulu G, Voute C, Ferreras E, Muleya CM, Malama K, Pezzoli L, Mufunda J, Robert H, Uzzeni F, Luquero FJ, Chizema E, Ciglenecki I. Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia. Bull World Health Organ 2017; 96:86-93. [PMID: 29403111 PMCID: PMC5791774 DOI: 10.2471/blt.16.189241] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Objective To describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting. Method In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated. Findings Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$ 0.41 per dose. Conclusion We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.
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Affiliation(s)
- Marc Poncin
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | - Gideon Zulu
- Republic of Zambia Ministry of Health, Lusaka, Zambia
| | - Caroline Voute
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | | | | | | | | | | | - Hugues Robert
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | - Florent Uzzeni
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | | | | | - Iza Ciglenecki
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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