TY - JOUR
T1 - Protection against cholera from killed whole-cell oral cholera vaccines
T2 - a systematic review and meta-analysis
AU - on behalf of the
AU - Oral Cholera Vaccine Working Group of The Global Task Force on Cholera Control
AU - Oral Cholera Vaccine Working Group of The Global Task Force on Cholera Control
AU - Bi, Qifang
AU - Ferreras, Eva
AU - Pezzoli, Lorenzo
AU - Legros, Dominique
AU - Ivers, Louise C.
AU - Date, Kashmira
AU - Qadri, Firdausi
AU - Digilio, Laura
AU - Sack, David A.
AU - Ali, Mohammad
AU - Lessler, Justin
AU - Luquero, Francisco J.
AU - Azman, Andrew S.
AU - Cavailler, Philippe
AU - Date, Kashmira
AU - Sreenivasan, Nandini
AU - Matzger, Helen
AU - Luquero, Francisco
AU - Grais, Rebecca
AU - Wiesner, Lale
AU - Ko, Melissa
AU - Rouzier, Vanessa
AU - Peak, Corey
AU - Qadri, Firdausi
AU - Landegger, Justine
AU - Lynch, Julia
AU - Azman, Andrew
AU - Sack, David
AU - Henkens, Myriam
AU - Ciglenecki, Iza
AU - Ivers, Louise
AU - Diggle, Emma
AU - Weiss, Mitchell
AU - Hinman, Alan
AU - Maina, Kahindo
AU - Mirza, Imran
AU - Gimeno, Guillermo
AU - Levine, Myron
N1 - Publisher Copyright:
© 2017 World Health Organization
PY - 2017/10
Y1 - 2017/10
N2 - Background Killed whole-cell oral cholera vaccines (kOCVs) are becoming a standard cholera control and prevention tool. However, vaccine efficacy and direct effectiveness estimates have varied, with differences in study design, location, follow-up duration, and vaccine composition posing challenges for public health decision making. We did a systematic review and meta-analysis to generate average estimates of kOCV efficacy and direct effectiveness from the available literature. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Review Library on July 9, 2016, and ISI Web of Science on July 11, 2016, for randomised controlled trials and observational studies that reported estimates of direct protection against medically attended confirmed cholera conferred by kOCVs. We included studies published on any date in English, Spanish, French, or Chinese. We extracted from the published reports the primary efficacy and effectiveness estimates from each study and also estimates according to number of vaccine doses, duration, and age group. The main study outcome was average efficacy and direct effectiveness of two kOCV doses, which we estimated with random-effect models. This study is registered with PROSPERO, number CRD42016048232. Findings Seven trials (with 695 patients with cholera) and six observational studies (217 patients with cholera) met the inclusion criteria, with an average two-dose efficacy of 58% (95% CI 42–69, I2=58%) and effectiveness of 76% (62–85, I2=0). Average two-dose efficacy in children younger than 5 years (30% [95% CI 15–42], I2=0%) was lower than in those 5 years or older (64% [58–70], I2=0%; p<0·0001). Two-dose efficacy estimates of kOCV were similar during the first 2 years after vaccination, with estimates of 56% (95% CI 42–66, I2=45%) in the first year and 59% (49–67, I2=0) in the second year. The efficacy reduced to 39% (13 to 57, I2=48%) in the third year, and 26% (−46 to 63, I2=74%) in the fourth year. Interpretation Two kOCV doses provide protection against cholera for at least 3 years. One kOCV dose provides at least short-term protection, which has important implications for outbreak management. kOCVs are effective tools for cholera control. Funding The Bill & Melinda Gates Foundation.
AB - Background Killed whole-cell oral cholera vaccines (kOCVs) are becoming a standard cholera control and prevention tool. However, vaccine efficacy and direct effectiveness estimates have varied, with differences in study design, location, follow-up duration, and vaccine composition posing challenges for public health decision making. We did a systematic review and meta-analysis to generate average estimates of kOCV efficacy and direct effectiveness from the available literature. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Review Library on July 9, 2016, and ISI Web of Science on July 11, 2016, for randomised controlled trials and observational studies that reported estimates of direct protection against medically attended confirmed cholera conferred by kOCVs. We included studies published on any date in English, Spanish, French, or Chinese. We extracted from the published reports the primary efficacy and effectiveness estimates from each study and also estimates according to number of vaccine doses, duration, and age group. The main study outcome was average efficacy and direct effectiveness of two kOCV doses, which we estimated with random-effect models. This study is registered with PROSPERO, number CRD42016048232. Findings Seven trials (with 695 patients with cholera) and six observational studies (217 patients with cholera) met the inclusion criteria, with an average two-dose efficacy of 58% (95% CI 42–69, I2=58%) and effectiveness of 76% (62–85, I2=0). Average two-dose efficacy in children younger than 5 years (30% [95% CI 15–42], I2=0%) was lower than in those 5 years or older (64% [58–70], I2=0%; p<0·0001). Two-dose efficacy estimates of kOCV were similar during the first 2 years after vaccination, with estimates of 56% (95% CI 42–66, I2=45%) in the first year and 59% (49–67, I2=0) in the second year. The efficacy reduced to 39% (13 to 57, I2=48%) in the third year, and 26% (−46 to 63, I2=74%) in the fourth year. Interpretation Two kOCV doses provide protection against cholera for at least 3 years. One kOCV dose provides at least short-term protection, which has important implications for outbreak management. kOCVs are effective tools for cholera control. Funding The Bill & Melinda Gates Foundation.
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U2 - 10.1016/S1473-3099(17)30359-6
DO - 10.1016/S1473-3099(17)30359-6
M3 - Article
C2 - 28729167
AN - SCOPUS:85024477897
SN - 1473-3099
VL - 17
SP - 1080
EP - 1088
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 10
ER -