TY - JOUR
T1 - Effectiveness of one dose of oral cholera vaccine in response to an outbreak
T2 - a case-cohort study
AU - Azman, Andrew S.
AU - Parker, Lucy A.
AU - Rumunu, John
AU - Tadesse, Fisseha
AU - Grandesso, Francesco
AU - Deng, Lul L.
AU - Lino, Richard Laku
AU - Bior, Bior K.
AU - Lasuba, Michael
AU - Page, Anne Laure
AU - Ontweka, Lameck
AU - Llosa, Augusto E.
AU - Cohuet, Sandra
AU - Pezzoli, Lorenzo
AU - Sodjinou, Dossou Vincent
AU - Abubakar, Abdinasir
AU - Debes, Amanda K.
AU - Mpairwe, Allan M.
AU - Wamala, Joseph F.
AU - Jamet, Christine
AU - Lessler, Justin
AU - Sack, David A.
AU - Quilici, Marie Laure
AU - Ciglenecki, Iza
AU - Luquero, Francisco J.
N1 - Funding Information:
ASA, DAS, AKD, JL, and FJL were funded by grants from the Bill & Melinda Gates Foundation (OPP1089243 and OPP153556). The laboratory work at Institut Pasteur was funded by the Institut Pasteur and the French Institute for Public Health Surveillance. The laboratory work at Johns Hopkins and the reagents used in the field were supported by the Bill & Melinda Gates Foundation through the Delivering Oral Cholera Vaccines Effectively (DOVE) project. We thank all the study participants, study staff, vaccination teams, the Médecins Sans Frontières Juba team, the laboratory teams including Jean Rauzier (Institut Pasteur) and Abiem Bona But (South Sudan National Public Health), Jean Clement Cabrol, Javier Gori, Barbara Rusch, and Micaela Serafini for making this study and public health intervention possible. We thank Vincent Muller for the mapping support and Larry Moulton for the helpful comments.
Publisher Copyright:
© 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2-4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Médecins Sans Frontières, and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine effectiveness study in conjunction with this large public health intervention. Methods We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the first day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confirmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India). Findings Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classified as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine effectiveness was 80·2% (95% CI 61·5-100·0) and after adjusting for potential confounders was 87·3% (70·2-100·0). Interpretation One dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings. Funding Médecins Sans Frontières.
AB - Background Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2-4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Médecins Sans Frontières, and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine effectiveness study in conjunction with this large public health intervention. Methods We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the first day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confirmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India). Findings Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classified as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine effectiveness was 80·2% (95% CI 61·5-100·0) and after adjusting for potential confounders was 87·3% (70·2-100·0). Interpretation One dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings. Funding Médecins Sans Frontières.
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U2 - 10.1016/S2214-109X(16)30211-X
DO - 10.1016/S2214-109X(16)30211-X
M3 - Article
C2 - 27765293
AN - SCOPUS:84995960792
SN - 2214-109X
VL - 4
SP - e856-e863
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 11
ER -