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Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030
Date of Publication:
The Journal of Infectious Diseases
While safe drinking water and advanced sanitation systems have made the Global North cholera-free for decades, the disease still affects 47 countries across the globe resulting in an estimated 2.86 million cases and 95,000 deaths per year worldwide. Cholera impacts communities already burdened by conflict, lack of infrastructure, poor health systems, and malnutrition. In October 2017, the Global Task Force on Cholera Control (GTFCC) launched an initiative titled Ending Cholera: A Global Roadmap to 2030, with the objective to reduce cholera deaths by 90% worldwide, and eliminate cholera in at least 20 countries by 2030. The GTFCC is working to position cholera control not as a vertical programme but instead using cholera as a marker of inequity and an indicator of poverty, linking the objectives of the Roadmap to the SDGs. The roadmap consists of targeted multi-sectoral interventions, supported by a coordination mechanism, along 3 axes: (1) early detection and quick response to contain outbreaks; (2) a multisectoral approach to prevent cholera recurrence in hotspots; (3) an effective partnership mechanism of coordination for technical support, countries capacity building, research and M&E, advocacy and resource mobilization. Every case and every death from cholera is preventable with the tools we have today.
Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings
Amber Hsiao | Sachin N Desai | Vittal Mogasale | Jean-Louis Excler | Laura Digilio
Date of Publication:
Bulletin of the World Health Organization
Improving water and sanitation is the preferred choice for cholera control in the long-term. Nevertheless, vaccination is an available tool that has been shown to be a cost-effective option for cholera prevention in endemic countries or during outbreaks. In 2011 the first low-cost oral cholera vaccine (OCV) for international use was given prequalification by the World Health Organization (WHO). To increase and prioritize use of the vaccine, WHO created a global stockpile in 2013 from which countries may request OCV for reactive campaigns. WHO has issued specific guidelines for applying for the vaccine, which was previously in short supply (despite prequalification for a second OCV in 2015). The addition of a third WHO-prequalified OCV in 2016 is expected to increase the global stockpile considerably and alleviate supply issues. However, prioritization and best use of the vaccine (e.g. how, when and where to use) will remain challenges. We describe 12 OCV campaigns, conducted in settings with varying burdens of cholera. These case studies illustrate three key challenges faced in the use of the OCV: regulatory hurdles, cold chain logistics and vaccine coverage and uptake. To pave the way for the introduction of current and future OCVs, we discuss operational challenges and make recommendations for future research with respect to each of these challenges.
The Impact of a One-Dose versus Two-Dose Oral Cholera Vaccine Regimen in Outbreak Settings: A Modeling Study
Andrew S. Azman | Francisco J. Luquero | Iza Ciglenecki | Rebecca F. Grais | David A. Sack | Justin Lessler
Date of Publication:
Aug 25, 2015
In 2013, a stockpile of oral cholera vaccine (OCV) was created for use in outbreak response, but vaccine availability remains severely limited. Innovative strategies are needed to maximize the health impact and minimize the logistical barriers to using available vaccine. Here we ask under what conditions the use of one dose rather than the internationally licensed two-dose protocol may do both.
Using mathematical models we determined the minimum relative single-dose efficacy (MRSE) at which single-dose reactive campaigns are expected to be as or more effective than two-dose campaigns with the same amount of vaccine.
Reactive vaccination campaigns using a single dose of OCV may avert more cases and deaths than a standard two-dose campaign when vaccine supplies are limited, while at the same time reducing logistical complexity. These findings should motivate consideration of the trade-offs between one- and two-dose campaigns in resource-constrained settings, though further field efficacy data are needed and should be a priority in any one-dose campaign.